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Hoffmann O, Gold R, Meuth SG, Linker RA, Skripuletz T, Wiendl H, Wattjes MP. Prognostic relevance of MRI in early relapsing multiple sclerosis: ready to guide treatment decision making? Ther Adv Neurol Disord 2024; 17:17562864241229325. [PMID: 38332854 PMCID: PMC10851744 DOI: 10.1177/17562864241229325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Magnetic resonance imaging (MRI) of the brain and spinal cord plays a crucial role in the diagnosis and monitoring of multiple sclerosis (MS). There is conclusive evidence that brain and spinal cord MRI findings in early disease stages also provide relevant insight into individual prognosis. This includes prediction of disease activity and disease progression, the accumulation of long-term disability and the conversion to secondary progressive MS. The extent to which these MRI findings should influence treatment decisions remains a subject of ongoing discussion. The aim of this review is to present and discuss the current knowledge and scientific evidence regarding the utility of MRI at early MS disease stages for prognostic classification of individual patients. In addition, we discuss the current evidence regarding the use of MRI in order to predict treatment response. Finally, we propose a potential approach as to how MRI data may be categorized and integrated into early clinical decision making.
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Affiliation(s)
- Olaf Hoffmann
- Department of Neurology, Alexianer St. Josefs-Krankenhaus Potsdam, Allee nach Sanssouci 7, 14471 Potsdam, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Ralf A. Linker
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Mike P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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2
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Lauerer M, McGinnis J, Bussas M, El Husseini M, Pongratz V, Engl C, Wuschek A, Berthele A, Riederer I, Kirschke JS, Zimmer C, Hemmer B, Mühlau M. Prognostic value of spinal cord lesion measures in early relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 95:37-43. [PMID: 37495267 PMCID: PMC10804039 DOI: 10.1136/jnnp-2023-331799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Spinal cord (SC) lesions have been associated with unfavourable clinical outcomes in multiple sclerosis (MS). However, the relation of whole SC lesion number (SCLN) and volume (SCLV) to the future occurrence and type of confirmed disability accumulation (CDA) remains largely unexplored. METHODS In this monocentric retrospective study, SC lesions were manually delineated. Inclusion criteria were: age between 18 and 60 years, relapsing-remitting MS, disease duration under 2 years and clinical follow-up of 5 years. The first CDA event after baseline, determined by a sustained increase in the Expanded Disability Status Scale over 6 months, was classified as either progression independent of relapse activity (PIRA) or relapse-associated worsening (RAW). SCLN and SCLV were compared between different (sub)groups to assess their prospective value. RESULTS 204 patients were included, 148 of which had at least one SC lesion and 59 experienced CDA. Patients without any SC lesions experienced significantly less CDA (OR 5.8, 95% CI 2.1 to 19.8). SCLN and SCLV were closely correlated (rs=0.91, p<0.001) and were both significantly associated with CDA on follow-up (p<0.001). Subgroup analyses confirmed this association for patients with PIRA on CDA (34 events, p<0.001 for both SC lesion measures) but not for RAW (25 events, p=0.077 and p=0.22). CONCLUSION Patients without any SC lesions are notably less likely to experience CDA. Both the number and volume of SC lesions on MRI are associated with future accumulation of disability largely independent of relapses.
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Affiliation(s)
- Markus Lauerer
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Julian McGinnis
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- Institute for AI in Medicine, Technical University, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Malek El Husseini
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
| | - Christina Engl
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Alexander Wuschek
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
| | - Isabelle Riederer
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mark Mühlau
- Department of Neurology, School of Medicine, Technical University, Munich, Germany
- TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
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3
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Ruggieri S, Prosperini L, Petracca M, Logoteta A, Tinelli E, De Giglio L, Ciccarelli O, Gasperini C, Pozzilli C. The added value of spinal cord lesions to disability accrual in multiple sclerosis. J Neurol 2023; 270:4995-5003. [PMID: 37386292 PMCID: PMC10511608 DOI: 10.1007/s00415-023-11829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
Spinal cord MRI is not routinely performed for multiple sclerosis (MS) monitoring. Here, we explored whether spinal cord MRI activity offers any added value over brain MRI activity for clinical outcomes prediction in MS. This is a retrospective, monocentric study including 830 MS patients who underwent longitudinal brain and spinal cord MRI [median follow-up 7 years (range: < 1-26)]. According to the presence (or absence) of MRI activity defined as at least one new T2 lesion and/or gadolinium (Gd) enhancing lesion, each scan was classified as: (i) brain MRI negative/spinal cord MRI negative; (ii) brain MRI positive/spinal cord MRI negative; (iii) brain MRI negative/spinal cord MRI positive; (iv) brain MRI positive/spinal cord MRI positive. The relationship between such patterns and clinical outcomes was explored by multivariable regression models. When compared with the presence of brain MRI activity alone: (i) Gd + lesions in the spine alone and both in the brain and in the spinal cord were associated with an increased risk of concomitant relapses (OR = 4.1, 95% CI 2.4-7.1, p < 0.001 and OR = 4.9, 95% CI 4.6-9.1, p < 0.001, respectively); (ii) new T2 lesions at both locations were associated with an increased risk of disability worsening (HR = 1.4, 95% CI = 1.0-2.1, p = 0.05). Beyond the presence of brain MRI activity, new spinal cord lesions are associated with increased risk of both relapses and disability worsening. In addition, 16.1% of patients presented asymptomatic, isolated spinal cord activity (Gd + lesions). Monitoring MS with spinal cord MRI may allow a more accurate risk stratification and treatment optimization.
