The effects of high-dose methylprednisolone on gadolinium-enhanced magnetic resonance imaging and cerebrospinal fluid measurements in multiple sclerosis |
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Authors: | Stephan T F M Frequin Frederik Barkhof Karel J B Lamers and Otto R Hommes |
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Institution: | a Institute of Neurology, University Hospital of Nijmegen, Nijmegen, Netherlands b Department of Diagnostic Radiology, Free University Hospital, Amsterdam, Netherlands |
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Abstract: | Blood-brain barrier (BBB) disruption is probably the first event in the lesion development in multiple sclerosis (MS). This stage can be visualized by gadolinium-enhanced magnetic resonance (MR) imaging of the brain. Serial MR imaging studies have indicated a continuous spectrum of disease activity with waxing and waning of acute lesions, even in clinically stable MS patients. High-dose intravenous methylprednisolone (MP) has a beneficial clinical effect; reduces gadolinium enhancement, indicating improvement of BBB integrity; and, in MS patients, decreases intrathecal immunoglobulin synthesis with reduction of cerebrospinal fluid (CSF) myelin basic protein (MBP). A correlative triad is noted between gadolinium enhancement, clinical improvement, and decrease of CSF MBP following MP treatment, indicating a relationship between restoration BBB integrity, clinical improvement and decrease of myelin breakdown. It is not clear whether MP interferes primarily with the process of demyelination or reacts non-specifically with its mediators. |
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Keywords: | Multiple sclerosis Methylprednisolone Gadolinium Magnetic resonance imaging Cerebrospinal fluid Myelin basic protein |
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