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Martí-Juan G, Sastre-Garriga J, Vidal-Jordana A, Llufriu S, Martinez-Heras E, Groppa S, González-Escamilla G, Rocca MA, Filippi M, Høgestøl EA, Harbo HF, Foster MA, Collorone S, Toosy AT, Schoonheim MM, Strijbis E, Pontillo G, Petracca M, Deco G, Rovira À, Pareto D. Conservation of structural brain connectivity in people with multiple sclerosis. Netw Neurosci 2024; 8:1545-1562. [PMID: 39735510 PMCID: PMC11674932 DOI: 10.1162/netn_a_00404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/26/2024] [Indexed: 12/31/2024] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system. Structures affected in MS include the corpus callosum, connecting the hemispheres. Studies have shown that in mammalian brains, structural connectivity is organized according to a conservation principle, an inverse relationship between intra- and interhemispheric connectivity. The aim of this study was to replicate this conservation principle in subjects with MS and to explore how the disease interacts with it. A multicentric dataset has been analyzed including 513 people with MS and 208 healthy controls from seven different centers. Structural connectivity was quantified through various connectivity measures, and graph analysis was used to study the behavior of intra- and interhemispheric connectivity. The association between the intra- and the interhemispheric connectivity showed a similar strength for healthy controls (r = 0.38, p < 0.001) and people with MS (r = 0.35, p < 0.001). Intrahemispheric connectivity was associated with white matter fraction (r = 0.48, p < 0.0001), lesion volume (r = -0.44, p < 0.0001), and the Symbol Digit Modalities Test (r = 0.25, p < 0.0001). Results show that this conservation principle seems to hold for people with MS. These findings support the hypothesis that interhemispheric connectivity decreases at higher cognitive decline and disability levels, while intrahemispheric connectivity increases to maintain the balance.
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Affiliation(s)
- Gerard Martí-Juan
- Neuroradiology Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS and Universitat de Barcelona, Barcelona, Spain
| | - Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS and Universitat de Barcelona, Barcelona, Spain
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Centre of the Johannes Gutenberg University Mainz, Rhine Main Neuroscience Network (rmn2), Mainz, Germany
| | - Gabriel González-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), University Medical Centre of the Johannes Gutenberg University Mainz, Rhine Main Neuroscience Network (rmn2), Mainz, Germany
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute, San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute, San Raffaele University, Milan, Italy
| | - Einar A. Høgestøl
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Hanne F. Harbo
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael A. Foster
- Queen Square MS Centre, Department of Neuroinflammation, Queen Square UCL Institute of Neurology, University College London, London, United Kingdom
| | - Sara Collorone
- Queen Square MS Centre, Department of Neuroinflammation, Queen Square UCL Institute of Neurology, University College London, London, United Kingdom
| | - Ahmed T. Toosy
- Queen Square MS Centre, Department of Neuroinflammation, Queen Square UCL Institute of Neurology, University College London, London, United Kingdom
| | - Menno M. Schoonheim
- Anatomy and Neurosciences, MS Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Eva Strijbis
- Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Giuseppe Pontillo
- Queen Square MS Centre, Department of Neuroinflammation, Queen Square UCL Institute of Neurology, University College London, London, United Kingdom
- Departments of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples “Federico II”, Naples, Italy
| | - Maria Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Naples, Italy
| | - Gustavo Deco
- Centre for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats, Universitat Pompeu Fabra, Barcelona, Spain
| | - Àlex Rovira
- Neuroradiology Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Neuroradiology Section, Radiology Department (IDI), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Deborah Pareto
- Neuroradiology Group, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
- Neuroradiology Section, Radiology Department (IDI), Vall d’Hebron University Hospital, Barcelona, Spain
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Lomer NB, Asalemi KA, Saberi A, Sarlak K. Predictors of multiple sclerosis progression: A systematic review of conventional magnetic resonance imaging studies. PLoS One 2024; 19:e0300415. [PMID: 38626023 PMCID: PMC11020451 DOI: 10.1371/journal.pone.0300415] [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: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic neurodegenerative disorder that affects the central nervous system (CNS) and results in progressive clinical disability and cognitive decline. Currently, there are no specific imaging parameters available for the prediction of longitudinal disability in MS patients. Magnetic resonance imaging (MRI) has linked imaging anomalies to clinical and cognitive deficits in MS. In this study, we aimed to evaluate the effectiveness of MRI in predicting disability, clinical progression, and cognitive decline in MS. METHODS In this study, according to PRISMA guidelines, we comprehensively searched the Web of Science, PubMed, and Embase databases to identify pertinent articles that employed conventional MRI in the context of Relapsing-Remitting and progressive forms of MS. Following a rigorous screening process, studies that met the predefined inclusion criteria were selected for data extraction and evaluated for potential sources of bias. RESULTS A total of 3028 records were retrieved from database searching. After a rigorous screening, 53 records met the criteria and were included in this study. Lesions and alterations in CNS structures like white matter, gray matter, corpus callosum, thalamus, and spinal cord, may be used to anticipate disability progression. Several prognostic factors associated with the progression of MS, including presence of cortical lesions, changes in gray matter volume, whole brain atrophy, the corpus callosum index, alterations in thalamic volume, and lesions or alterations in cross-sectional area of the spinal cord. For cognitive impairment in MS patients, reliable predictors include cortical gray matter volume, brain atrophy, lesion characteristics (T2-lesion load, temporal, frontal, and cerebellar lesions), white matter lesion volume, thalamic volume, and corpus callosum density. CONCLUSION This study indicates that MRI can be used to predict the cognitive decline, disability progression, and disease progression in MS patients over time.
