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Irish Journal of Medical Science (1971 -)

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01-11-2019 | Multiple Sclerosis | Original Article

Acute multiple sclerosis lesion pathology does not predict subsequent clinical course—a biopsy study

Authors: Hugh Kearney, Tucker Price, Jane Cryan, Alan Beausang, Seamus Looby, Francesca M. Brett, Michael Farrell

Published in: Irish Journal of Medical Science (1971 -) | Issue 4/2019

Abstract

Background

Knowledge of the clinical outcome in tumefactive demyelination remains limited.

Aims

This study aims to characterise the natural history of biopsy-proven, pathogen-free, cerebral demyelination in an adult Irish population.

Methods

We identified all patients with biopsy-proven demyelination in a single neuropathology centre between 1999 and 2017. A baseline, and at least one follow-up MRI scan was available in each instance (mean of 3 scans per patient), together with both the presenting and most recent clinical details including disability level and disease-modifying drugs.

Results

In 21 patients, white matter biopsies showed the following: macrophages with myelin debris, myelin-axonal dissociation, reactive astrocytes and occasional lymphocytes. During a mean follow-up time of 8 years (± 4.4), 17 patients developed MS, confirmed both clinically and on MRI, using the 2010 McDonald criteria: 11 relapsing remitting (RR) MS, four secondary progressive and two primary progressive MS. Four patients had a monophasic illness with lesion regression, without clinical or radiological evidence of any further disease activity on follow-up. The patients with progressive MS had significantly higher levels of physical disability than either the RRMS or monophasic patients.

Conclusion

Uniform white matter subacute demyelination is associated with a diverse clinical course ranging from a monophasic illness to progressive MS, suggesting that extraneous factors distinct from the basic pathology significantly influence the clinical course in MS.

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Title: Acute multiple sclerosis lesion pathology does not predict subsequent clinical course—a biopsy study
Authors: Hugh Kearney
Tucker Price
Jane Cryan
Alan Beausang
Seamus Looby
Francesca M. Brett
Michael Farrell
Publication date: 01-11-2019
Publisher: Springer London
Keywords: Multiple Sclerosis
Pathology
Published in: Irish Journal of Medical Science (1971 -) / Issue 4/2019
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-019-01983-z

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Conclusion

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