Center of Neurology Hamburg

Author Of 1 Presentation

Imaging Poster Presentation

P0586 - Impact of Cladribine Tablets on Brain Volume Protection in Highly Active MS (ID 1173)

Speakers
Presentation Number
P0586
Presentation Topic
Imaging

Abstract

Background

Brain volumetry is an accepted monitoring tool for the diffuse, not relapse-related inflammatory activity in MS. As thalamus volume turned out to be most affected by the atrophic process in MS, a special focus is put on this region.

Objectives

We present first data from our ongoing study, addressing the effect of Cladribine Tablets on global and regional brain atrophy.

Methods

45 consecutive patients with highly active MS from our observational study are presented (mean age 39 y, mean EDSS 2.1, 31 female, 14 male). Clinical and brain MRI evaluations were carried out at baseline prior to Cladribine treatment and repeated after 6 and 12 months following Cladribine treatment initialization. All images were acquired with the same 3T Philips Achieva scanner using the same 3D MPRAGE protocol. Global and regional brain volumes were derived using a previously described atlas based volumetry approach implemented in SPM12 in cooperation with jung diagnostics. Quantified parameters include brain parenchymal volume (BPV), grey matter volume (GMV), white matter volume (WMV), Corpus callosum volume (CCV) and thalamus volume (THV). All atrophy parameters of the single subjects were tested against the normative database. All volumes were tranformated to age-corrected z-volumes. Z<-1.96 means significant atrophy. 0.0 equals the mean of the normative database.

Results

As expected, at baseline the regional brain volumetry revealed the highest pretreatment mean loss in THV, e.g. the highest sensitivity for the atrophic process in thalamus (z= -1.64), followed by CCV (z=-1.22), WMV (z=-1.67) and GMV (z=-0.54). 6 and 12 months after Cladribine initialization the z-differences from baseline to first visit and second visit to third visit were for BPV +0.21, -0.11; GMV +0.18, +0.01; WMV +0.07, -0.18; THV +0.21, +0.06; CCV +0.13, +0.02. GMV, THV and CCV are fully protected by Cladribine tablets for the entire first treatment year. For WMV and BPV respectively there is a slight trend to volume reduction. The z-difference in the second half of the first treatment year equals an estimated annual volume loss of age-corrected 0.2% which is still an excellent effect.

Conclusions

From the first data of this ongoing study can be concluded that the first treatment period with Cladribine tablets fully protects GMV including the highly sensitive thalamus. With the exception of CCV with good protection, the effect of Cladribine on WMV seems to decrease in the second half of the first treatment year.

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