Premorbid Structural Reserve Mitigates Disability Accrual in Multiple Sclerosis

Strategic Insights -

Researchers have made significant findings on the impact of premorbid structural reserve on disability accumulation in multiple sclerosis (MS) patients. The study, conducted by a team of neuroscientists from S. Camillo-Forlanini Hospital in Rome, Italy, explored the influence of structural reserve, measured by intracranial volume (ICV) and spinal cervical canal area (SCCA), on the long-term disability accumulation in MS patients. The researchers examined 253 patients with relapsing-onset MS over a 5-year follow-up period, using 3D T1-weighted magnetic resonance imaging (MRI) scans to estimate ICV and SCCA.

Key Takeaways:

  • The study revealed that higher SCCA was associated with fewer progression independent of relapse activity (PIRA) events (adjusted event rate ratio = 0.74, p = 0.014) and delayed PIRA onset (subdistribution hazard ratio = 0.50, p = 0.05).
  • Larger ICV was associated with fewer relapse-associated worsening (RAW) events (adjusted event rate ratio = 0.70, p = 0.033) and both later occurrence (subdistribution hazard ratio = 0.41, p = 0.02) and older age at RAW (subdistribution hazard ratio = 0.30, p = 0.002).
  • Patients with high combined reserve (both larger ICV and SCCA) reached Expanded Disability Status Scale (EDSS) 6.0 later (hazard ratio = 0.33, p = 0.025) and at older age (hazard ratio = 0.37, p = 0.045) than those with low reserve.

Statistics:

  • 253 patients with relapsing-onset MS participated in the study.
  • The patients were followed up for 5 years.
  • The median follow-up period was 17 years.
  • The study used 3D T1-weighted MRI scans to estimate ICV and SCCA.
  • The researchers used negative binomial regression to estimate adjusted event rate ratios (ERRs) and competing risk models to derive subdistribution hazard ratios (SHRs) for PIRA and RAW events.

Sources:

  • How premorbid structural reserve affects disability accrual in multiple sclerosis. Multiple Sclerosis Journal, 2025:13524585251372440.
  • Sage Publications Ltd, 1 Olivers Yard, 55 City Road, London EC1Y 1SP, England.
  • Luca Prosperini, Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy.
  • Elena Barbuti, Serena Ruggieri, Shalom Haggiag, Alessandro Stasolla, Carlo Pozzilli, Claudio Gasperini, Carla Tortorella, and Maria Petracca.