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Affiliation(s)
- Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
- Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Rome, Italy.
| | - Luca Prosperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Alessandra Logoteta
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Tinelli
- Unit of Neuroradiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Radiology, Neurological Center of Latium, Rome, Rome, Italy
| | | | - Olga Ciccarelli
- Queen Square MS Centre, Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
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4
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Wuschek A, Bussas M, El Husseini M, Harabacz L, Pineker V, Pongratz V, Berthele A, Riederer I, Zimmer C, Hemmer B, Kirschke JS, Mühlau M. Somatosensory evoked potentials and magnetic resonance imaging of the central nervous system in early multiple sclerosis. J Neurol 2023; 270:824-830. [PMID: 36205793 PMCID: PMC9886619 DOI: 10.1007/s00415-022-11407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Somatosensory evoked potentials (SSEP) are still broadly used, although not explicitly recommended, for the diagnostic work-up of suspected multiple sclerosis (MS). OBJECTIVE To relate disability, SSEP, and lesions on T2-weighted magnetic resonance imaging (MRI) in patients with early MS. METHODS In this monocentric retrospective study, we analyzed a cohort of patients with relapsing-remitting MS or clinically isolated syndrome, with a maximum disease duration of two years, as well as with available data on the score at the expanded disability status scale (EDSS), on SSEP, on whole spinal cord (SC) MRI, and on brain MRI. RESULTS Complete data of 161 patients were available. Tibial nerve SSEP (tSSEP) were less frequently abnormal than SC MRI (22% vs. 68%, p < 0.001). However, higher EDSS scores were significantly associated with abnormal tSSEP (median, 2.0 vs. 1.0; p = 0.001) but not with abnormal SC MRI (i.e., at least one lesion; median, 1.5 vs. 1.5; p = 0.7). Of the 35 patients with abnormal tSSEP, 32 had lesions on SC MRI, and 2 had corresponding lesions on brain MRI. CONCLUSION Compared to tSSEP, SC MRI is the more sensitive diagnostic biomarker regarding SC involvement. In early MS, lesions as detectable by T2-weighted MRI are the main driver of abnormal tSSEP. However, tSSEP were more closely associated with disability, which is compatible with a potential role of tSSEP as prognostic biomarker in complementation of MRI.
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Affiliation(s)
- Alexander Wuschek
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Malek El Husseini
- Dept. of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Laura Harabacz
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Viktor Pineker
- Dept. of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Isabelle Riederer
- TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.,Dept. of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Dept. of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jan S Kirschke
- Dept. of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.
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5
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Oechtering J, Lincke T, Schaedelin S, Décard BF, Maceski A, Orleth A, Meier S, Willemse E, Buchmann A, Khalil M, Derfuss T, Benkert P, Heijnen I, Regeniter A, Müller S, Achtnichts L, Lalive P, Salmen A, Pot C, Gobbi C, Kappos L, Granziera C, Leppert D, Schlaeger R, Lieb JM, Kuhle J. Intrathecal IgM synthesis is associated with spinal cord manifestation and neuronal injury in early MS. Ann Neurol 2022; 91:814-820. [PMID: 35293622 PMCID: PMC9320956 DOI: 10.1002/ana.26348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
Abstract
Objective Intrathecal Immunoglobulin M synthesis (IgMIntrathecal Fraction (IF)+) and spinal MRI lesions are both strong independent predictors of higher disease activity and severity in multiple sclerosis (MS). We investigated whether IgMIF+ is associated with spinal cord manifestation and higher neuroaxonal damage in early MS. Methods In 122 patients with a first demyelinating event associations between (1) spinal versus (vs) non‐spinal clinical syndrome (2) spinal vs cerebral T2‐weighted (T2w) and (3) contrast‐enhancing (CE) lesion counts with IgGIF+ (vs IgGIF−) or IgMIF+ (vs IgMIF−) were investigated by logistic regression adjusted for age and sex, respectively. For serum neurofilament light chain (sNfL) analysis patients were categorized for presence or absence of oligoclonal IgG bands (OCGB), IgGIF and IgMIF (>0% vs 0%, respectively): (1) OCGB−/IgGIF−/IgMIF−; (2) OCGB+/IgGIF−/IgMIF−; (3) OCGB+/IgGIF+/IgMIF−; and (4) OCGB+/IgGIF+/IgMIF+. Associations between categories 2 to 4 vs category 1 with sNfL concentrations were analyzed by robust linear regression, adjusted for sex and MRI parameters. Results Patients with a spinal syndrome had a 8.36‐fold higher odds of IgMIF+ (95%CI 3.03–23.03; p < 0.01). Each spinal T2w lesion (odds Ratio 1.39; 1.02–1.90; p = 0.037) and CE lesion (OR 2.73; 1.22–6.09; p = 0.014) was associated with an increased risk of IgMIF+ (but not of IgGIF+); this was not the case for cerebral lesions. OCGB+/IgGIF+/IgMIF+ category patients showed highest sNfL levels (estimate:1.80; 0.55–3.06; p < 0.01). Interpretation Intrathecal IgM synthesis is strongly associated with spinal manifestation and independently more pronounced neuroaxonal injury in early MS, suggesting a distinct clinical phenotype and pathophysiology. ANN NEUROL 2022;91:814–820
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Affiliation(s)
- Johanna Oechtering
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Therese Lincke
- Division of Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Switzerland
| | - Sabine Schaedelin
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland.,Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bernhard F Décard
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Aleksandra Maceski
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Annette Orleth
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Stephanie Meier
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Eline Willemse
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Arabella Buchmann
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland.,Department of Neurology, Medical University of Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Austria
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Pascal Benkert
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland.,Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ingmar Heijnen
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | - Patrice Lalive
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland.,Diagnostic Department, Division of Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Caroline Pot
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Claudio Gobbi
- Neurocentre of Southern Switzerland, Multiple sclerosis centre, Ospedale Civico, Lugano, Switzerland
| | - Ludwig Kappos
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
| | - Regina Schlaeger
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johanna M Lieb
- Division of Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Switzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Switzerland
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6
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Abdel Ghany H, Karam-Allah A, Edward R, Abdel Naseer M, Hegazy MI. Sensitivity and Specificity of Central Vein Sign as a Diagnostic Biomarker in Egyptian Patients with Multiple Sclerosis. Neuropsychiatr Dis Treat 2022; 18:1985-1992. [PMID: 36072679 PMCID: PMC9444024 DOI: 10.2147/ndt.s377877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics. PATIENTS AND METHODS Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2*-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients' clinical presentation. The MS consultant made the final diagnosis without reviewing the T2*-weighted gradient-echo sequence or the CVS analysis results. RESULTS Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919-1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017). CONCLUSION The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%.
