Atrophy of a key brain area may become a new biomarker to predict the onset
of multiple sclerosis, researchers say. If so, that would add to established
criteria such as the presence of brain lesions to diagnose the progressive,
Using special MRI images, scientists from three continents found that the
thalamus - which acts as a "relay center" for nervous-system signals - had
atrophied in nearly 43% of patients who had suffered an initial neurological
episode that often comes before a multiple sclerosis (MS) diagnosis.
"The telling appearance of lesions, which is a hallmark of the disease, is
only part of the pathology," said study author Dr Robert Zivadinov, director of
the Buffalo Neuroimaging Analysis Center at the University of Buffalo, in New
"Our finding is more related to [initiating] clinical trials, to using
thalamic volume as a new biomarker for testing and treatment, and to increasing
awareness among investigators that this disease is more than just about
What is MS?
Believed to be an auto-immune disorder, MS results in lesions on the brain
and spinal cord that disrupt nerve signals to various parts of the body.
Symptoms, which can come and go, include numbness, tingling, vision
disturbances, problems walking, dizziness, and bowel and bladder problems.
More than 2 million people live with MS worldwide, according to the Multiple
For the new research, Zivadinov and his team used contrast-enhanced MRI
images to evaluate more than 200 patients who had suffered an initial,
short-term neurological episode known as clinically isolated syndrome.
About 85% people who have one of these episodes will go on to be diagnosed
with MS within two years, and the diagnosis also relies on a second attack and
the detection of new or enlarging lesions using MRI.
Biomarker for MS
The study performed follow-up scans on patients at six months, one year and
two years. It found that decreases in the size of the thalamus were
independently associated with the development of clinically definite MS, along
with an increased volume in another part of the brain known as the lateral
The findings suggest shrinkage of the thalamus could become a biomarker for
MS because it's detectable at a very early stage, Zivadinov said.
"What's triggering this and how it's connected with the thalamus should be
explored," he said, "but that this research is indicating that the thalamus is
profoundly affected so early on leads us to focus more on those regions of the
Dr Gary Birnbaum, director of the MS Treatment and Research Center at the
Minneapolis Clinic of Neurology, said he thinks the study highlights the concept
that MS is a combination of inflammatory and degenerative processes.
But Birnbaum, who was not involved with the study, said measuring the size of
the thalamus on special MRI scans is more complex than what is possible with
traditional scans. He said this new finding needs to be confirmed before being
useful in clinical MS diagnoses.
"The [thalamic] measurement may become a very valuable tool in terms of
measuring the effectiveness of new therapies," he said.
"But in terms of the day-to-day practice of a neurologist trying to figure
out if a person has MS, at this particular time it's perhaps not as valuable as
measuring new lesions."
To learn more about MS, visit the National
Multiple Sclerosis Society.