Robert Zivadinov, MD, professor of neurology at the University of Buffalo: If you asked me, “Can community neurologists assess the cortical atrophy in the way we did in this clinical trial?” The simple answer is no. Because you really need a high-quality MRI and you need the high-quality analysis to produce this data.
But, what community and academic neurologists should take away as a take-home message from this study is that they should not rely just on the lesion development to lead to the clinically definite MS, but they should think that, even in those people who do not have lesions and develop new lesions, they can develop substantial neurodegeneration in the cortex. As a matter of fact, sub-analysis of this study showed that cortical atrophy developed even in those patients who did not have Gd+ enhancing lesions at baseline. So they didn’t have inflammatory activity.