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Affiliation(s)
- Hend Abdel Ghany
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Karam-Allah
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ramy Edward
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maged Abdel Naseer
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed I Hegazy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Radiologically isolated syndrome: from biological bases to practical management. Neurol Sci 2021; 42:1335-1344. [PMID: 33496891 DOI: 10.1007/s10072-021-05069-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. CONCLUSION At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.
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8
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Dostál M, Keřkovský M, Stulík J, Bednařík J, Praksová P, Hulová M, Benešová Y, Koriťáková E, Šprláková-Puková A, Mechl M. MR Diffusion Properties of Cervical Spinal Cord as a Predictor of Progression to Multiple Sclerosis in Patients with Clinically Isolated Syndrome. J Neuroimaging 2020; 31:108-114. [PMID: 33253445 DOI: 10.1111/jon.12808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE This study's aim was to investigate diffusion properties of the cervical spinal cord in patients with clinically isolated syndrome (CIS) through analysis of diffusion tensor imaging (DTI) data and thereby to assess the capacity of this technique for predicting the progression of CIS to clinically definite multiple sclerosis (CDMS). METHODS The study groups were comprised of 47 patients with CIS (15 of them with progression to CDMS within 2 years of follow-up) and 57 asymptomatic controls. All patients and controls had undergone magnetic resonance imaging (MRI) of the cervical spine including DTI and brain MRI. Methodological approaches included histogram analysis of the cervical cord's diffusion parameters and evaluation of T2 hyperintense lesions of the spinal cord and brain. All parameters were compared between the study groups. Sensitivity and specificity calculations were then performed with a view to predicting conversion to CDMS. RESULTS The patient subgroups defined by progression to CDMS differed significantly in values of fractional anisotropy (FA) kurtosis measured within white matter (WM) and normal-appearing WM (NAWM). The same parameters also differed significantly when patients with progression to CDMS were compared to healthy controls. Receiver operating characteristic (ROC) analysis revealed sensitivity and specificity of FA kurtosis of WM and NAWM of 93% and 72%, respectively, in terms of predicting CIS to CDMS progression. CONCLUSION This study presents evidence that histogram analysis of diffusion parameters of the cervical spinal cord in patients with CIS may be helpful in predicting conversion to CDMS.
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Affiliation(s)
- Marek Dostál
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Jakub Stulík
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Josef Bednařík
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Petra Praksová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Monika Hulová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Yvonne Benešová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Eva Koriťáková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrea Šprláková-Puková
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Marek Mechl
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
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9
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Leguy S, Combès B, Bannier E, Kerbrat A. Prognostic value of spinal cord MRI in multiple sclerosis patients. Rev Neurol (Paris) 2020; 177:571-581. [PMID: 33069379 DOI: 10.1016/j.neurol.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis [MS] is a common inflammatory, demyelinating and neurodegenerative disease of the central nervous system that affects both the brain and the spinal cord. In clinical practice, spinal cord MRI is performed far less frequently than brain MRI, mainly owing to technical limitations and time constraints. However, improvements of acquisition techniques, combined with a strong diagnosis and prognostic value, suggest an increasing use of spinal cord MRI in the near future. This review summarizes the current data from the literature on the prognostic value of spinal cord MRI in MS patients in the early and later stages of their disease. Both conventional and quantitative MRI techniques are discussed. The prognostic value of spinal cord lesions is clearly established at the onset of disease, underlining the interest of spinal cord conventional MRI at this stage. However, studies are currently lacking to affirm the prognostic role of spinal cord lesions later in the disease, and therefore the added value of regular follow-up with spinal cord MRI in addition to brain MRI. Besides, spinal cord atrophy, as measured by the loss of cervical spinal cord area, is also associated with disability progression, independently of other clinical and MRI factors including spinal cord lesions. Although potentially interesting, this measurement is not currently performed as a routine clinical procedure. Finally, other measures extracted from quantitative MRI have been established as valuable for a better understanding of the physiopathology of MS, but still remain a field of research.
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Affiliation(s)
- S Leguy
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - B Combès
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - E Bannier
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France; CHU de Rennes, Radiology department, Rennes, France
| | - A Kerbrat
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France.
