Severity of white matter microstructural damage in a Brazilian relapsing-remitting multiple sclerosis cohort: A possible window to optimize treatment.

BACKGROUND: Multiple sclerosis (MS) is an important cause of acquired neurological disability in young adults, characterized by multicentric inflammation, demyelination, and axonal damage. OBJECTIVE: The objective is to investigate white matter (WM) damage progression in a Brazilian MS patient cohort, using diffusion tensor imaging (DTI) post-processed by tract-based spatial statistics (TBSS). METHODS: DTI scans were acquired from 76 MS patients and 37 sex-and-age matched controls. Patients were divided into three groups based on disease duration. DTI was performed along 30 non-collinear directions by using a 1.5T imager. For TBSS analysis, the WM skeleton was created, and a 5000 permutation-based inference with a threshold of p < .05 was used, to enable the identification of abnormalities in fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). RESULTS: Decreased FA and increased RD, MD, and AD were seen in patients compared to controls and a decreased FA and increased MD and RD were seen, predominantly after the first 5 years of disease, when compared between groups. CONCLUSION: Progressive WM deterioration is seen over time with a more prominent pattern after 5 years of disease onset, providing evidence that the early years might be a window to optimize treatment and prevent disability.

No evidence of disease activity in multiple sclerosis patients.

INTRODUCTION: Multiple Sclerosis is a chronic inflammatory demyelinating disease that affects 2.5 million people in the world. NEDA (No evidence of disease Activity) -4 is a new concept related to absence of disease activity in the context of MS. It takes into account the following four parameters: relapses; disability progression; lesion load and brain atrophy. Areas covered: The purpose of this paper is to visit the new emerging concepts of NEDA. Although it is considered important and attractive, there is a lack of uniformity. Expert commentary: Although NEDA-4 embraces important markers of disease activity and degeneration, this definition is still evolving and other parameters apart from the loss of brain volume might be included, especially those related to disability, such as cognitive problems, visual function, fatigue and pain.