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From Free University Hospital, Departments of Diagnostic Radiology (Drs. Barkhof and Valk) and Neurology (Dr. Scheltens), Amsterdam, and University Hospital Nijmegen, Institute of Neurology (Drs. Frequin and Hommes, and K. hers and W.J.A. van Geel), Nijmegen, The Netherlands.
In a prospective study, we compared the number of gadolinium-DTPA (Gd-DTPA) enhancing lesions on MRI with the CSF and clinical findings before and after a total of 20 courses of high-dose intravenous methylprednisolone in relapsing multiple sclerosis patients. Before treatment, there was a significant correlation of Gd-DTPA enhancement (seen on 16 of 20 scans) and CSF myelin basic protein (MBP). If enhancement with Gd-DTPA represents inflammation and CSF-MBP indicates myelin breakdown, the amount of inflamed tissue should correlate with the amount of myelin being damaged. Clinical improvement occurred following 15 of 20 courses, and decrease of Gd-DTPA enhancement in 12 of 16 scans; the mean CSF-MBP level was the only CSF variable to return to reference values. There was a significant correlative triad of decrease in CSF-MBP, Gd-DTPA enhancement, and clinical disability. Thus, the clinical effect of methylprednisolone might be accompanied by a reduction of inflammation and myelin breakdown.
Address correspondence and reprint requests to Dr. F. Barkhof, Department of Diagnostic Radiology, Free University Hospital, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Supported by grants from the "Praeventiefonds" (28–1453), and the Nolet Foundation.
Received April 1, 1991. Accepted for publication in final form June 26, 1991.
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