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10
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Durand-Dubief F. Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? Synthesis. Rev Neurol (Paris) 2020; 176:490-493. [DOI: 10.1016/j.neurol.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
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11
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Grzegorski T, Losy J. What do we currently know about the clinically isolated syndrome suggestive of multiple sclerosis? An update. Rev Neurosci 2020; 31:335-349. [DOI: 10.1515/revneuro-2019-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 12/31/2022]
Abstract
AbstractMultiple sclerosis (MS) is a chronic, demyelinating, not fully understood disease of the central nervous system. The first demyelinating clinical episode is called clinically isolated syndrome (CIS) suggestive of MS. Although the most common manifestations of CIS are long tracts dysfunction and unilateral optic neuritis, it can also include isolated brainstem syndromes, cerebellar involvement, and polysymptomatic clinical image. Recently, the frequency of CIS diagnosis has decreased due to the more sensitive and less specific 2017 McDonald criteria compared with the revisions from 2010. Not all patients with CIS develop MS. The risk of conversion can be estimated based on many predictive factors including epidemiological, ethnical, clinical, biochemical, radiological, immunogenetic, and other markers. The management of CIS is nowadays widely discussed among clinicians and neuroscientists. To date, interferons, glatiramer acetate, teriflunomide, cladribine, and some other agents have been evaluated in randomized, placebo-controlled, double-blind studies relying on large groups of patients with the first demyelinating event. All of these drugs were shown to have beneficial effects in patients with CIS and might be used routinely in the future. The goal of this article is to explore the most relevant topics regarding CIS as well as to provide the most recent information in the field. The review presents CIS definition, classification, clinical image, predictive factors, and management. What is more, this is one of very few reviews summarizing the topic in the light of the 2017 McDonald criteria.
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Affiliation(s)
- Tomasz Grzegorski
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
| | - Jacek Losy
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
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12
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Cortese R, Ciccarelli O. Clinical monitoring of multiple sclerosis should routinely include spinal cord imaging - Yes. Mult Scler 2018; 24:1536-1537. [PMID: 30033804 DOI: 10.1177/1352458518778010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rosa Cortese
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK/National Institute for Health Research (NIHR), Biomedical Research Centre, University College London Hospitals (UCLH), London, UK
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13
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Mahajan KR, Ontaneda D. The Role of Advanced Magnetic Resonance Imaging Techniques in Multiple Sclerosis Clinical Trials. Neurotherapeutics 2017; 14:905-923. [PMID: 28770481 PMCID: PMC5722766 DOI: 10.1007/s13311-017-0561-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging has been crucial in the development of anti-inflammatory disease-modifying treatments. The current landscape of multiple sclerosis clinical trials is currently expanding to include testing not only of anti-inflammatory agents, but also neuroprotective, remyelinating, neuromodulating, and restorative therapies. This is especially true of therapies targeting progressive forms of the disease where neurodegeneration is a prominent feature. Imaging techniques of the brain and spinal cord have rapidly evolved in the last decade to permit in vivo characterization of tissue microstructural changes, connectivity, metabolic changes, neuronal loss, glial activity, and demyelination. Advanced magnetic resonance imaging techniques hold significant promise for accelerating the development of different treatment modalities targeting a variety of pathways in MS.
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Affiliation(s)
- Kedar R Mahajan
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA.
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14
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Smith AK, By S, Lyttle BD, Dortch RD, Box BA, Mckeithan LJ, Thukral S, Bagnato F, Pawate S, Smith SA. Evaluating single-point quantitative magnetization transfer in the cervical spinal cord: Application to multiple sclerosis. Neuroimage Clin 2017; 16:58-65. [PMID: 28761809 PMCID: PMC5521031 DOI: 10.1016/j.nicl.2017.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/03/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Abstract
Spinal cord (SC) damage is linked to clinical deficits in patients with multiple sclerosis (MS), however, conventional MRI methods are not specific to the underlying macromolecular tissue changes that may precede overt lesion detection. Single-point quantitative magnetization transfer (qMT) is a method that can provide high-resolution indices sensitive to underlying macromolecular composition in a clinically feasible scan time by reducing the number of MT-weighted acquisitions and utilizing a two-pool model constrained by empirically determined constants. As the single-point qMT method relies on a priori constraints, it has not been employed extensively in patients, where these constraints may vary, and thus, the biases inherent in this model have not been evaluated in a patient cohort. We, therefore, addressed the potential biases in the single point qMT model by acquiring qMT measurements in the cervical SC in patient and control cohorts and evaluated the differences between the control and patient-derived qMT constraints (kmf, T2fR1f, and T2m) for the single point model. We determined that the macromolecular to free pool size ratio (PSR) differences between the control and patient-derived constraints are not significant (p > 0.149 in all cases). Additionally, the derived PSR for each cohort was compared, and we reported that the white matter PSR in healthy volunteers is significantly different from lesions (p < 0.005) and normal appearing white matter (p < 0.02) in all cases. The single point qMT method is thus a valuable method to quantitatively estimate white matter pathology in MS in a clinically feasible scan time.
