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MS and brain atrophy
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Nancy04232004 posted:
Just visited a new neuro that specializes in MS and had an MRI done recently. At the follow up appt to discuss the results, she pointed out that I have mild brain atrophy. I would like expert opinion on how common is it to have this from MS and how serious is this? The MRI did not show any new lesions, just the current ones showing inflamation with none of them showing enhancement. Because of this, I did not need a course of steroids. I was on Avonex and she put me on Tysabri instead, hoping this will be effective.
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hackwriter responded:
Dear Nancy,

Brain atrophy--tissue loss in the gray matter--is a common occurrence in MS. New studies have been showing that this occurs earlier in the disease process than previously thought. It used to be thought that atrophy occurred late in the disease process based on autopsies of older MS patients. Now that MRI technology has improved and gray matter damage is being revealed in young patients, opinion is changing.

The links below contain reports about the correlation between brain atrophy, degree of disability, and cognitive dysfunction, as well as a discussion of the correlation between white matter lesions and gray matter damage. These pages also list other articles on the topic for further reading:
http://www.ncbi.nlm.nih.gov/pubmed/22615886

http://neurology.jwatch.org/cgi/content/full/2002/510/1


I hope our resident MS specialist, Dr. Lava, will comment on your question next Friday as well.

Kim
 
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Nancy04232004 replied to hackwriter's response:
I am with you, Kim in having Dr. Lava commenting my question. I never knew I had this brain atrophy before my most recent MRI, although it is currently mild. The knowledge of this does scare me somewhat, which is why I posted my question. How serious is brain atrophy for someone with MS? Can the disease modifying drugs (DMD) slow this brain atrophy down? Or does it get worse in spite of this medication? Or is there a DMD that works better to fight brain atrophy? This concept of brain atrophy in MS patients is new to me even though I have had MS for 9 years and I have not seen this in any of my research of MS. Because of this, I am looking forward to Dr. Lava's comment.
 
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Neil S Lava, MD replied to Nancy04232004's response:
Brain atrophy occurs in everyone as we age. However in multiple sclerosis, the atrophy occurs a bit more quickly. The change in brain volume represents loss of nerve cells.
The medications that we use for multiple sclerosis reduce the number of attacks and therefore there is less damage and destruction of nerve cells. We think we changed the natural history of this disease with our medications. Unfortunately none of our medications are perfect and they are unable to stop disease. We are still looking for more effective medications that will stop the disease from progressing.
It is important that patients with multiple sclerosis beyond a therapy to help reduce the number of attacks, thereby protecting more nerve cells.