The loss of brain volume (BVL), or brain atrophy, has been classically considered as a marker present in severe or advanced stages of the disease
The objective of this study was analyze the percentage of brain volume loss (PBVL) during the first year and physical and cognitive impairment over 3 years multiple sclerosis (MS) patients
prospective cohort study that include naïve patients who initiated fingolimod. Patients were followed longitudinally for at least 36 months evaluating relapses and EDSS progression (defined as worsening of 1 point on the EDSS). Magnetic resonance image (MRI) evaluation was done at 6 months (range 4-7 months) after fingolimod initiation (baseline MRI), and then at 12, 24 and 36 months after. PBVL loss between the baseline MRI and the first year MRI after treatment initiation was done by SIENA. Cognitive evaluation was done at study entry to exclude patients with cognitive impairment (CI) (defined as patients who scored at least 2 SDs below controls on at least 2 domains) and then at month 24 and 36. At 36 months patients with CI and EDSS progression were identified. Logistic regression analysis between the first year BVL and CI and EDSS progression was done adjusted by co-variables
A total of 71 patients were included, mean age 35.4 ± 3 years, mean follow up time 43 ± 5 months. At month 36, 12% patients were classified as CI and 5.6% had EDSS progression. In the CI group, first year PBVL was -0.52 (± 0.07) vs. -0.42 (± 0.04) in no CI (p 0.003, OR=2.13, 95% CI 1.63-2.31). In the group that showed EDSS progression the PBVL was 0.59 (± 0.05) vs. 0.42 (± 0.03) (p 0.008, OR=2.13, 95% CI 1.63-2.31).
In patients that progressed in terms of CI and physical disability, the rate of PBVL during the first year of treatment was significantly high than in patients that did not. This is the first study that shows this association in our region.