"As a follow-up to yesterday's post on brain atrophy; please study the MRIs above. These MRIs are from two MSers I met when I did my PhD from 1993 to 1996; they were participating in a phase 2 clinical trial of a biological therapy that targeted CD4 T-cells (anti-CD4 therapy). Unfortunately, the anti-CD4 trial was negative. This trial still questions the role that CD4 cells play in the pathogenesis of MS; well at least in my mind. Most immunologists still believe MS is driven by CD4 T cells; but that is another story."
"What the serial MRIs on these MSers show is the extraordinary amount of brain atrophy that can occur over an 18 month period - look at the black spaces in the centre of the brain, the ventricles, and see how they enlarge over 18 months. Also look at the black spaces on the surface of the brain, the sulci, and see how they open up over 18 months. This brain atrophy is partly due to loss of axons and neurones and is unequivocally linked to disability progression and cognitive impairment. This is why there is increasing emphasis on drugs that can prevent or at least slow the rate of brain atrophy down."
"Preventing atrophy completely is unlikely to happen as brain atrophy occurs as part of normal ageing; from the age of 35 our brains shrink - mine included. The aim therefore would be shift the brain atrophy rate in MSers to that which occurs in normal ageing. Can we do this? Not yet, although several DMTs are showing promise in this area. This is why we are keen to explore attitudes to incorporating brain atrophy into clinical practice."