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Affiliation(s)
- Alex K. Smith
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Functional MRI of the Brain Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Samantha By
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Bailey D. Lyttle
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Richard D. Dortch
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Bailey A. Box
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Lydia J. Mckeithan
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
| | - Saakshi Thukral
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Merrol Hyde Magnet School, Hendersonville, TN, USA
| | - Francesca Bagnato
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Siddharama Pawate
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Merrol Hyde Magnet School, Hendersonville, TN, USA
| | - Seth A. Smith
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Sciences, Vanderbilt University, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
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15
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Prognostic value of oligoclonal IgG bands in Japanese clinically isolated syndrome converting to clinically definite multiple sclerosis. J Neuroimmunol 2017; 307:1-6. [DOI: 10.1016/j.jneuroim.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/08/2017] [Accepted: 03/15/2017] [Indexed: 01/08/2023]
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16
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Arrambide G, Rovira A, Sastre-Garriga J, Tur C, Castilló J, Río J, Vidal-Jordana A, Galán I, Rodríguez-Acevedo B, Midaglia L, Nos C, Mulero P, Arévalo MJ, Comabella M, Huerga E, Auger C, Montalban X, Tintore M. Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor. Mult Scler 2017; 24:301-312. [DOI: 10.1177/1352458517697830] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The usefulness of performing a spinal cord (SC) magnetic resonance imaging (MRI) in all clinically isolated syndromes (CIS) is controversial. Objective: To assess the value of SC lesions for predicting multiple sclerosis (MS) diagnosis and disability accrual in CIS. Methods: Concerning SC lesions and MS diagnosis (2010 McDonald), adjusted Cox regression analyses were performed in increasingly specific CIS groups: all cases ( n = 207), non-SC CIS ( n = 143), non-SC CIS with abnormal brain MRI ( n = 90) and non-SC CIS with abnormal brain MRI not fulfilling 2010 MS ( n = 67). For the outcome Expanded Disability Status Scale (EDSS) ≥3.0, similar analyses were performed in all cases ( n = 207), non-SC CIS ( n = 143) and SC CIS ( n = 64). Performance at 2 years was assessed for all outcomes. Results: The presence of SC lesions increased MS risk 2.0–2.6 times independently of factors like brain lesions. If considering lesion number, the risk ranged from 1.6 to 2.1 for one lesion to 2.4–3.3 for ≥2. SC lesions increased the short-term disability risk around fivefold, better demonstrated in non-SC CIS. SC lesions were very specific for evolution to MS and showed very high sensitivity for EDSS ≥3.0. Conclusion: SC lesions are independent predictors of MS in all CIS and contribute to short-term disability accrual. SC MRIs in CIS could be useful to estimate their prognosis.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Jesús Arévalo
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Huerga
- Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Alroughani R, Akhtar S, Ahmed S, Behbehani R, Al-Hashel J. Is Time to Reach EDSS 6.0 Faster in Patients with Late-Onset versus Young-Onset Multiple Sclerosis? PLoS One 2016; 11:e0165846. [PMID: 27802328 PMCID: PMC5089776 DOI: 10.1371/journal.pone.0165846] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/18/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND & OBJECTIVES Published natural history data on late-onset of multiple sclerosis are limited. We aimed to assess the risk of attaining EDSS 6.0 among patients with late-onset (> 40 years) MS (LOMS) and young-onset (18-40 years) MS (YOMS). METHODS This cross-sectional cohort study was conducted to identify LOMS and YOMS patients' with relapsing remitting course at MS diagnosis. Time (years) to reach sustained EDSS 6.0 was compared between LOMS and AOMS patients. Cox proportional hazards model was used to evaluate the demographic and clinical predictors of time to EDSS 6.0 in these cohorts. RESULTS LOMS and YOMS cohorts comprised 99 (10.7%) and 804 (89.3%) patients respectively. Spinal cord presentation at MS onset was more common among LOMS patients (46.5% vs. 32.3%). The proportions of LOMS and YOMS patients reaching EDSS 6.0 during the follow-up period were 19.2% and 15.7% respectively. In multivariable Cox proportional hazards model, older age at MS onset (adjusted hazard ratio (aHR) = 3.96; 95% CI: 2.14-7.32; p < 0.001), male gender (aHR = 1.85; 95% CI: 1.22-2.81; p = 0.004) and spinal cord presentation at onset (aHR = 1.47; 95% CI: 0.98-2.21; p = 0.062) were significantly associated with shorter time to EDSS 6.0. CONCLUSIONS LOMS patients attained EDSS 6.0 in a significantly shorter period that was influenced by male gender and spinal cord presentation at MS onset.
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Affiliation(s)
- Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
- Neurology Clinic, Dasman Diabetes Institute, Dasman, Dasman, Kuwait
- * E-mail:
| | - Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, University of Kuwait, Jabriya, Kuwait
| | - Samar Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Raed Behbehani
- Department of Ophthalmology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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18
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Galassi S, Prosperini L, Logoteta A, Hirsch MN, Fanelli F, De Giglio L, Pozzilli C. A lesion topography-based approach to predict the outcomes of patients with multiple sclerosis treated with Interferon Beta. Mult Scler Relat Disord 2016; 8:99-106. [PMID: 27456883 DOI: 10.1016/j.msard.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND With increasing availability of effective disease-modifying treatments for multiple sclerosis (MS), an early identification of patients who do not adequately respond to Interferon Beta (IFNB) is relevant to decide the future strategy. OBJECTIVE To investigate the predictive role of new lesion location on the risk of breakthrough disease in IFNB-treated patients with MS. METHODS We analysed data from 392 patients starting IFNB and regularly followed up to 5 years. Before and after one year of IFNB treatment, all patients underwent a conventional brain and spinal cord magnetic resonancer imaging (MRI) scan with the same 1.5T magnet to obtain the count and location of new MRI lesions. Relapses and MRI activity occurred in the first year of IFNB treatment (year 0-1) were included in the set of potential predictors for relapses and disability worsening in the subsequent four years (year 2-5). RESULTS We found that 96 (24.5%) patients had relapses and/or MRI activity in the first year of IFNB treatment, while 41.6% of the patients experienced relapses and 17.8% experienced disability worsening. from year 2 to 5. The risk of relapses (year 2-5) was associated with ≥2 relapses (HR=5.65, p<0.001) and new T2-hyperintense lesions (for 2 new lesions: HR=1.96, p=0.011; for ≥3 new lesions: HR=3.55, p<0.001) in the first year of treatment. Other than male sex (HR=2.01, p=0.01) and higher EDSS score (HR=2.17, p<0.001), the risk of disability worsening (year 2-5) was associated with ≥2 relapses (HR=4.33, p<0.001) and new spinal cord or infratentorial lesions (HR=4.45,p<0.001) in the first year of treatment. CONCLUSIONS Our findings suggest a dose-effect relationship between the lesion count and the risk of future relapses, while the occurrence of new MRI lesions in sites representing anatomical bottle-necks was better than lesion count at predicting the future risk of disability worsening despite IFNB treatment.
