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Okuda DT, Moog TM, McCreary M, Shan K, Zubkow K, Newton BD, Smith AD, Patel MA, Burgess KW, Lebrun-Frénay C. Dynamic Expansion and Contraction of Multiple Sclerosis T2-Weighted Hyperintense Lesions Are Present below the Threshold of Visual Perception. AJNR Am J Neuroradiol 2025; 46:443-450. [PMID: 39151959 PMCID: PMC11878956 DOI: 10.3174/ajnr.a8453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND AND PURPOSE The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of MS. We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data. MATERIALS AND METHODS A retrospective study was performed of people with MS, incorporating data from 3 consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well-defined, noncoalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3D lesion volumes were followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied. RESULTS The study cohort comprised 115 people (81 (70.4%) women; mean disease duration of 9.36 years [standard deviation: 7.72 years]) who were primarily White (79.1%). A total of 1426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, most lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI = [-83.89% to -33.01%], P = .0008) and 74.02% reduction relative to high-efficacy treatment individuals (95% CI = [-87.37% to -46.56%], P < .0001). CONCLUSIONS Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.
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Affiliation(s)
- Darin T Okuda
- From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. Brain Institute (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tatum M Moog
- From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. Brain Institute (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Morgan McCreary
- From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. Brain Institute (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Shan
- School of Medicine (K.S.), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kasia Zubkow
- Division of Neurology (K.Z.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Braeden D Newton
- Division of Neurosurgery (B.D.N.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander D Smith
- School of Medicine (A.D.S), Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mahi A Patel
- From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. Brain Institute (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katy W Burgess
- From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. Brain Institute (D.T.O., T.M.M., M.M., M.A.P., K.W.B.), The University of Texas Southwestern Medical Center, Dallas, Texas
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Sparaco M, Bonavita S. Clinical Insights and Radiological Features on Multiple Sclerosis Comorbid with Migraine. J Clin Med 2025; 14:561. [PMID: 39860566 PMCID: PMC11765521 DOI: 10.3390/jcm14020561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/15/2024] [Accepted: 12/23/2024] [Indexed: 01/27/2025] Open
Abstract
Background: Multiple sclerosis (MS) and migraine are neurological diseases, affecting young women. Migraine is the most prevalent type of headache in people with MS (pwMS). Objectives: The aim of this review is to describe the clinical, radiological, and therapeutic features of MS and migraine comorbidity. The clinical section focuses on the characteristics of migraine in pwMS and of MS in co-occurrence with migraine, and on the presence of other possible comorbidities. The radiological section deals with the differential diagnosis of white matter lesions and changes in connectivity patterns on brain magnetic resonanceto investigate a possible link between MS and migraine. The therapeutic section evaluates the effects of MS-disease-modifying therapies on migraine and of prophylactic migraine treatments on MS. Methods: The literature search was conducted using PubMed as an electronic database. The papers that reported relevant clinical, radiological and therapeutic findings were selected. Results: Among 1351 results retrieved, at the end of screening procedures, 34 studies were selected. Migraine can impact the perception of some symptoms and the presence of some comorbidities, particularly relevant in MS. Furthermore, migraine and MS share some radiological features, leading to diagnostic challenges, however identifying some lesion characteristics and changes in the connectivity pathway may be supportive. Medications for migraine and MS should be administered considering both the adverse events and multiple drug interactions. Conclusions: The data emerging from this review illustrate the research efforts aimed at providing valuable insights into accurate diagnosis, effective clinical management, and the definition of targeted treatment schedules that could improve the quality of life for pwMS with migraine.
