A COMPARISON OF THE PATHOLOGY OF PRIMARY AND SECONDARY PROGRESSIVE MULTIPLE-SCLEROSIS

The dynamics of primary progressive multiple sclerosis differ from tho se of the more common secondary progressive form. The observation by M RI that the frequency of enhancement with gadolinium-DTPA, a marker fo r blood-brain barrier dysfunction, is significantly less in the primar y progressive form, has led to the hypothesis that inflammation is les s intense in this group. To test this, we have studied post-mortem mat erial from nine cases judged from a retrospective analysis of case not es to show clear clinical evidence of either primary progressive or se condary progressive disease. Five hundred and seventy-eight lesions we re analysed. There was significantly more inflammation in secondary pr ogressive multiple sclerosis (as judged by the frequency of perivascul ar cuffing and cellularity of the parenchyma) than in primary progress ive disease. These observations have implications for therapeutic stra tegies in progressive multiple sclerosis.