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Affiliation(s)
- Stefania Galassi
- Department of Diagnostic Imaging, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | | | | | | | - Laura De Giglio
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy; S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy; S. Andrea Hospital, Sapienza University, Rome, Italy
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19
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Dula AN, Pawate S, Dortch RD, Barry RL, George-Durrett KM, Lyttle BD, Dethrage LM, Gore JC, Smith SA. Magnetic resonance imaging of the cervical spinal cord in multiple sclerosis at 7T. Mult Scler 2015. [PMID: 26209591 DOI: 10.1177/1352458515591070] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical course of multiple sclerosis (MS) is mainly attributable to cervical and upper thoracic spinal cord dysfunction. High-resolution, 7T anatomical imaging of the cervical spinal cord is presented. Image contrast between gray/white matter and lesions surpasses conventional, clinical T1- and T2-weighted sequences at lower field strengths. OBJECTIVE To study the spinal cord of healthy controls and patients with MS using magnetic resonance imaging at 7T. METHODS Axial (C2-C5) T1- and T2*-weighted and sagittal T2*-/spin-density-weighted images were acquired at 7T in 13 healthy volunteers (age 22-40 years), and 15 clinically diagnosed MS patients (age 19-53 years, Extended Disability Status Scale, (EDSS) 0-3) in addition to clinical 3T scans. In healthy volunteers, a high-resolution multi-echo gradient echo scan was obtained over the same geometry at 3T. Evaluation included signal and contrast to noise ratios and lesion counts for healthy and patient volunteers, respectively. RESULTS/CONCLUSION High-resolution images at 7T exceeded resolutions reported at lower field strengths. Gray and white matter were sharply demarcated and MS lesions were more readily visualized at 7T compared to clinical acquisitions, with lesions apparent at both fields. Nerve roots were clearly visualized. White matter lesion counts averaged 4.7 vs 3.1 (52% increase) per patient at 7T vs 3T, respectively (p=0.05).
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Affiliation(s)
- Adrienne N Dula
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - Siddharama Pawate
- Department of Neuroscience, Vanderbilt University Medical Center, USA
| | - Richard D Dortch
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - Robert L Barry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | | | - Bailey D Lyttle
- Department of Neuroscience, Vanderbilt University Medical Center, USA
| | - Lindsey M Dethrage
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA
| | - John C Gore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA/Department of Biomedical Engineering, Vanderbilt University Medical Center, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, USA/Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, USA/Department of Biomedical Engineering, Vanderbilt University Medical Center, USA
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20
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Abstract
Optic neuritis, myelitis and brainstem syndrome accompanied by a symptomatic MRI T2 or FLAIR hyperintensity and T1 hypointensity are highly suggestive of multiple sclerosis (MS) in young adults. They are called "clinically isolated syndrome" (CIS) and correspond to the typical first multiple sclerosis (MS) episode, especially when associated with other asymptomatic demyelinating lesions, without clinical, radiological and immunological sign of differential diagnosis. After a CIS, the delay of apparition of a relapse, which corresponds to the conversion to clinically definite MS (CDMS), varies from several months to more than 10 years (10-15% of cases, generally called benign RRMS). This delay is generally associated with the number and location of demyelinating lesions of the brain and spinal cord and the results of CSF analysis. Several studies comparing different MRI criteria for dissemination in space and dissemination in time of demyelinating lesions, two hallmarks of MS, provided enough substantial data to update diagnostic criteria for MS after a CIS. In the last revision of the McDonald's criteria in 2010, diagnostic criteria were simplified and now the diagnosis can be made by a single initial scan that proves the presence of active asymptomatic lesions (with gadolinium enhancement) and of unenhanced lesions. However, time to conversion remains highly unpredictable for a given patient and CIS can remain isolated, especially for idiopathic unilateral optic neuritis or myelitis. Univariate analyses of clinical, radiological, biological or electrophysiological characteristics of CIS patients in small series identified numerous risk factors of rapid conversion to MS. However, large series of CIS patients analyzing several characteristics of CIS patients and the influence of disease modifying therapies brought important information about the risk of CDMS or RRMS over up to 20 years of follow-up. They confirmed the importance of the initial MRI pattern of demyelinating lesions and of CSF oligoclonal bands. Available treatments of MS (immunomodulators or immunosuppressants) have also shown unequivocal efficacy to slow the conversion to RRMS after a CIS, but they could be unnecessary for patients with benign RRMS. Beyond diagnostic criteria, knowledge of established and potential risk factors of conversion to MS and of disability progression is essential for CIS patients' follow-up and initiation of disease modifying therapies.
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Affiliation(s)
- Éric Thouvenot
- Hôpital Carémeau, service de neurologie, 30029 Nîmes cedex 9, France; Université de Montpellier, institut de génomique fonctionnelle, équipe « neuroprotéomique et signalisation des maladies neurologiques et psychiatriques », UMR 5203, 34094 Montpellier cedex, France.