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Affiliation(s)
- Maddalena Sparaco
- 2nd Division of Neurology, University Hospital of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy;
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Okuda DT, Azevedo CJ, Pelletier D, Moog TM, Moazami S, Rezvani S, Bovis F, Sormani MP, Siva A, Kantarci O, Lebrun-Frénay C. Dimethyl fumarate preserves brainstem and cervical spinal cord integrity in radiologically isolated syndrome. J Neurol 2024; 271:5899-5910. [PMID: 38980342 DOI: 10.1007/s00415-024-12514-x] [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: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND PURPOSE The first randomized placebo-controlled therapeutic trial in radiologically isolated syndrome (RIS), ARISE, demonstrated that treatment with dimethyl fumarate (DMF) delayed the onset of a first clinical event related to CNS demyelination and was associated with a significant reduction in new and/or newly enlarging T2-weighted hyperintense lesions. The purpose of this study was to explore the effect of DMF on volumetric measures, including whole brain, thalamic, and subcortical gray matter volumes, brainstem and upper cervical spine three-dimensional (3D) volumes, and brainstem and upper cervical spine surface characteristics. METHODS Standardized 3T MRIs including 3D isotropic T1-weighted gradient echo images were acquired at baseline and end-of-study according to the ARISE study protocol. The acquired data were analyzed using Structural Image Evaluation Using Normalization of Atrophy (SIENA), FreeSurfer v7.3, and an in-house pipeline for 3D conformational metrics. Multivariate mixed models for repeated measures were used to analyze rates of change in whole brain, thalamic, subcortical gray matter, as well as change in the 3D surface curvature of the dorsal pons and dorsal medulla and 3D volume change at the medulla-upper cervical spinal cord. RESULTS The study population consisted of 64 RIS subjects (DMF:30, placebo:34). No significant difference was seen in whole brain, thalamic, or subcortical gray matter volumes in treated vs. untreated RIS patients. A significant difference was observed in dorsal pons curvature with the DMF group having a lower least squares mean change of - 4.46 (standard estimate (SE): 3.77) when compared to placebo [6.94 (3.71)] (p = 0.036). In individuals that experienced a first clinical event, a greater reduction in medulla-upper cervical spinal cord volume (p = 0.044) and a decrease in surface curvature was observed at the dorsal medulla (p = 0.009) but not at the dorsal pons (p = 0.443). CONCLUSIONS The benefit of disease-modifying therapy in RIS may extend to CNS structures impacted by neurodegeneration that is below the resolution of conventional volumetric measures.
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Affiliation(s)
- Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA.
- Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | | | - Tatum M Moog
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA
- Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Saeed Moazami
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Aksel Siva
- University of Cerrahpasa School of Medicine, Istanbul, Turkey
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Okuda DT, Lebrun-Frénay C. Radiologically isolated syndrome in the spectrum of multiple sclerosis. Mult Scler 2024; 30:630-636. [PMID: 38619142 PMCID: PMC11071642 DOI: 10.1177/13524585241245306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
The radiologically isolated syndrome (RIS) currently represents the earliest detectable preclinical phase of multiple sclerosis (MS). Remarkable advancements have been recently made, including the identification of risk factors for disease evolution, revisions to the existing 2009 RIS criteria, and our understanding of the impact of early disease-modifying therapy use in the prevention/delay of symptomatic MS from two randomized clinical trials. Here, we discuss RIS in the context of the spectrum of MS, implications in the clinical management of individuals, and provide insights into future opportunities and challenges given the anticipated inclusion of asymptomatic MS in the formal definition of MS.
