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NEUROLOGY 2009;72:1760-1765
© 2009 American Academy of Neurology

Quality of life in multiple sclerosis is associated with lesion burden and brain volume measures

E. M. Mowry, MD, A. Beheshtian, MD, E. Waubant, MD, PhD, D. S. Goodin, MD, B. A. Cree, MD, PhD, MCR, P. Qualley, MA, R. Lincoln, BS, M. F. George, BA, R. Gomez, BS, S. L. Hauser, MD, D. T. Okuda, MD and D. Pelletier, MD

From the Department of Neurology, University of California, San Francisco, CA.

Address correspondence and reprint requests to Dr. Ellen M. Mowry, University of California, San Francisco, UCSF Multiple Sclerosis Center, 350 Parnassus Ave., Suite 908, San Francisco, CA 94117 ellen.mowry{at}ucsf.edu

Background: Health-related quality of life (HRQOL) is reduced in multiple sclerosis (MS). It is unclear whether HRQOL is associated with white matter lesion burden or measures of brain atrophy.

Methods: A cross-sectional baseline analysis of 507 patients with MS in a prospective cohort study at the University of California, San Francisco was performed. Multivariate linear regression models were used to determine whether MRI measures were associated with the Emotional Well-Being and Thinking/Fatigue subscale scores of the Functional Assessment in Multiple Sclerosis, a validated HRQOL measure in MS. The difference in each MRI metric associated with a minimal clinically important difference in each HRQOL subscale was calculated.

Results: Higher T1 lesion load (15 mL; p = 0.024), normalized T1 lesion volume (20 mL; p = 0.016), or T2 lesion load (25 mL; p = 0.028) was associated with worse scores for Emotional Well-Being. Meaningfully lower scores on this subscale were correlated with lower normalized gray matter volume (118 mL; p = 0.037). Reduced Thinking/Fatigue scores were associated with higher normalized T1 lesion volume (21 mL; p = 0.024), or T2 lesion load (22 mL; p = 0.010) and with lower normalized gray matter (87 mL; p = 0.004), white matter (85 mL; p = 0.025), or brain parenchymal (98 mL; p = 0.001) volume.

Conclusions: Aspects of health-related quality of life (HRQOL) in multiple sclerosis are associated with MRI evidence of white matter lesions and brain atrophy. These findings strengthen the argument for the use of HRQOL outcome measures in trials and suggest that lesion burden on conventional MRI is important for HRQOL.

Abbreviations: CIS = clinically isolated syndrome; DMT = disease-modifying therapy; EDSS = Expanded Disability Status Scale; EWB = Emotional Well-Being; FAMS = Functional Assessment in Multiple Sclerosis; FOV = field of view; HRQOL = health-related quality of life; IQR = interquartile range; IRSPGR = inversion recovery spoiled gradient-recalled; PASAT = Paced Auditory Serial Addition Test; PPMS = primary progressive multiple sclerosis; PRMS = progressive relapsing multiple sclerosis; MS = multiple sclerosis; MSFC = Multiple Sclerosis Functional Composite; nBPV = normalized brain parenchymal volume; NEX = number of excitations; nGMV = normalized gray matter volume; nT1LV = normalized T1 lesion volume; nWMV = normalized white matter volume; RRMS = relapsing–remitting multiple sclerosis; SPMS = secondary progressive multiple sclerosis; TE = echo time; TI = inversion time; TF = Thinking/Fatigue; TR = repetition time; UCSF = University of California, San Francisco.

Supplemental data at www.neurology.org

Supported in part by grants from the NIH (NS26799, AI067152, R01 NS049477, U19 AI067152, K23 NS048869), the National Multiple Sclerosis Society (RG 3517), a research grant from GlaxoSmithKline, and gifts from the Signe Ostby Foundation and the Friends of Amy. This work was also made possible by a Partners MS Center Clinical Fellowship Award, a Genentech Fellowship Award, and a National Multiple Sclerosis Society Sylvia Lawry Fellowship Award (to E.M.M.). D.P. is a Harry Weaver Neuroscience Scholar of the National Multiple Sclerosis Society.

Disclosure: The authors report no disclosures.

Medical Device: 3-Tesla GE Excite scanner (GE Healthcare Technologies, Waukesha, WI).

Received December 4, 2008. Accepted in final form February 17, 2009.






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