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To the Editor:
Ge et al.1 report that whole brain N-acetylaspartate (WBNAA) concentration decreases over time in multiple sclerosis (MS) patients more rapidly than brain volume. These findings imply that axonal dysfunction precedes brain atrophy in patients with MS, suggesting that axonal dysfunction is the cause of atrophy.
In their discussion, the authors state, “…axons might die from direct damage from early inflammation, followed by Wallerian degeneration, leaving behind largely intact but empty myelin sheaths.” We disagree with this statement and its interpretation.
Wallerian degeneration has been investigated in animals and humans, and is associated with a stereotyped set of events culminating in both axonal degeneration and demyelination.2,3⇓ Although the time course of demyelination associated with Wallerian degeneration may take …
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