Massimiliano Calabrese
Several studies pointed out that gray matter damage in multiple sclerosis (MS) is not a late phenomenon. It appears to start early in the disease course, sometimes already at clinical onset. However, because it is often impossible to date the biological/subclinical onset of MS, which in adult patients may precede its clinical onset by some months to several years, the assessment of how early gray matter damage begins and its evolution, as well as its relationship with white matter inflammation, is very difficult. This problem could be overcome by studying the pediatric population, in which the interval of time between the biological and clinical onset of the disease, though unpredictable, should likely be shorter than in adult-onset MS.
Our findings suggest that gray matter lesions and atrophy are strictly associated with the biological onset of MS, and proceed linearly and partly independently of white matter pathology. Therefore, a proper monitoring of the disease evolution, performed by MRI, should not be limited to studying the white matter lesions but should also include the evaluation of gray matter lesion load and atrophy. The double inversion recovery, an MRI sequence with high sensitivity for cortical lesions, therefore has been added to our routine MRI protocol.
Many colleagues confirmed to me that MRI signs of gray matter damage are already present in their pediatric populations since clinical onset and asked me to plan a multicenter study.
Thanks to the help of many other MS centers in the north of Italy, we are now increasing the number of pediatric patients included in the study in order to confirm our preliminary results in a multicenter setting.
Data from this study will be likely presented at the next American Academy of Neurology meeting.