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Affiliation(s)
- Darin T Okuda
- Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute, Dallas, TX, USA
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Amin M, Nakamura K, Ontaneda D. Differentiating multiple sclerosis from non-specific white matter changes using a convolutional neural network image classification model. Mult Scler Relat Disord 2024; 82:105420. [PMID: 38183693 DOI: 10.1016/j.msard.2023.105420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/07/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The diagnosis of multiple sclerosis (MS) relies heavily on neuroimaging with magnetic resonance imaging (MRI) and exclusion of mimics. This can be a challenging task due to radiological overlap in several disorders and may require ancillary testing or longitudinal follow up. One of the most common radiological MS mimickers is non-specific white matter disease (NSWMD). We aimed to develop and evaluate models leveraging machine learning algorithms to help distinguish MS and NSWMD. METHODS All adult patients who underwent MRI brain using a demyelinating protocol with available electronic medical records between 2015 and 2019 at Cleveland Clinic affiliated facilities were included. Diagnosis of MS and NSWMD were assessed from clinical documentation. Those with a diagnosis of MS and NSWMD were matched using total T2 lesion volume (T2LV) and used to train models with logistic regression and convolutional neural networks (CNN). Performance metrices were reported for each model. RESULTS A total of 250 NSWMD MRI scans were identified, and 250 unique MS MRI scans were matched on T2LV. Cross validated logistic regression model was able to use 20 variables (including spinal cord area, regional volumes, and fractions) to predict MS compared to NSWMD with 68.0% accuracy while the CNN model was able to classify MS compared to NSWMD in two independent validation and testing cohorts with 77% and 78% accuracy on average. CONCLUSION Automated methods can be used to differentiate MS compared to NSWMD. These methods can be used to supplement currently available diagnostic tools for patients being evaluated for MS.
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Affiliation(s)
- Moein Amin
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kunio Nakamura
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Zuppichini MD, Sivakolundu DK, West KL, Okuda DT, Rypma B. Investigating the link between regional oxygen metabolism and cognitive speed in multiple sclerosis: Implications for fatigue. Mult Scler Relat Disord 2023; 80:105074. [PMID: 37866021 DOI: 10.1016/j.msard.2023.105074] [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: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Most multiple sclerosis (MS) patients experience fatigue and cognitive decline but the underlying mechanisms remain unknown. Previous work has shown whole brain resting cerebral metabolic rate of oxygen (CMRO2) is associated with the extent of these symptoms. However, it is not known if the association between global CMRO2 and MS-related cognitive speed and fatigue can be localized to specific brain regions. Based upon previous research suggesting prefrontal involvement in MS-related changes in cognitive speed and fatigue, we hypothesized that oxygen metabolic changes within prefrontal cortex (PFC) might form the pathophysiologic basis of cognitive performance and fatigue in MS patients. OBJECTIVE Investigate whether PFC ΔCMRO2 is associated with cognitive speed and fatigue in MS. METHODS MS and healthy control (HC) participants were scanned using a dual--echo fMRI sequence and underwent a hypercapnia calibration experiment that permitted estimation of ΔCMRO2 while performing a scanner version of symbol-digit modalities task, a measure of information processing speed and utilized in the clinic as a reliable sentinel biomarker for global cognitive impairment in MS. Participants then completed the Modified Fatigue Impact Scale (MFIS) to measure fatigue. RESULTS MS patients exhibited significant reductions in cognitive performance relative to HCs (p < 0.04). Prefrontal ΔCMRO2 explained significant variability (ΔR2 = 0.11) in cognitive speed, over and above disease and demographic variables, for the MS group only. Prefrontal ΔCMRO2 was not associated with fatigue across groups. ΔCMRO2 in visual and motor areas were not associated with cognitive performance or fatigue for either group. CONCLUSION Prefrontal oxygen metabolism may be a sensitive measure of MS-related cognitive decline.
