Why Grey Matter matters Gavin Giovannoni, Barts and The London, g.giovannoni@qmul.ac.uk

Brain atrophy in MS: what are its consequences?

SOC

IAL

Compared with the general population, MSers are 40% more likely to separate, or divorce, and do so sooner.

DIVORCE

OC

CU

PATI

ON

AL

Kobelt et al. Neurol Neurosurg Psychiatry 2006;77:918–926.

10 years after diagnosis 50% of MSers are unemployed.

By the time you need a wheel chair, over 80% of MSers are unemployed.

JOBS

CO

GN

ITIV

E

Feuillet et al. Mult Scler. 2007; 13:124-127.

MEMORY At the time of the first clinical attack over 50% of CISers have cognitive impairment in at least two cognitive areas.

MS

BR

AIN

The brains of MSers shrink at a rate of 0.5-1.0% per year compared to a rate of between 0.1-0.4% in normal brains.

ATROPHY

Barkhof F et al. Nat Rev Neurol 2009. Simon JH. Mult Scler 2006; 12 (6): 679-687.

Fotenos AF et al. Arch Neurol 2008.

MS

LESI

ON

In each cubic millimetre of an acute MS lesion there are over 11,000 transected axons, or nerve fibres, compared to less than one in normal brains.

INFLAMMATION

Trapp B, et al. N Engl J Med 1998; 1998;338:278-85.

MS

LESI

ON

After a single attack of optic neuritis approximately 20% of the nerve fibres are lost in the optic nerve.

OPTIC NEURITIS

Hickman et al. Neuroradiology 2001;43:123-8.

Save your Grey Matter it really does matter. Version 4.0, 29 September 2013.

MS

BR

AIN

Brain atrophy, or brain shrinkage, in MS, as measured by MRI, is associated with disability and cognitive impairment.

BRAIN VOLUME

Rudick RA et al . J Neurol Sci. 2009 Jul 15;282(1-2):106-11. Calabrese M et al. Arch Neurol. 2009 Sep;66(9):1144-50.

Goodin et al. J Neurol Neurosurg Psychiatry. 2012 Mar;83(3):282-7.

MO

RTA

LITY

MS reduces life expectancy by approximately 8 years and half of MSers die of MS-related complications.

SURVIVAL

Torkildsen G et al. Mult Scler. 2008;14:1191-1198.

Smestad C et al. Mult Scler. 2009;15:1263-70.

Kingwell E et al. J Neurol Neurosurg Psychiatry. 2012;83:61-66.

Society rates the quality of life

of someone with MS who is

bed bound as being worse

than death.

SOC

IETY

QUALITY OF LIFE

Orme M et al. Value In Health. 2007;10:54-60.

PH

YSIC

AL The average time from MS

onset to needing a walking

stick is 20 years, and for a

wheelchair 30 years.

DISABILITY

Confavreaux, Compston. McAlpine’s Multiple Sclerosis, 4th Edition. 2005.

EMO

TIO

NA

L MSers have a 2-7x higher chance of committing suicide.

SUICIDE

Torkildsen G et al. Mult Scler. 2008;14:1191-1198.

Sadovnick AD et al. Neurology. 1991;41:1193-1196.

Pfleger CC et al. Mult Scler. 2010;16:121-126.

MS

BR

AIN

Brain atrophy, or shrinkage, occurs in the majority of MSers at all stages. Grey matter atrophy accelerates over time and with disease progression.

BRAIN ATROPHY

Simon JH. Mult Scler 2006. Fisher E et al. Ann Neurol 2008.

MS

LESI

ON

In MS there is extensive demyelination, neuronal transection and death, and loss of neurons, in the cerebral cortex or grey matter.

GREY MATTER

Peterson al. Ann Neurol 2001;50:389–400. Image: Schmierer-Lab, Blizard Institute