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Caucheteux N, Maarouf A, Genevray M, Leray E, Deschamps R, Chaunu MP, Daelman L, Ferré JC, Gout O, Pelletier J, Pierot L, Edan G, Tourbah A. Criteria improving multiple sclerosis diagnosis at the first MRI. J Neurol 2015; 262:979-87. [DOI: 10.1007/s00415-015-7668-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
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22
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Hua LH, Donlon SL, Sobhanian MJ, Portner SM, Okuda DT. Thoracic spinal cord lesions are influenced by the degree of cervical spine involvement in multiple sclerosis. Spinal Cord 2015; 53:520-5. [PMID: 25582716 DOI: 10.1038/sc.2014.238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/14/2014] [Accepted: 11/27/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional analyses. OBJECTIVE To determine whether cervical spinal cord lesions predict the presence of thoracic cord lesions in multiple sclerosis (MS) patients. SETTING Single MS Clinic, AZ, USA. METHODS All MS patients, with MRI studies of the brain, cervical and thoracic spine obtained during a single scanning session, were acquired during a 1-year period. Clinical, demographic and imaging covariates were used in a multivariate regression model to refine predictors of thoracic cord involvement. RESULTS A total of 687 patients were evaluated, and patients were excluded because of a diagnosis of other neurological disorders, not meeting the 2010 McDonald criteria for MS (n=222) or incomplete neuraxis imaging (n=339). The study cohort comprised 126 patients. There was an increase in the odds ratio (OR) of thoracic spine involvement when any cervical spine lesion was present (OR=6.08, 95% confidence interval (2.21-16.68), P<0.001). The multivariate logistic regression model demonstrated a substantial and significant increase in the odds of thoracic spine involvement when more than two cervical spine lesions were present, two lesions (OR 4.44, (0.91-21.60), P=0.06), three lesions (OR 19.76, (3.51-111.17), P=0.001), four or more lesions (OR 20.49, (1.97-213.23), P=0.012) and diffuse lesions (OR 71.94, (5.28-979.88), P=0.001), when adjusting for significant covariates including clinical symptoms, brain lesions, disease duration and treatment exposure. CONCLUSIONS Thoracic spinal cord lesions appear to be predicated on the degree of cervical spine involvement in patients with MS, a risk that appears to be independent of brain findings or clinical features.
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Affiliation(s)
- L H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
| | - S L Donlon
- Arizona Neurological Institute, Phoenix, AZ, USA
| | - M J Sobhanian
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S M Portner
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - D T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Alroughani RA, Akhtar S, Ahmed SF, Al-Hashel JY. Clinical predictors of disease progression in multiple sclerosis patients with relapsing onset in a nation-wide cohort. Int J Neurosci 2014; 125:831-7. [DOI: 10.3109/00207454.2014.976641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hutchinson M. Spinal cord MRI should always be performed in clinically isolated syndrome patients: Commentary. Mult Scler 2014; 20:1690-1. [PMID: 25326506 DOI: 10.1177/1352458514556141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Hutchinson
- St Vincent's University Hospital and University College Dublin, Dublin, Ireland
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25
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Arrambide G, Sastre-Garriga J. Predictive markers of disease evolution after a CIS in everyday practice. J Neurol Sci 2014; 343:8-14. [DOI: 10.1016/j.jns.2014.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 01/04/2023]
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26
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Cobo-Calvo Á, Alentorn A, Mañé Martínez MA, Bau L, Matas E, Bruna J, Romero-Pinel L, Martínez-Yélamos S. Etiologic spectrum and prognosis of longitudinally extensive transverse myelopathies. Eur Neurol 2014; 72:86-94. [PMID: 24942967 DOI: 10.1159/000358512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with a first episode of longitudinal extensive transverse myelopathy (LETM) were reviewed with two objectives: to evaluate the clinical spectrum of LETM and to analyze the related clinical and laboratory variables that can be used as functional prognostic markers. METHODS A retrospective review was conducted of clinical, radiologic and biochemical data of patients admitted for LETM between 1993 and 2011. RESULTS Our cohort included 72 patients [median age 41 years, interquartile range (IQR) 29-61.5]. Median follow-up was 34 months (IQR 17.2-63). The modified Rankin Scale (mRS) score was ≥2 at the end of follow-up in 72.2%. The final diagnosis was idiopathic LETM in 22 patients, multiple sclerosis in 18, parainfectious disease in 11, systemic disease in 9, spinal cord infarction and neuromyelitis optica spectrum disorders in 3 patients each, and acute demyelinating encephalomyelitis, dural fistula, and tumor-related LETM in 2 patients each. Unfavorable outcome was associated with mRS ≥2 at admission [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.16-1.66] and older age (OR 1.06, 95% CI 1.01-1.11). CONCLUSION Idiopathic LETM was the most frequent diagnosis at the end of follow-up. Older age and clinically severe disease at onset were independent prognostic factors of poorer functional recovery.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
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Lieury A, Chanal M, Androdias G, Reynolds R, Cavagna S, Giraudon P, Confavreux C, Nataf S. Tissue remodeling in periplaque regions of multiple sclerosis spinal cord lesions. Glia 2014; 62:1645-58. [DOI: 10.1002/glia.22705] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/23/2014] [Accepted: 05/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Alice Lieury
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
- University Lyon 1; Lyon France
| | - Marie Chanal
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
- University Lyon 1; Lyon France
| | - Géraldine Androdias
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
- University Lyon 1; Lyon France
- Service de Neurologie A and Eugène Devic Foundation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon (Lyon University Hospital); Bron France