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Affiliation(s)
- Mark D Zuppichini
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Dinesh K Sivakolundu
- Department of Neurology, Yale School of Medicine and Yale New-Haven Hospital, New Haven, CT, USA
| | - Kathryn L West
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA
| | - Darin T Okuda
- Clinical Center for Multiple Sclerosis, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bart Rypma
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, USA; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
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Oh J, Airas L, Harrison D, Järvinen E, Livingston T, Lanker S, Malik RA, Okuda DT, Villoslada P, de Vries HE. Neuroimaging to monitor worsening of multiple sclerosis: advances supported by the grant for multiple sclerosis innovation. Front Neurol 2023; 14:1319869. [PMID: 38107636 PMCID: PMC10722910 DOI: 10.3389/fneur.2023.1319869] [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: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Key unmet needs in multiple sclerosis (MS) include detection of early pathology, disability worsening independent of relapses, and accurate monitoring of treatment response. Collaborative approaches to address these unmet needs have been driven in part by industry-academic networks and initiatives such as the Grant for Multiple Sclerosis Innovation (GMSI) and Multiple Sclerosis Leadership and Innovation Network (MS-LINK™) programs. We review the application of recent advances, supported by the GMSI and MS-LINK™ programs, in neuroimaging technology to quantify pathology related to central pathology and disease worsening, and potential for their translation into clinical practice/trials. GMSI-supported advances in neuroimaging methods and biomarkers include developments in magnetic resonance imaging, positron emission tomography, ocular imaging, and machine learning. However, longitudinal studies are required to facilitate translation of these measures to the clinic and to justify their inclusion as endpoints in clinical trials of new therapeutics for MS. Novel neuroimaging measures and other biomarkers, combined with artificial intelligence, may enable accurate prediction and monitoring of MS worsening in the clinic, and may also be used as endpoints in clinical trials of new therapies for MS targeting relapse-independent disease pathology.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Laura Airas
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Daniel Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore VA Medical Center, VA Maryland Healthcare System, Baltimore, MD, United States
| | - Elina Järvinen
- Neurology and Immunology, Medical Unit N&I, Merck OY (an affiliate of Merck KGaA), Espoo, Finland
| | - Terrie Livingston
- Patient Solutions and Center of Excellence Strategic Engagement, EMD Serono, Inc., Rockland, MA, United States
| | - Stefan Lanker
- Neurology & Immunology, US Medical Affairs, EMD Serono Research & Development Institute, Inc., (an affiliate of Merck KGaA), Billerica, MA, United States
| | - Rayaz A. Malik
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Darin T. Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, UT Southwestern Medical Center, Dallas, TX, United States
| | - Pablo Villoslada
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Helga E. de Vries
- MS Center Amsterdam, Department of Molecular Cell Biology and Immunology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Centers (Amsterdam UMC), Location VUmc, Amsterdam, Netherlands
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Lebrun-Frenay C, Kantarci O, Siva A, Azevedo CJ, Makhani N, Pelletier D, Okuda DT. Radiologically isolated syndrome. Lancet Neurol 2023; 22:1075-1086. [PMID: 37839432 DOI: 10.1016/s1474-4422(23)00281-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 10/17/2023]
Abstract
Individuals can be deemed to have radiologically isolated syndrome (RIS) if they have incidental demyelinating-appearing lesions in their brain or spinal cord that are highly suggestive of multiple sclerosis but their clinical history does not include symptoms consistent with multiple sclerosis. Data from international longitudinal cohorts indicate that around half of people with RIS will develop relapsing or progressive symptoms of multiple sclerosis within 10 years, suggesting that in some individuals, RIS is a presymptomatic stage of multiple sclerosis. Risk factors for progression from RIS to clinical multiple sclerosis include younger age (ie, <35 years), male sex, CSF-restricted oligoclonal bands, spinal cord or infratentorial lesions, and gadolinium-enhancing lesions. Other imaging, biological, genetic, and digital biomarkers that might be of value in identifying individuals who are at the highest risk of developing multiple sclerosis need further investigation. Two 2-year randomised clinical trials showed the efficacy of approved multiple sclerosis immunomodulatory medications in preventing the clinical conversion to multiple sclerosis in some individuals with RIS. If substantiated in longer-term studies, these data have the potential to transform our approach to care for the people with RIS who are at the greatest risk of diagnosis with multiple sclerosis.
