Neurology 2000;54:15
© 2000 American Academy of Neurology
Expedited Publication
Total brain N-acetylaspartate
A new measure of disease load in MS
O. Gonen, PhD,
I. Catalaa, MD,
J.
S. Babb, PhD,
Y. Ge, MD,
L.
J. Mannon, RT,
D.
L. Kolson, MD, PhD and
R.
I. Grossman, MD
From the Division of
Medical Science (Dr. Gonen) and Department of Biostatistics (Dr. Babb), Fox
Chase Cancer Center, and Departments of Radiology (Drs. Catalaa, Ge, and
Grossman, and L.J. Mannon) and Neurology (Dr. Kolson), University of
Pennsylvania Medical Center, Philadelphia, PA.
Address
correspondence and reprint requests to Dr. Robert I. Grossman, Department
of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA
19104; e-mail: grossman{at}oasis.rad.upenn.edu
OBJECTIVE: To quantitate the extent of neuronal cell loss
in MS via the whole brain’s N-acetylaspartate (NAA)
concentration (WBNAA).
METHODS: Because NAA is assumed to be present
only in neuronal cell bodies and their axons, we measured WBNAA as a marker
for viable neurons in 12 patients (9 women and 3 men, 26 to 53 years of
age) suffering from relapsing-remitting (RR) MS for at least 5 years and
compared them with 13 age- and sex-matched normal controls. Total brain NAA
was determined with proton MR spectroscopy, and WBNAA was obtained by
dividing it by the total brain volume, calculated from high resolution
MRI.
RESULTS: The WBNAA of the RR MS patients was lower than their
matched controls (p < 0.005). This difference was greater among
older than younger subjects. The linear prediction equations of WBNAA with
age indicate a faster, x10, decline in the patients,  0.8% per
year of age (p = 0.022).
CONCLUSION: The
age-dependent decrease of whole brain N-acetylaspartate (WBNAA) in
the patients suggests that progressive neuronal cell loss is a cardinal
feature of this disease. WBNAA offers a quick, highly reproducible measure
of disease progression and may be an important marker of treatment efficacy
in MS as well as other neurodegenerative
diseases.
Key words: N-acetylaspartate—Proton
nuclear magnetic resonance
spectroscopy—MS
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