Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options

Athina Andravizou; Efthimios Dardiotis; Artemios Artemiadis; Maria Sokratous; Vasileios Siokas; Zisis Tsouris; Athina-Maria Aloizou; Ioannis Nikolaidis; Christos Bakirtzis; Georgios Tsivgoulis; Georgia Deretzi; Nikolaos Grigoriadis; Dimitrios P Bogdanos; Georgios M Hadjigeorgiou

doi:10.1186/s13317-019-0117-5

Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options

Auto Immun Highlights. 2019 Aug 10;10(1):7. doi: 10.1186/s13317-019-0117-5. eCollection 2019 Dec.

Authors

Athina Andravizou^#¹, Efthimios Dardiotis^#¹, Artemios Artemiadis², Maria Sokratous^{1

3}, Vasileios Siokas¹, Zisis Tsouris¹, Athina-Maria Aloizou¹, Ioannis Nikolaidis⁴, Christos Bakirtzis⁴, Georgios Tsivgoulis⁵, Georgia Deretzi⁶, Nikolaos Grigoriadis⁴, Dimitrios P Bogdanos³, Georgios M Hadjigeorgiou^{1

7}

Affiliations

¹ 1Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Biopolis, Mezourlo Hill, 41100 Larissa, Greece.
² 2Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vas. Sophias Ave 72-74, 11528 Athens, Greece.
³ 3Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, University of Thessaly, Viopolis, 40500 Larissa, Greece.
⁴ Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ 5Second Department of Neurology, School of Medicine, University of Athens, "Attikon" University Hospital, Athens, Greece.
⁶ 6Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece.
⁷ 7Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus.

^# Contributed equally.

Abstract

Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system characterized by focal or diffuse inflammation, demyelination, axonal loss and neurodegeneration. Brain atrophy can be seen in the earliest stages of MS, progresses faster compared to healthy adults, and is a reliable predictor of future physical and cognitive disability. In addition, it is widely accepted to be a valid, sensitive and reproducible measure of neurodegeneration in MS. Reducing the rate of brain atrophy has only recently been incorporated as a critical endpoint into the clinical trials of new or emerging disease modifying drugs (DMDs) in MS. With the advent of easily accessible neuroimaging softwares along with the accumulating evidence, clinicians may be able to use brain atrophy measures in their everyday clinical practice to monitor disease course and response to DMDs. In this review, we will describe the different mechanisms contributing to brain atrophy, their clinical relevance on disease presentation and course and the effect of current or emergent DMDs on brain atrophy and neuroprotection.

Keywords: Atrophy; Axon; Bran; Drugs; Inflammation; Multiple sclerosis; Neurodegeneration; Neuroprotection.

Publication types

Review