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Affiliation(s)
- Christine Lebrun-Frenay
- CRC-SEP Nice, Neurologie CHU Nice, Hôpital Pasteur 2, UMR2CA-URRIS, Université Côte d'Azur, Nice, France.
| | | | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkiye
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darin T Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Selective vulnerability of brainstem and cervical spinal cord regions in people with non-progressive multiple sclerosis of Black or African American and European ancestry. Mult Scler 2022; 29:691-701. [PMID: 36507671 DOI: 10.1177/13524585221139575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: We evaluated imaging features suggestive of neurodegeneration within the brainstem and upper cervical spinal cord (UCSC) in non-progressive multiple sclerosis (MS). Methods: Standardized 3-Tesla three-dimensional brain magnetic resonance imaging (MRI) studies were prospectively acquired. Rates of change in volume, surface texture, curvature were quantified at the pons and medulla-UCSC. Whole and regional brain volumes and T2-weighted lesion volumes were also quantified. Independent regression models were constructed to evaluate differences between those of Black or African ancestry (B/AA) and European ancestry (EA) with non-progressive MS. Results: 209 people with MS (pwMS) having at least two MRI studies, 29% possessing 3–6 timepoints, resulted in 487 scans for analysis. Median follow-up time between MRI timepoints was 1.33 (25th–75th percentile: 0.51–1.98) years. Of 183 non-progressive pwMS, 88 and 95 self-reported being B/AA and EA, respectively. Non-progressive pwMS demonstrated greater rates of decline in pontine volume ( p < 0.0001) in B/AA and in medulla-UCSC volume ( p < 0.0001) for EA pwMS. Longitudinal surface texture and curvature changes suggesting reduced tissue integrity were observed at the ventral medulla-UCSC ( p < 0.001), dorsal pons ( p < 0.0001) and dorsal medulla ( p < 0.0001) but not the ventral pons ( p = 0.92) between groups. Conclusions: Selectively vulnerable regions within the brainstem-UCSC may allow for more personalized approaches to disease surveillance and management.
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Okuda DT, Stanley T, McCreary M, Smith AD, Burgess KW, Wilson A, Guo X, Moog TM. Dorsal medulla surface texture: Differentiating neuromyelitis optica spectrum disorder from multiple sclerosis. J Neuroimaging 2022; 32:1090-1097. [PMID: 36181675 DOI: 10.1111/jon.13059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE The timely and accurate diagnosis of neuromyelitis optica spectrum disorder (NMOSD) is essential and exposure to multiple sclerosis (MS) disease-modifying therapies may result in permanent neurological disability. METHODS Standardized 3-Tesla 3-dimensional brain MRI studies were retrospectively studied from people with NMOSD, MS, other CNS neurological diseases, and healthy control subjects. Comparisons of surface texture characteristics at the area postrema involving absolute introverted planar triangle counts, representing more complex and concave tissue topography, along with the spatial dissemination pattern of these triangles were performed cross-sectionally and longitudinally. An ideal introverted planar triangle threshold separating groups with NMOSD and MS was accomplished using the highest Youden's J statistic. For the classification of NMOSD, out-of-sample and in-sample measurements of the following were acquired: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The study cohort included 60 people with NMOSD, 100 people with MS, 12 with other neurological diseases, and five healthy controls. Significantly higher cross-sectional median introverted triangle counts were observed when the NMOSD (median [interquartile range]: 100 [23.5]) group was compared to MS (65 [20.25]; p < .0001) and other neurological diseases (66 [13.75]; p < .0001). Distinct spatial dissemination patterns of triangles extending craniocaudally at the region of interest within the dorsal medulla was also seen between groups with NMOSD and MS (p < .0001). For the identification of NMOSD, out-of-sample sensitivity (83%), specificity (100%), PPV (100%), and NPV (60%) were achieved. CONCLUSIONS Cross-sectional and longitudinal dorsal medulla surface texture differences within selective regions of vulnerability differentiate NMOSD from MS.
