부산대학교 도서관

Objectives: To examine the occurrence and extent of demyelination in the cerebral cortex in multiple sclerosis (MS) patients. Methods: The material consisted of formalin fixed brains from 20 MS patients and 6 patients with no neurological disease. Irrespective of macroscopically evident lesions, tissue blocks were taken from the gyrus cinguli, frontal, temporal and parietal lobes. Only specimens where strict sampling of brain tissue from the predetermined areas could be achieved were included in this series. Paraffin-embedded sections were immunostained for myelin basic protein. Areas of gray and white matter, and areas of demyelination were analyzed by morphometry. Results: In control brains cortical demyelination was not detected. In 18 out of 20 MS brains there was cortical myelin loss. Median percentage demyelinated area in the cerebral cortex was 14.1% (mean: 26.5%), in the subcortical white matter it was 0% (mean: 6.5%). The percentage demyelinated area was highest in the gyrus cinguli (49.4%), lower in the temporal (19.4%), frontal (14.3%), and parietal lobe (2.2%). Ninety-two of 109 lesions, with 85.6% of the total cortical demyelinated area, were entirely intracortical. The most common pattern of cortical lesions was subpial demyelination, which was extensive in 5 (25%) of the MS patients. Conclusion: There is extensive demyelination in the cerebral cortex of multiple sclerosis patients. This may affect cortical functions and is of possible importance for the cognitive impairment frequently present in this disease. [ABSTRACT FROM AUTHOR]