London Health Sciences Center

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Observational Studies Late Breaking Abstracts

LB1233 - Blood brain barrier permeability and high dose corticosteroids for MS relapses: a pilot study (ID 2113)

Speakers
Presentation Number
LB1233
Presentation Topic
Observational Studies

Abstract

Background

High dose corticosteroids (HDC) are standard of care for MS relapses. There is scant literature regarding whether relapse localization or timing of HDC affects relapse recovery or blood brain barrier (BBB) recovery.

Objectives

1) To gather data on BBB recovery after HDC treatment using a novel CT technique measuring BBB permeability; and 2) to better understand BBB recovery and examine the clinical correlates associated with BBB recovery after HDC relapse treatment.

Methods

Consecutive persons with MS diagnosed with a relapse requiring HDC treatment were approached. Subjects were excluded if they received HDC in the last 30 days/had started HDC, had an allergy to iodine/CT contrast, had eGFR < 35 mL/min or were diabetic, or if the relapse localized to the optic nerve. Subjects underwent a CT with contrast on days 0 (before HDC), and days 2, 4, and 6 after starting HDC. CT studies were analyzed to generate functional maps of blood flow, blood volume and BBB permeability. Clinical evaluations (EDSS) occurred at relapse, and 4, 12, or 24 weeks after HDC. Planned recruitment was 26 subjects; early termination occurred due to the COVID19 pandemic.

Results

Sixteen subjects agreed to participate; one subject did not to take HDC and was removed. At the time of this abstract, CT data on 2 subjects had not yet been analyzed. All subjects had relapsing MS, with a mean age of 33.1 (+/- 8.3) years. Nine (69.2%) were female; median EDSS was 3.0 (2.0-5.0) at relapse assessment. Mean number of days between symptom onset and HDC was 8.9 (SD 6.5). Relapses clinically localized to the brain (3), posterior fossa (4) or cervical spinal cord (6). Six (46.0%) of subjects demonstrated an improvement in BBB permeability early (responders), while 5 (38.5%) responded slowly and 2 (15.4) did not respond to HDC. There was no significant difference between responders vs non-responders in terms of age, gender, days between onset and HDC, or relapse localization. There was no significant difference between recovery (EDSS) at 4, 12, or 24 weeks between responders vs non-responders.

Conclusions

We did not show any difference between BBB permeability in responders vs non responders (or slow responders) after HDC treatment in terms or relapse recovery. Also, there were no predictors regarding responders vs non-responders. This study may have been underpowered due to early termination. The finding that some subjects’ BBB permeability did not respond at all to HDC warrants further exploration.

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