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Affiliation(s)
- Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Thomas Stanley
- Department of Computer Science, University of Texas at Dallas, Dallas, Texas, USA
| | - Morgan McCreary
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Alexander D Smith
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Katy W Burgess
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Andrew Wilson
- Department of Computer Science, University of Texas at Dallas, Dallas, Texas, USA
| | - Xiaohu Guo
- Department of Computer Science, University of Texas at Dallas, Dallas, Texas, USA
| | - Tatum M Moog
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Moog TM, McCreary M, Wilson A, Stanley T, Yu FF, Pinho M, Guo X, Okuda DT. Direction and magnitude of displacement differ between slowly expanding and non-expanding multiple sclerosis lesions as compared to small vessel disease. J Neurol 2022; 269:4459-4468. [PMID: 35380254 DOI: 10.1007/s00415-022-11089-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating between multiple sclerosis (MS) and small vessel disease (SVD) lesions represents a key challenge in the day-to-day management of patients. We aimed to distinguish between MS and SVD by identifying the dynamics of lesion movement patterns between enlarging and contracting foci from two MRI time points. METHODS Standardized 3-Tesla 3-dimensional brain magnetic resonance imaging (MRI) studies were performed at two time points on enrolled MS and SVD patients. Selected supratentorial lesions were segmented and longitudinal changes in the direction of lesion displacement and magnitude along with the evolution of contracting and expanding T1-weighted and T2-weighted MS lesions were quantified based on lesion centroid positioning. Bayesian linear mixed effects regression models were constructed to evaluate associations between changes in lesion transitions and disease state. RESULTS A total of 420 lesions were analyzed from 35 MS (female (F):22 (62.9%); median age (range):38 years (y) (22-61), median disease duration:7.38y (0.38-20.99)) and 12 SVD patients (F:11 (100%); 54y (40-66)). MS T2-weighted lesions that increased in volume between MRI time points demonstrated movement toward the cortex (p = 0.01), whereas those that decreased in volume moved toward the center (p < 0.0001). Lesion volume changes related to SVD demonstrated no effect on movement direction over time. Both expanding (p = 0.03) and contracting (p = 0.01) MS lesions demonstrated greater distances between centroids when compared to SVD. CONCLUSION Lesion dynamics may reveal distinct characteristics associated with the biology of disease while providing further insights into the behavior of inflammatory CNS disorders.
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Affiliation(s)
- Tatum M Moog
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA
| | - Morgan McCreary
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA
| | - Andrew Wilson
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Thomas Stanley
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Fang F Yu
- UT Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Marco Pinho
- UT Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Xiaohu Guo
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA.
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Zhao Y, Xu J, Feng Z, Wang J. Impact of 25-Hydroxy Vitamin D on White Matter Hyperintensity in Elderly Patients: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:721427. [PMID: 35095709 PMCID: PMC8794798 DOI: 10.3389/fneur.2021.721427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Some studies show that low serum vitamin D levels are associated with white matter hyperintensity (WMH), while other studies report no association. This meta-analysis aimed to investigate the presence of an association between serum 25-hydroxy vitamin D [25(OH)D] levels and WMH. PubMed, Embase, the Cochrane Library, CNKI, WANFANG, and VIP were searched for available papers published up to December 2020. The outcomes were the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between different vitamin D statuses and WMH. All meta-analyses were performed using a random-effects model. Five studies (4393 patients) were included. Compared with sufficient 25(OH)D levels, 25(OH)D deficiency was not associated with WMH (OR = 1.67, 95%CI: 0.92–3.04; I2 = 70.2%, Pheterogeneity = 0.009), nor was 25(OH)D insufficiency (OR = 1.21, 95%CI: 0.89–1.65; I2 = 48.1%, Pheterogeneity = 0.103). A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH (OR = 1.83, 95%CI: 1.34-2.49; I2 = 0%, Pheterogeneity= 0.512). The sensitivity analyses showed that the results were robust. 25(OH)D deficiency and insufficiency are not associated with WMH. A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH, but this result will have to be confirmed. Prospective trials, both cross-sectional and longitudinal, are necessary to examine the association between 25(OH)D levels and WMH.
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