Brain Atrophy in Multiple Sclerosis Explained by Neurologist
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- Опубликовано: 5 фев 2025
- In multiple sclerosis, the rate of brain atrophy (shrinkage) is accelerated compared to normal aging. How fast is the rate of atrophy? Can disease modifying therapies stop it? What about HSCT?
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Selected Sources:
Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options: autoimmunhighl...
Cortical atrophy is relevant in multiple sclerosis at clinical onset: link.springer....
Brain atrophy and disability progression in multiple sclerosis patients: a 10-year follow-up study: jnnp.bmj.com/c...
The effect of disease-modifying therapies on brain atrophy in patients with clinically isolated syndrome: a systematic review and meta-analysis: journals.sagep...
MAGNIMS consensus recommendations on the use of brain and spinal cord atrophy measures in clinical practice: www.nature.com...
Table 1 Brain atrophy outcomes in pivotal trials of approved disease-modifying drugs: www.nature.com...
Five years of ocrelizumab in relapsing multiple sclerosis OPERA studies open-label extension: n.neurology.or...
Reduced brain atrophy rates are associated with lower risk of disability progression in patients with relapsing multiple sclerosis treated with cladribine tablets: journals.sagep...
Early brain pseudoatrophy while on natalizumab therapy is due to white matter volume changes: journals.sagep...
Impact of autologous haematopoietic stem cell transplantation on disability and brain atrophy in secondary progressive multiple sclerosis: journals.sagep...
Intermediate-Intensity Autologous Hematopoietic Stem Cell Transplantation Reduces Serum Neurofilament Light Chains and Brain Atrophy in Aggressive Multiple Sclerosis: www.ncbi.nlm.n...
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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.
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Atrophy is what frightens me the most
Agree!
Me too
Same
Ditto…
Did you know there are MANY other causes of brain atrophy besides MS? Depression can also cause atrophy.
Thanks so much Dr. Beaber! Yes, I would love to see a follow up video that includes diet and lifestyle changes along with DMTs if there is data on that.
I unfortunately don't think there is specific data on it, but in Dr. Wahls' study, she is doing MRIs and there will be data on brain atrophy. You'll have to wait 2-3 years though.
Thank you Dr Brandon for covering this! It is an incredibly overlooked component of MS that is certain. I am always surprised that it is not really taken into consideration in the current model of progression (lesions are localized instances of inflammation, general atrophy is the entire picture of smoldering inflammation/damage). I take alpha lipoic acid daily. It seems to be an effective treatment for the brain atrophy component from several studies now! It is cheap and seems to work very well. Interestingly like DMF/tecifidera/vumerity it is also an antioxidant. From a paper called: "Novel Drugs in a Pipeline for Progressive Multiple Sclerosis" : QUOTE: Ultimately, the impact of ALA on patients with SPMS was studied in the phase II randomized, double-blinded, placebo-controlled clinical trial. ALA, at a dose of 1200 mg/day, was administered to 51 patients for 2 years. The results showed a 68% reduction in brain atrophy in the patients treated with ALA compared to placebo. This is massive...
I'd be very interesting to hear Dr. Brandon's view on ALA for MS patients.
@@yeayeahh123 Hi there, indeed david sinclair is an interesting character who is pushing the boundaries of longevity. Not surprising he also takes ALA. I also take about 600-800 mg as the risks are very low /none from what I can find (at these doses*). Also you are correct when it comes to the variant of ALA - I believe most that is available is a blend of the two. Considering it is a key antioxidant found in veg it may perhaps work in a similar manner to DMF / vumerity/tecfidera. Activation of the Nrf2 pathway / reducing or dampening the general inflammation in the body caused by free radicals/oxidative stress. It is an interesting topic and I also wonder why this hasn't been explored further. A 68% reduction in brain atrophy seems like an incredible finding for such a cheap and available supplement.
@@yeayeahh123 agreed :)
Thank you for making these!
No problem
Does the age breakdown data for Lemtrada take disease duration into account? I.e., would a newly diagnosed 45+ patient see more benefit than someone of the same age who's had the disease for a long time, or is the benefit entirely determined by age?
Also, a question for a potential future video:
If the immune system in MS sees myelin (or MOG, or whatever specific antigens) as a foreign invader, why is it not attacking myelin everywhere in the CNS all the time? What accounts for the focal / episodic nature of MS inflammation?
Great questions!
MS just attacks myelin in CNS...
CIDP attacks myelin in the peripheral nerves...totally different diseases.
@@mary-vy3mo I don't think you're understanding my question correctly. I'm only talking about MS and the CNS here. The question is, why doesn't the immune system attack all of the CNS, all of the time? Why does it focus on (e.g.) a particular spot in the periventricular area, and why does the attack only last a few weeks or months? What is special about that place and time period that causes the immune system to attack myelin?
@@brianguppyNo one knows this yet...but focal inflammation only lasts
when younger age...older age it stops
happening and becomes neurodegenerative.
