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Evolution of regional brain atrophy in children with multiple sclerosis

While multiple sclerosis (MS) has classically been considered to be a white matter disease, it is now clear that gray matter changes are seen at onset. Importantly, regional gray matter atrophy correlates strongly with motor outcomes in adult patients.1 Individuals with pediatric-onset MS have greater disease burden, as evidenced by higher relapse rate2 and increased lesion volume and atrophy on MRI3 than those with adult-onset MS. Furthermore, cognitive decline may be seen as early as 2 years after diagnosis in this population.4 Importantly, studies of structural correlates of disease progression in pediatric-onset MS must take the dynamic and maturational changes known to occur in the pediatric brain into account, including age- and sex-specific growth in some areas and regression and pruning in others.5 To this end, previous studies focused on white matter tracts and head size in pediatric-onset MS, and showed alterations in growth trajectories in patients with pediatric-onset MS in comparison with healthy youth.6 Others have demonstrated the extent of gray matter injury in the pediatric MS population, but have largely focused on specific deep gray matter structures.7 Much less is known about the dynamic pattern of growth and regression of various gray matter regions, and their relationship to outcomes in the pediatric patients with MS.