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- 1. Why Grey Matter matters Gavin Giovannoni, Barts and The London, [email protected] Brain atrophy in MS: what are its consequences? SOCIAL Compared with the general population, MSers are 40% more likely to separate, or divorce, and do so sooner. DIVORCE OCCUPATIONAL Kobelt et al. Neurol Neurosurg Psychiatry 2006;77:918–926. 10 years after diagnosis 50% of MSers are unemployed. By the time you need a wheel chair, over 80% of MSers are unemployed. JOBS COGNITIVE Feuillet et al. Mult Scler. 2007; 13:124-127. MEMORY At the time of the first clinical attack over 50% of CISers have cognitive impairment in at least two cognitive areas. MSBRAIN The brains of MSers shrink at a rate of 0.5-1.0% per year compared to a rate of between 0.1-0.4% in normal brains. ATROPHY Barkhof F et al. Nat Rev Neurol 2009. Simon JH. Mult Scler 2006; 12 (6): 679-687. Fotenos AF et al. Arch Neurol 2008. MSLESION In each cubic millimetre of an acute MS lesion there are over 11,000 transected axons, or nerve fibres, compared to less than one in normal brains. INFLAMMATION Trapp B, et al. N Engl J Med 1998; 1998;338:278-85. MSLESION After a single attack of optic neuritis approximately 20% of the nerve fibres are lost in the optic nerve. OPTIC NEURITIS Hickman et al. Neuroradiology 2001;43:123-8. Save your Grey Matter it really does matter. Version 4.0, 29 September 2013. MSBRAIN Brain atrophy, or brain shrinkage, in MS, as measured by MRI, is associated with disability and cognitive impairment. BRAIN VOLUME Rudick RA et al . J Neurol Sci. 2009 Jul 15;282(1-2):106-11. Calabrese M et al. Arch Neurol. 2009 Sep;66(9):1144-50. Goodin et al. J Neurol Neurosurg Psychiatry. 2012 Mar;83(3):282-7. MORTALITY MS reduces life expectancy by approximately 8 years and half of MSers die of MS- related complications. SURVIVAL Torkildsen G et al. Mult Scler. 2008;14:1191-1198. Smestad C et al. Mult Scler. 2009;15:1263-70. Kingwell E et al. J Neurol Neurosurg Psychiatry. 2012;83:61-66. Society rates the quality of life of someone with MS who is bed bound as being worse than death. SOCIETY QUALITY OF LIFE OrmeM et al. Value In Health. 2007;10:54-60. PHYSICAL The average time from MS onset to needing a walking stick is 20 years, and for a wheelchair 30 years. DISABILITY Confavreaux, Compston. McAlpine’s Multiple Sclerosis, 4th Edition. 2005. EMOTIONAL MSers have a 2-7x higher chance of committing suicide. SUICIDE Torkildsen G et al. Mult Scler. 2008;14:1191-1198. Sadovnick AD et al. Neurology. 1991;41:1193-1196. Pfleger CC et al. Mult Scler. 2010;16:121-126. MSBRAIN Brain atrophy, or shrinkage, occurs in the majority of MSers at all stages.Grey matter atrophy accelerates over time and with disease progression. BRAIN ATROPHY Simon JH. Mult Scler 2006. Fisher E et al. Ann Neurol 2008. MSLESION In MS there is extensive demyelination, neuronal transection and death, and loss of neurons, in the cerebral cortex or grey matter. GREY MATTER Peterson al. Ann Neurol 2001;50:389–400. Image: Schmierer-Lab, Blizard Institute