| | - Richard Reynolds
- Wolfson Neuroscience Laboratories, Hammersmith Hospital Campus, Imperial College Faculty of Medicine; London United Kingdom
| | - Sylvie Cavagna
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
| | - Pascale Giraudon
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
| | - Christian Confavreux
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
- University Lyon 1; Lyon France
- Service de Neurologie A and Eugène Devic Foundation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon (Lyon University Hospital); Bron France
| | - Serge Nataf
- INSERM U1028, CNRS UMR 5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team; Lyon France
- University Lyon 1; Lyon France
- Banque de Cellules et de Tissus, Hôpital Edouard Herriot, Hospices Civils de Lyon (Lyon University Hospital); Lyon France
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28
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Hummel HM, Brück W, Dreha-Kulaczewski S, Gärtner J, Wuerfel J. Pediatric onset multiple sclerosis: McDonald criteria 2010 and the contribution of spinal cord MRI. Mult Scler 2013; 19:1330-5. [DOI: 10.1177/1352458513493033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Diagnostic magnetic resonance imaging (MRI) criteria have not been sufficiently validated in pediatric multiple sclerosis (MS) despite differences in epidemiologic data and clinical disease courses between pediatric and adult MS. Objective: The objective of this paper is to evaluate the diagnostic applicability and validity of the revised McDonald diagnostic criteria 2010 in a large cohort of pediatric-onset MS patients (POMS) and compare them to previously recommended MRI-based classifications. Furthermore, we aimed to investigate the contribution of spinal cord lesions to the revised McDonald criteria 2010. Methods: A cohort of 85 patients with definite MS, age at onset 2.8–18 years, was analyzed in a retrospective multicenter study. Number and regional distribution of T2w and contrast-enhancing T1w lesions at initial and follow-up MRIs were main outcome measures. Results: In 62% of POMS the initial MRI within four weeks after symptom onset was sufficient to diagnose MS according to the revised McDonald criteria 2010. In a subcohort of patients with spinal MRI at first presentation, 10% reached the dissemination in space (DIS) and dissemination in time (DIT) criteria only by the inclusion of contrast-enhancing spinal lesions. Conclusions: The revised McDonald criteria 2010 facilitate the diagnosis of POMS already at first presentation. The addition of a spinal cord MRI was helpful only in selected cases.
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Affiliation(s)
- Hannah-Maria Hummel
- Department of Pediatrics and Pediatric Neurology, University Medicine Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, University Medicine Göttingen, Germany
| | | | - Jutta Gärtner
- Department of Pediatrics and Pediatric Neurology, University Medicine Göttingen, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Germany
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Hsueh CJ, Kao HW, Chen SY, Lo CP, Hsu CC, Liu DW, Hsu WL. Comparison of the 2010 and 2005 versions of the McDonald MRI criteria for dissemination-in-time in Taiwanese patients with classic multiple sclerosis. J Neurol Sci 2013; 329:51-4. [DOI: 10.1016/j.jns.2013.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/10/2013] [Accepted: 03/25/2013] [Indexed: 11/16/2022]
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30
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Yamout B, Alroughani R, Al-Jumah M, Khoury S, Abouzeid N, Dahdaleh M, Alsharoqi I, Inshasi J, Hashem S, Zakaria M, ElKallab K, Alsaadi T, Tawfeek T, Bohlega S. Consensus guidelines for the diagnosis and treatment of multiple sclerosis. Curr Med Res Opin 2013; 29:611-21. [PMID: 23514115 DOI: 10.1185/03007995.2013.787979] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The diagnosis of multiple sclerosis (MS) is dependent on the presence of clinical and paraclinical evidence demonstrating dissemination of central nervous system lesions in both space and time, as well as the exclusion of other disorders. Diagnostic criteria were originally promulgated in 1965 by the Schumacher committee and modified subsequently by the Poser committee to include paraclinical evidence. The most recent criteria are the 2010 modifications of the 2001 McDonald criteria, which are focused on making an earlier diagnosis of MS. This article provides guidelines, derived from clinical experience as well as evidence-based medicine, for the diagnosis and management of MS with special emphasis on practices in the Middle East.
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Affiliation(s)
- B Yamout
- American University of Beirut Medical Center, Beirut, Lebanon.
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Expansion of CD27high plasmablasts in transverse myelitis patients that utilize VH4 and JH6 genes and undergo extensive somatic hypermutation. Genes Immun 2013; 14:291-301. [PMID: 23594958 DOI: 10.1038/gene.2013.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 12/18/2022]
Abstract
Patients with the autoimmune disease multiple sclerosis (MS) typically present with the clinically isolated syndromes (CIS) transverse myelitis (TM) or optic neuritis (ON). B-cell disturbances have been well documented in patients with MS and CIS patients with ON, but not in CIS patients with TM, despite the fact that these patients have the worst clinical outcome of all CIS types. The goal of this study was to characterize the B-cell populations and immunoglobulin genetics in TM patients. We found a unique expansion of CD27(high) plasmablasts in both the cerebrospinal fluid and periphery of TM patients that is not present in ON patients. Additionally, plasmablasts from TM patients show evidence for positive selection with increased somatic hypermutation accumulation in VH4(+) B cells and receptor editing that is not observed in ON patients. These characteristics unique to TM patients may impact disease severity and progression.
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32
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Rocca MA, Messina R, Filippi M. Multiple sclerosis imaging: recent advances. J Neurol 2012; 260:929-35. [DOI: 10.1007/s00415-012-6788-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 01/28/2023]
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