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Abstract Details

Cervical Spinal Cord Atrophy in Multiple Sclerosis: Age, Sex, and Hormonal Status
Multiple Sclerosis
P11 - Poster Session 11 (11:45 AM-12:45 PM)
18-005
Investigate the influence of age, sex, and menopause on upper cervical spinal cord (UCC) atrophy and its association with disability metrics in persons with multiple sclerosis (pwMS)

Men with MS often experience a more aggressive disease course earlier in life, whereas women demonstrate accelerated disability worsening after menopause. In parallel, men show a more prominent brain atrophy early on, while brain atrophy rates become similar between sexes after 50 years of age. However, sex and hormonal differences in spinal cord (SC) atrophy are understudied in MS.
UCC area was obtained from 3T brain MRIs using an established automated method in pwMS and controls. Clinical measures, including expanded disability status scale (EDSS) and MS Functional Composite (MSFC), were obtained in pwMS. 
When controls (n=118) were age- and sex-matched to pwMS (n=118), pwMS (51.4±5.3 mm2) had a smaller UCC area than controls (54.2±4.4 mm2, p<0.001). UCC area inversely correlated with age in pwMS (r=–0.24, p=0.010) but not in controls (r=–0.03, p=0.786). In the entire pwMS cohort (n=173; 413 MRIs), UCC was smaller in; 1) men (49.5±5.9 mm2) than women (51.6±5.5 mm2, p<0.001), 2) postmenopausal (49.4±5.6 mm2) than premenopausal women (52.9±4.1 mm2, p<0.001), and 3) progressive (47.5±5.6 mm2) than relapsing MS (52.1±5.2 mm2, p<0.001). Using the mean age at menopause (47.0±5.9 years), men were classified as younger men (18–47 years) and older men (>47 years). Consequently, UCC was smaller in younger men (50.3±6.7 mm²) compared with premenopausal women (52.9±4.1 mm², p=0.001), but similar between older men (48.5±4.4 mm²) and postmenopausal women (49.4±5.6 mm², p=0.318). Smaller UCC also correlated with longer disease duration (r=-0.39, p<0.001), worse 9-hole peg test scores (r=-0.26, p=0.005), and higher frequency of EDSS≥6 (r=-0.27, p<0.001).
Older age, male sex, and menopause correlate with greater SC atrophy, which is an important biomarker of progressive MS and disability in MS.
Authors/Disclosures
Nur Neyal, MD (Mayo Clinic)
PRESENTER 		Dr. Neyal has nothing to disclose.
Jiye Son, MD Dr. Son has nothing to disclose.
Christopher Schwarz The institution of Christopher Schwarz has received research support from NIH.
Elizabeth Atkinson Ms. Atkinson has nothing to disclose.
Holly Morrison, BS Miss Morrison has nothing to disclose.
Nabeela Nathoo, MD, PhD Dr. Nathoo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
Kejal Kantarci, MD (Mayo Clinic) The institution of Dr. Kantarci has received research support from Eli Lilly. The institution of Dr. Kantarci has received research support from NIH. The institution of Dr. Kantarci has received research support from ADDF. The institution of Dr. Kantarci has received research support from Eisai. The institution of Dr. Kantarci has received research support from BioArctic.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
John Port, MD, PhD The institution of Prof. Port has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clario.
Orhun H. Kantarci, MD Dr. Kantarci has nothing to disclose.
Burcu Zeydan, MD (Mayo Clinic) The institution of Dr. Zeydan has received research support from National Institutes of Health.