Primary progressive multiple sclerosis: a 5-year clinical and MR study

Brain. 2003 Nov;126(Pt 11):2528-36. doi: 10.1093/brain/awg261. Epub 2003 Aug 5.


Longitudinal imaging studies of primary progressive multiple sclerosis (PPMS) have shown significant changes in MR measures over 1 to 2 years. Correlation with clinical change over the same period has not been evident; we investigated the possibility that this is because the period of observation was insufficient for these associations to become apparent. Forty-one patients with PPMS were followed prospectively for 5 years. Patients had clinical [Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite Measure (MSFC)] and MRI assessment (brain and spinal cord) at baseline, 1, 2 and 5 years. At 5 years, significant deterioration was seen in all clinical and MRI measures (P<0.01, P<0.001 respectively). Associations were seen between increase in EDSS score and decrease in cord area (r=0.31, P<0.05) and between increase in MSFC and both rate of ventricular enlargement (r=0.31, P<0.05) and increase in T2 load (r=0.31, P<0.05). The rates of change of MR measures were not associated with age or disease duration and were more consistent within than between patients. Longer duration of follow-up demonstrates modest associations between change in clinical and MR measures and provides new insights into the pattern of change within and between individuals with PPMS.

MeSH terms

  • Brain / pathology
  • Cerebral Ventricles / pathology
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / pathology*
  • Prospective Studies
  • Severity of Illness Index
  • Spinal Cord / pathology