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Affiliation(s)
| | | | - Alia Saberi
- Department of Neurology, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kasra Sarlak
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Degraeve B, Sequeira H, Mecheri H, Lenne B. Corpus callosum damage to account for cognitive, affective, and social-cognitive dysfunctions in multiple sclerosis: A model of callosal disconnection syndrome? Mult Scler 2023; 29:160-168. [PMID: 35475386 DOI: 10.1177/13524585221091067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The corpus callosum (CC) is the major commissure interconnecting the two hemispheres and is particularly affected in multiple sclerosis (MS). In the present review, we aimed to investigate the role played by callosal damages in the pathogenesis of MS-related dysfunctions and examine whether a model of callosal disconnection syndrome is a valid model for MS. For this purpose, we will first review structural and functional evidence of callosal pathology in MS. Second, we will account for the potential role of CC abnormalities in MS-related dysfunctions. Finally, we will report data concurring with a "multiple disconnection hypothesis" that has been proposed to explain those dysfunctions, and we will examine evidence pointing toward MS as a "callosal disconnection syndrome." We will end by discussing the contribution of this interpretation to the understanding of MS and MS-related deficits.
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Affiliation(s)
| | - Henrique Sequeira
- UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, CNRS, University of Lille, Lille, France
| | - Halima Mecheri
- ETHICS (EA7446), Lille Catholic University, FLSH, Lille, France
| | - Bruno Lenne
- ETHICS (EA7446), Lille Catholic University, FLSH, Lille, France; Neurology Department, Groupement des hôpitaux de l'institut catholique de Lille (GHICL), Lille, France
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Schiavi S, Azzari A, Mensi A, Graziano N, Daducci A, Bicego M, Inglese M, Petracca M. Classification of multiple sclerosis patients based on structural disconnection: A robust feature selection approach. J Neuroimaging 2022; 32:647-655. [PMID: 35297554 PMCID: PMC9546205 DOI: 10.1111/jon.12991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Although structural disconnection represents the hallmark of multiple sclerosis (MS) pathophysiology, classification attempts based on structural connectivity have achieved low accuracy levels. Here, we set out to fill this gap, exploring the performance of supervised classifiers on features derived from microstructure informed tractography and selected applying a novel robust approach. Methods Using microstructure informed tractography with diffusion MRI data, we created quantitative connectomes of 55 MS patients and 24 healthy controls. We then used a robust approach—based on two classical methods of feature selection— to select relevant features from three network representations (whole connectivity matrices, node strength, and local efficiency). Classification accuracy of the selected features was tested with five different classifiers, while their meaningfulness was tested via correlation with clinical scales. As a comparison, the same classifiers were run on features selected with the standard procedure in network analysis (thresholding). Results Our procedure identified 11 features for the whole net, five for local efficiency, and seven for node strength. For all classifiers, the accuracy was in the range 64.5%‐91.1%, with features extracted from the whole net reaching the maximum, and overcoming results obtained with the standard procedure in all cases. Correlations with clinical scales were identified across functional domains, from motor and cognitive abilities to fatigue and depression. Conclusion Applying a robust feature selection procedure to quantitative structural connectomes, we were able to classify MS patients with excellent accuracy, while providing information on the white matter connections and gray matter regions more affected by MS pathology.