I appreicte Dr. Beaber's videos and insight but miss the videos shot in his his office. I just have to know if he ever opened that Amazon package:)
haha. My office is all clean and neat now. I swear. :)
Im suffering from longitudinal extensive transverse myelitis , is there a hope in future to heal my spinal cord
Yes. Remyelination is on the horizon.
@@BaBaYaga1999-p7u thanks
Thank you dr. Brandon, I have some new MRIS coming up soon so I guess that will tell the tale, fingers crossed
Thanks for the video Dr. Beaber. During your career, do you notice a connection between low c-reactive levels and brain atrophy in people with ms? Thanks.
I can't comment on this as CRP is not a test I would typically order for people with MS. As far as I know there is no known correlation.
Thanks , doc! 🎉
Thank you!!
No one mentioned psedo atrophy from tysabri to me. That would have eased my mind a little.
Im curious what MRIs this month will be once i get them done. I know it said im already at a loss more than normal rate only 3 yrs in to this disease.
unless they use a nueuro quant program on your mri you can not see
atrophy on an mri until it is already
severe.
Atrophy is not visible to naked eye.
Thanks for your content Dr. Beaber! Could you share your thoughts on Vidofludimus Calcium. I've seen it has a similar mechanism to Teriflunomide but with neuroprotective effects as well. Pretty safe too.
So I ask again, for the thousandth time (not you, Dr. Beaber, just shouting at the moon in general) - WHY DO WE STILL USE INTERFERON. I have been on interferon beta for 10 years now. I can't imagine the atrophy that accumulated just because they didn't put me on something stronger (and they still refuse to do so).
Who are “they”? Where do you live? And, have you have progression of your disease (new lesions) on interferon?
@@BaBaYaga1999-p7u you're right, I sound paranoid. Let me rephrase - why is interferon still used for MS when there are superior treatments?
I live in Europe, so insurance (cost) is not an issue.
What is the argument for continued use of interferon? My neurologist says it's safe. That's great, but what good is a safety profile if I'll still lose a lot of brain volume as if I wasn't on any therapy at all.
Hello Dr B, thanks a lot for such an informative video! What would you recommend a patient having 4% BVL yearly? 2 years getting diagnosed and on tecfidera, EDSS 1.5. Neurologists say you are NEDA 3, atrophy is not that much important. Apart from lemtrada, what would you recommend? Tysabri or ocrevus? Thanks a lot,
I can't give you personal advice here but 4% annually is much more than expected and I would question the validity of that result. In general, highly effective disease modifying therapies may be more effective in reducing brain atrophy.
Thank you Dr Beaber this is excellent! Is there any data on Natalizumab and brain atrophy?
see "tysabri brain atrophy ms news today"
tysabri results in gray matter atrophy that does not show in white matter mri..gray matter causes most disability..your best chance is to
drop tysabri for lemtrada or hsct
to have normal life.
see "usual suspect lesions zivadinov"
Is there volume loss in spastic paraplegia?
I know it happens, after 28 years I’ve got Swiss cheese 🧠.
Great video
#sharingiscaring
Is it true that Aubagio is as successful as Kesimpta in reducing brain atrophy?
This is correct from the ASCLEPIOS trials: "surprisingly, brain atrophy was not slower in the ofatumumab-treated patients compared with teriflunomide" www.neurologylive.com/view/ofatumumab-for-relapsing-ms
But isn’t it true to say that teriflunomide is one of the best first line treatments when it comes to slowing brain volume loss just looking for celerity on that so that people don’t overlook K /ofatumumab
i feel every day Bladder disorders, i thought about would be the bladder restored, maybe then also the MS is cleared, like a virsus taken out of body.
What about Tysabri?
see "tysabri brain atrophy ms news today"
Awesome
Brandon, I have a question for you and my question is to you how bad does methamphetamine mess with multiple sclerosis if he just smokes it and only other druggies on is marijuana 6:28 😅
just stick to marijuana...
what about Alpha Lipon acid i believe it was in beta form?
There is some evidence for alpha lipoic acid as a treatment for neuropathic pain in people with diabetic neuropathy, and I have used it as an alternative treatment for neuropathic pain in MS.
@@DrBrandonBeaber according to a study it lowered brain atrophy by 66 percent. From 0.66 to 0.22 but there were only 50 or smthg people in that trial.
@@TankoxD Do you have the source of this?
@@DrBrandonBeaber I think YT wouldn't allow me to post the link. "Lipoic acid in secondary progressive MS
A randomized controlled pilot trial" is the title of the article.
@@TankoxD I found the article, and you are correct. The rate of brain atrophy was .21%/yr with ALA vs. 0.65%/yr with placebo, and this was statistically significant. This is the article: nn.neurology.org/content/4/5/e374.long
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Thank you, Baruch Hashem. This american is rooting for your safety.
Biogen
biiiird
Your brain has definitely degenerated.