Brain atrophy in multiple sclerosis

Rebecca Spain has been studying lipoic acid as an agent to reduce the rate of brain shrinkage in MS patients. From a report to the
US Dept of Veterans Affairs:


Despite all the breakthroughs in MS research, treatments for secondary progressive MS (SPMS) are still lacking. With the help of many colleagues, I (Dr. Rebecca Spain) conducted a pilot trial at the VA Portland Health Care System to see if the over-the counter supplement, lipoic acid, would help people with SPMS. Lipoic acid is a substance naturally made by our bodies. It has a number of useful actions such as boosting energy production of cells, keeping the immune system from over-reacting, and fighting damaging and aging forces (free radicals) in the body. Although we don’t fully understand what happens to cause SPMS, we do know that a loss of energy, altered immune system, and free radicals may all make SPMS worse. Therefore, it made sense to see if lipoic acid could help slow the worsening of disability in SPMS.

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Why is brain atrophy important? Brain atrophy is a normal part of aging that happens to all of us, starting in our mid-20’s. However, in MS this atrophy can happen faster than the normal pace. The increased brain atrophy goes hand in hand with greater MS disability. Therefore, we believe that by slowing the rate of atrophy, we may slow the rate of worsening disability from MS.



link: https://www.va.gov/MS/Veterans/research/Research_Lipoic_Acid_and_Secondary_Progressive_MS.asp

MutlipleSclerosisNewsToday discusses the significance of a specific atrophy measure, the shrinkage of previously existent lesions:


However, researchers now suggest that the disappearance of lesions may indicate pathological change, such as atrophy, as well as beneficial alterations, including resolution or repair of myelin (the protective layer of nerve fibers which is typically damaged in MS patients).

Focusing on pathological changes in brain lesions, the scientists examined lesions observed in prior scans, but later replaced by cerebrospinal fluid (the liquid filling the brain and spinal cord). This opposed the traditional approach of examining new lesions, they noted.

“The big news here is that we did the opposite of what has been done in the last 40 years,” Michael G. Dwyer, PhD, first author of the five-year study, said in a press release. “Instead of looking at new brain lesions, we looked at the phenomenon of brain lesions disappearing into the cerebrospinal fluid.”

Specifically, investigators compared the rate of lesion loss due to atrophy to the appearance or enlargement of lesions both at the start of the study and at five or 10 years of follow-up.

Conducted at the University at Buffalo (UB) in New York, the five-year study included 192 patients with either the most common form of MS, relapsing-remitting MS (126 patients), progressive MS (48), or clinically isolated syndrome — the first episode of inflammation and loss of myelin, but not yet meeting the criteria for MS.

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“We didn’t find a correlation between people who developed more or larger lesions and developed increased disability,” Dwyer said, “but we did find that atrophy of lesion volume predicted the development of more physical disability.”

When dividing the analysis by MS types, the scientists found that patients with relapsing-remitting MS had the highest number of new lesions, while those with progressive MS (the most severe subtype of the disease) had the most pronounced atrophy of brain lesions.

“Atrophied lesion volume is a unique and clinically relevant imaging marker in MS, with particular promise in progressive MS,” the researchers wrote.

“Paradoxically, we see that lesion volume goes up in the initial phases of the disease and then plateaus in the later stages,” said Robert Zivadinov, MD, PhD. Zivadinov is senior author of the five-year study and first author of the 10-year research. “When the lesions decrease over time, it’s not because the patients’ lesions are healing but because many of these lesions are disappearing, turning into cerebrospinal fluid.”



link: https://multiplesclerosisnewstoday.com/2018/06/07/atrophy-brain-lesions-predicts-disability-ms-study-finds/

The Buffalo work is not inconsistent with that of Rebecca Spain, and tends to support Spain's strategy.

See also
Lipoic acid and secondary progressive multiple sclerosis