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Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options

  • Andravizou, Athina1
  • Dardiotis, Efthimios1
  • Artemiadis, Artemios2
  • Sokratous, Maria1, 3
  • Siokas, Vasileios1
  • Tsouris, Zisis1
  • Aloizou, Athina-Maria1
  • Nikolaidis, Ioannis4
  • Bakirtzis, Christos4
  • Tsivgoulis, Georgios5
  • Deretzi, Georgia6
  • Grigoriadis, Nikolaos4
  • Bogdanos, Dimitrios P.3
  • Hadjigeorgiou, Georgios M.1, 7
  • 1 University of Thessaly, University Hospital of Larissa, Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, Biopolis, Mezourlo Hill, Larissa, 41100, Greece , Larissa (Greece)
  • 2 National and Kapodistrian University of Athens, Immunogenetics Laboratory, 1st Department of Neurology, Medical School, Aeginition Hospital, Vas. Sophias Ave 72-74, Athens, 11528, Greece , Athens (Greece)
  • 3 University General Hospital of Larissa, University of Thessaly, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, Viopolis, Larissa, 40500, Greece , Larissa (Greece)
  • 4 AHEPA University Hospital, Aristotle University of Thessaloniki, Multiple Sclerosis Center, 2nd Department of Neurology, Thessaloniki, Greece , Thessaloniki (Greece)
  • 5 University of Athens, “Attikon” University Hospital, Second Department of Neurology, School of Medicine, Athens, Greece , Athens (Greece)
  • 6 Papageorgiou General Hospital, Department of Neurology, Thessaloniki, Greece , Thessaloniki (Greece)
  • 7 University of Cyprus, Department of Neurology, Medical School, Nicosia, Cyprus , Nicosia (Cyprus)
Published Article
Autoimmunity Highlights
BioMed Central
Publication Date
Aug 10, 2019
DOI: 10.1186/s13317-019-0117-5
Springer Nature


Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system characterized by focal or diffuse inflammation, demyelination, axonal loss and neurodegeneration. Brain atrophy can be seen in the earliest stages of MS, progresses faster compared to healthy adults, and is a reliable predictor of future physical and cognitive disability. In addition, it is widely accepted to be a valid, sensitive and reproducible measure of neurodegeneration in MS. Reducing the rate of brain atrophy has only recently been incorporated as a critical endpoint into the clinical trials of new or emerging disease modifying drugs (DMDs) in MS. With the advent of easily accessible neuroimaging softwares along with the accumulating evidence, clinicians may be able to use brain atrophy measures in their everyday clinical practice to monitor disease course and response to DMDs. In this review, we will describe the different mechanisms contributing to brain atrophy, their clinical relevance on disease presentation and course and the effect of current or emergent DMDs on brain atrophy and neuroprotection.

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