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Affiliation(s)
- Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Computer Science, University of Verona, Verona, Italy
| | - Alberto Azzari
- Department of Computer Science, University of Verona, Verona, Italy
| | - Antonella Mensi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Nicole Graziano
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Manuele Bicego
- Department of Computer Science, University of Verona, Verona, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Petracca M, Cutter G, Cocozza S, Freeman L, Kangarlu J, Margoni M, Moro M, Krieger S, El Mendili MM, Droby A, Wolinsky JS, Lublin F, Inglese M. Cerebellar pathology and disability worsening in relapsing-remitting multiple sclerosis: A retrospective analysis from the CombiRx trial. Eur J Neurol 2022; 29:515-521. [PMID: 34695274 DOI: 10.1111/ene.15157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cerebellar damage is a valuable predictor of disability, particularly in progressive multiple sclerosis. It is not clear if it could be an equally useful predictor of motor disability worsening in the relapsing-remitting phenotype. AIM We aimed to determine whether cerebellar damage is an equally useful predictor of motor disability worsening in the relapsing-remitting phenotype. METHODS Cerebellar lesion loads and volumes were estimated using baseline magnetic resonance imaging from the CombiRx trial (n = 838). The relationship between cerebellar damage and time to disability worsening (confirmed disability progression [CDP], timed 25-foot walk test [T25FWT] score worsening, nine-hole peg test [9HPT] score worsening) was tested in stagewise and stepwise Cox proportional hazards models, accounting for demographics and supratentorial damage. RESULTS Shorter time to 9HPT score worsening was associated with higher baseline Expanded Disability Status Scale (EDSS) score (hazard ratio [HR] 1.408, p = 0.0042) and higher volume of supratentorial and cerebellar T2 lesions (HR 1.005 p = 0.0196 and HR 2.211, p = 0.0002, respectively). Shorter time to T25FWT score worsening was associated with higher baseline EDSS (HR 1.232, p = 0.0006). Shorter time to CDP was associated with older age (HR 1.026, p = 0.0010), lower baseline EDSS score (HR 0.428, p < 0.0001) and higher volume of supratentorial T2 lesions (HR 1.024, p < 0.0001). CONCLUSION Among the explored outcomes, single time-point evaluation of cerebellar damage only allows the prediction of manual dexterity worsening. In clinical studies the selection of imaging biomarkers should be informed by the outcome of interest.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sirio Cocozza
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Houston, Texas, USA
| | - John Kangarlu
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Monica Margoni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Padova Neuroscience Centre, University of Padua, Padua, Italy
| | - Matteo Moro
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, Genova, Italy
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohamed Mounir El Mendili
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jerry S Wolinsky
- University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
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The central vein sign helps in differentiating multiple sclerosis from its mimickers: lessons from Fabry disease. Eur Radiol 2022; 32:3846-3854. [PMID: 35029733 DOI: 10.1007/s00330-021-08487-4] [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: 08/09/2021] [Revised: 10/26/2021] [Accepted: 11/28/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Although the use of specific MRI criteria has significantly increased the diagnostic accuracy of multiple sclerosis (MS), reaching a correct neuroradiological diagnosis remains a challenging task, and therefore the search for new imaging biomarkers is crucial. This study aims to evaluate the incidence of one of the emerging neuroradiological signs highly suggestive of MS, the central vein sign (CVS), using data from Fabry disease (FD) patients as an index of microvascular disorder that could mimic MS. METHODS In this retrospective study, after the application of inclusion and exclusion criteria, MRI scans of 36 FD patients and 73 relapsing-remitting (RR) MS patients were evaluated. Among the RRMS participants, 32 subjects with a disease duration inferior to 5 years (early MS) were also analyzed. For all subjects, a Fazekas score (FS) was recorded, excluding patients with FS = 0. Different neuroradiological signs, including CVS, were evaluated on FLAIR T2-weighted and spoiled gradient recalled echo sequences. RESULTS Among all the recorded neuroradiological signs, the most striking difference was found for the CVS, with a detectable prevalence of 78.1% (57/73) in RRMS and of 71.4% (25/32) in early MS patients, while this sign was absent in FD (0/36). CONCLUSIONS Our results confirm the high incidence of CVS in MS, also in the early phases of the disease, while it seems to be absent in conditions with a different etiology. These results corroborate the possible role of CVS as a useful neuroradiological sign highly suggestive of MS. KEY POINTS • The search for new imaging biomarkers is crucial to achieve a correct neuroradiological diagnosis of MS. • The CVS shows an incidence superior to 70% in MS patients, even in the early phases of the disease, while it appears to be absent in FD. • These findings further corroborate the possible future central role of CVS in distinguishing between MS and its mimickers.
