Regional variations in the extent and pattern of grey matter demyelination in multiple sclerosis: a comparison between the cerebral cortex, cerebellar cortex, deep grey matter nuclei and the spinal cord

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 80; no. 2; pp. 182 - 187
• Main Authors: Gilmore, C P, Donaldson, I, Bö, L, Owens, T, Lowe, J, Evangelou, N
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.02.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood-brain barrier; Brain - pathology; Cerebellum - pathology; Cerebral Cortex - pathology; Demyelinating Diseases - epidemiology; Demyelinating Diseases - pathology; Female; Gyrus Cinguli - pathology; Humans; Male; Medical sciences; Middle Aged; Morphology; Motor Cortex - pathology; Multiple sclerosis; Multiple Sclerosis - epidemiology; Multiple Sclerosis - pathology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Pathology; Spinal cord; Spinal Cord - pathology; Studies; Thalamus - pathology; Topography; Cerebellum; Cerebral cortex; Spinal cord; Nervous system diseases; Multiple sclerosis; Grey matter; Central nervous system; Multiple comparison; Encephalon; Inflammatory disease; Cerebellar cortex; Demyelination; Central nervous system disease
• ISSN: 0022-3050; 1468-330X; 1468-330X
• DOI: 10.1136/jnnp.2008.148767

Background:Substantial grey matter (GM) demyelination occurs in both the cerebral cortex and spinal cord in multiple sclerosis (MS). GM demyelination also occurs in the cerebellar cortex and the deep GM nuclei of the brain. However, no study has made a direct “within subject” comparison of the extent of GM pathology between these regions.Aim:To examine the extent and pattern of GM demyelination in the motor cortex, cingulate gyrus, cerebellum, thalamus and spinal cord in MS.Methods:Postmortem study using material from 14 MS cases and three controls. Sections were taken from the five predetermined areas and stained for proteolipid protein. The extent of GM and white matter (WM) demyelination was assessed in each region.Results and conclusion:Overall, 28.8% of the GM was demyelinated compared with 15.6% of the WM (p<0.001), with demyelination being greater in the GM than in the WM at each of the anatomical sites. There was substantial variation in the extent of demyelination between the different CNS regions. GM demyelination was most extensive in the spinal cord and cerebellum while WM demyelination was most prominent in the spinal cord.