Disease duration, clinical course, age, and gender contribute to the dynamic nature of white matter MS pathology, according to an analysis of 1,220 tissue blocks from 120 patients with MS. Researchers found:
• Active plaques were most often found in early disease.
• In later stages, smoldering, inactive, and shadow plaques predominated.
• Early active plaques rapidly declined with disease duration.
• Plaque type distribution differed significantly by clinical course.
• The majority of plaques in acute monophasic and relapsing-remitting MS were active.
• In secondary progressive MS (SPMS) with attacks, all plaque types could be distinguished.
• In SPMS without attacks, inactive plaques predominated.
• Smoldering plaques were found almost exclusively in progressive MS.
• At 47 years of age, equilibrium was seen between active and inactive plaques and smoldering plaques began to peak.
• Men displayed a higher proportion of smoldering plaques.
Citation: Frischer JM, Weigand SD, Guo Y, et al. Clinical and pathological insights into the dynamic nature of the white matter multiple sclerosis plaque. [Published online ahead of print August 3, 2015]. Ann Neurol. doi: 10.1002/ana.24497.