Objective: To evaluate whether patients with multiple sclerosis who develop parkinsonism have significant differences in regional lesion burden compared to multiple sclerosis patients who do not develop parkinsonism.

Background: While multiple sclerosis (MS) and Parkinsonism/Parkinson’s disease (PoPD) represent independent disease processes, there have been multiple case reports of co-occurrence and nationwide cohort studies suggesting higher incidence rates and risk of PD in the MS population. There have been no studies beyond case reports comparing imaging characteristics of patients with and without this co-diagnosis to clarify the potential pathophysiologic basis of the increased risk of PD.

Method: We reviewed medical records from 2012-2022 within a single health care system for patients with multiple sclerosis and parkinsonism. An ICD code search resulted in 104 patients; on manual chart review 17 patients met final inclusion criteria. Ten patients had available MRI brain images for which lesion quantification was possible. Eight patients could be matched 1:3 to a control MS only cohort by sex, age at MS diagnosis, and MRI images near the age of PoPD diagnosis. T2 FLAIR lesions were identified and outlined with livewire mode segmentation to calculate volumes. Volume and location (basal ganglia, brainstem, cerebellum) were recorded for each lesion.

Results: Among 17 cases, the age of onset of MS ranged from 24-67 with a mean of 49 and median of 52, which was an older cohort compared to the general MS population where the age of diagnosis typically ranges from 20-49. The age of PoPD diagnosis ranged from 41-74 (mean 59). For the eight cases in which MRI images and controls were available, Wilcoxon matched pairs signed rank test showed no statistically significant difference in lesion burden globally or in specific regions (basal ganglia, brainstem, cerebellum) between cases and controls. There was a potential trend of increased global lesion burden in the co-diagnosis group that did not reach statistical significance (mean lesion volume p=0.19, total lesion volume p=0.74).

Conclusion: Our preliminary data did not find a statistically significant difference in white matter lesion burden globally or regionally in the comparative MRI brain image analysis between eight patients with a dual diagnosis of MS and PoPD and a matched cohort of MS patients who did not develop PoPD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/white-matter-lesion-characteristics-of-patients-with-multiple-sclerosis-and-parkinsonism/