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. 2014 Jun 4;85(12):1386–1395. doi: 10.1136/jnnp-2014-307712

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Pattern of cortical, white matter and deep grey matter (DGM) demyelination. The figure shows the patterns of cortical, white matter and DGM demyelination. (A–D) The lesion maps of the distinct types of multiple sclerosis (MS) are shown. Double-hemispheric sections of the presented cases of MS were stained for Luxol fast blue myelin stain, proteolipid protein and H&E, scanned and implemented into a matrix with different layers using Adobe Photoshop CS4. The extent of evaluated demyelination was marked in green for white matter demyelination, in yellow for white matter remyelination, in red for cortical demyelination and in blue for DGM demyelination. The lesion maps represent the disease courses of acute MS (A), relapsing/remitting MS (B), secondary progressive MS (C) and primary progressive MS (D). (E–G) Graphs illustrating the percentage of cortical (E), white matter (F) and DGM (G) demyelination according to MS type. The box plots represent the median value (50th percentile) and the range of percentages. The outliers (values that are between 1.5 and 3 times the IQR) are marked with a circle. The extreme values (values that are >3 times the IQR) are marked with an asterisk. Similar to the cortical and white matter demyelination, DGM demyelination was found among all of the MS types (A–G). Cortical demyelination was present in patients with acute-relapsing MS but was most pronounced in progressive MS patients (p<0.001) (A–E): the median percentage of cortical demyelination was 0.0% (range 0%–3.9%) in acute MS, 2.0% (range 0%–5.3%) in relapsing/remitting MS, 10.8% (range 0.1%–66.5%) in secondary progressive MS and 12.8% (range 0%–36.7%) in primary progressive MS. The percentage of white matter demyelination was extensive in progressive MS patients and acute MS and significantly lower in relapsing/remitting MS patients (p=0.009) (A–D, F): the median percentage of white matter demyelination was 31.3% (range 4.8%–85.5%) in acute MS, 4.9% (range 1.0%–35.7%) in relapsing/remitting MS, 26.2% (range 8.0%–60.4%) in secondary progressive MS and 7.6% (range 0.5%–76.5%) in primary progressive MS. The extent of DGM demyelination revealed no significant differences among the MS types (A–D, G): the median percentage of DGM demyelination was 3.1% (range 0%–26.8%) in acute MS, 14.5% (range 0.2%–31.6%) in relapsing/remitting MS, 6.0% (range 0%–46.4%) in secondary progressive MS and 9.9% (range 0%–91.3%) in primary progressive MS.