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Di Giovanni R, Solaro C, Grange E, Masuccio FG, Brichetto G, Mueller M, Tacchino A. A comparison of upper limb function in subjects with multiple sclerosis and healthy controls using an inertial measurement unit. Mult Scler Relat Disord 2021; 53:103036. [PMID: 34051695 DOI: 10.1016/j.msard.2021.103036] [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: 03/09/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Upper limbs (UL) dysfunction is frequent in people with Multiple Sclerosis (PwMS). Several objective measures of UL function are proposed; however, their use is mostly confined to assess subjects with mild-to-moderate disability and requires fine motor skills, often impaired in high disability level subjects. Thus, a tool to score UL function in the advanced disease stage is lacking. The aim of the study is to analyse and compare UL unilateral and bilateral movements of healthy control (HC) and PwMS, at different disability levels, using an instrumented version (Inertial Measurement Unit, IMU) of the 15-seconds finger-to-nose test (FNT). Each movement cycle was segmented in going/adjusting/returning phases. The inter-hand interval (IHI) allowed assessing bilateral coordination (i.e. synchrony) in each phase. The larger IHI, the more severe the bilateral coordination impairment is. After stratifying PwMS for disability level (PwMSLOW, Expanded Disability Status Scale, EDSS≤5.5 and PwMSHIGH, EDSS≥6), the ANOVA on IHI showed significant differences between PwMS and HC (p<0.001) in all phases. However, only the going phase IHI showed significantly higher asynchrony in PwMSHIGH than PwMSLOW and HC (p<0.001) and no differences between PwMSLOW and HC. The going phase IHI seems to be a clinical marker specific for high disability level PwMS. These findings suggest inertial sensors during FNT could be an easy-to-use method for a more detailed quantitative characterization of UL function in PwMS also in subjects with EDSS greater than 6.
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Affiliation(s)
| | - C Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy.
| | - E Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - F G Masuccio
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - G Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - M Mueller
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - A Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
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A matter of atrophy: differential impact of brain and spine damage on disability worsening in multiple sclerosis. J Neurol 2021; 268:4698-4706. [PMID: 33942160 PMCID: PMC8563557 DOI: 10.1007/s00415-021-10576-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
As atrophy represents the most relevant driver of progression in multiple sclerosis (MS), we investigated the impact of different patterns of brain and spinal cord atrophy on disability worsening in MS. We acquired clinical and MRI data from 90 patients with relapsing–remitting MS and 24 healthy controls (HC). Clinical progression at follow-up (mean 3.7 years) was defined according to the Expanded Disability Status Scale-Plus. Brain and spinal cord volumes were computed on MRI brain scans. After normalizing each participants’ brain and spine volume to the mean of the HC, z-score cut-offs were applied to separate pathologically atrophic from normal brain and spine volumes (accepting a 2.5% error probability). Accordingly, MS patients were classified into four groups (Group I: no brain or spinal cord atrophy N = 40, Group II: brain atrophy/no spinal cord atrophy N = 11, Group III: no brain atrophy/ spinal cord atrophy N = 32, Group IV: both brain and spinal cord atrophy N = 7). All patients’ groups showed significantly lower brain volume than HC (p < 0.0001). Group III and IV showed lower spine volume than HC (p < 0.0001 for both). Higher brain lesion load was identified in Group II (p = 0.049) and Group IV (p = 0.023) vs Group I, and in Group IV (p = 0.048) vs Group III. Spinal cord atrophy (OR = 3.75, p = 0.018) and brain + spinal cord atrophy (OR = 5.71, p = 0.046) were significant predictors of disability progression. The presence of concomitant brain and spinal cord atrophy is the strongest correlate of progression over time. Isolated spinal cord atrophy exerts a similar effect, confirming the leading role of spinal cord atrophy in the determination of motor disability.
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Petracca M, Pontillo G, Moccia M, Carotenuto A, Cocozza S, Lanzillo R, Brunetti A, Brescia Morra V. Neuroimaging Correlates of Cognitive Dysfunction in Adults with Multiple Sclerosis. Brain Sci 2021; 11:346. [PMID: 33803287 PMCID: PMC8000635 DOI: 10.3390/brainsci11030346] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a frequent and meaningful symptom in multiple sclerosis (MS), caused by the accrual of brain structural damage only partially counteracted by effective functional reorganization. As both these aspects can be successfully investigated through the application of advanced neuroimaging, here, we offer an up-to-date overview of the latest findings on structural, functional and metabolic correlates of cognitive impairment in adults with MS, focusing on the mechanisms sustaining damage accrual and on the identification of useful imaging markers of cognitive decline.
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Affiliation(s)
- Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
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