1
|
Andica C, Hagiwara A, Yokoyama K, Kato S, Uchida W, Nishimura Y, Fujita S, Kamagata K, Hori M, Tomizawa Y, Hattori N, Aoki S. Multimodal magnetic resonance imaging quantification of gray matter alterations in relapsing-remitting multiple sclerosis and neuromyelitis optica spectrum disorder. J Neurosci Res 2022; 100:1395-1412. [PMID: 35316545 DOI: 10.1002/jnr.25035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/08/2022]
Abstract
Herein, we combined neurite orientation dispersion and density imaging (NODDI) and synthetic magnetic resonance imaging (SyMRI) to evaluate the spatial distribution and extent of gray matter (GM) microstructural alterations in patients with relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica spectrum disorder (NMOSD). The NODDI (neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISOVF]) and SyMRI (myelin volume fraction [MVF]) measures were compared between age- and sex-matched groups of 30 patients with RRMS (6 males and 24 females; mean age, 51.43 ± 8.02 years), 18 patients with anti-aquaporin-4 antibody-positive NMOSD (2 males and 16 females; mean age, 52.67 ± 16.07 years), and 19 healthy controls (6 males and 13 females; mean age, 51.47 ± 9.25 years) using GM-based spatial statistical analysis. Patients with RRMS showed reduced NDI and MVF and increased ODI and ISOVF, predominantly in the limbic and paralimbic regions, when compared with healthy controls, while only increases in ODI and ISOVF were observed when compared with NMOSD. Compared to NDI and MVF, the changes in ODI and ISOVF were observed more widely, including in the cerebellar cortex. These abnormalities were associated with disease progression and disability. In contrast, patients with NMOSD only showed reduced NDI mainly in the cerebellar, limbic, and paralimbic cortices when compared with healthy controls and patients with RRMS. Taken together, our study supports the notion that GM pathologies in RRMS are distinct from those of NMOSD. However, owing to the limitations of the study, the results should be cautiously interpreted.
Collapse
Affiliation(s)
- Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shimpei Kato
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuma Nishimura
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Molazadeh N, Filippatou AG, Vasileiou ES, Levy M, Sotirchos ES. Evidence for and against subclinical disease activity and progressive disease in MOG antibody disease and neuromyelitis optica spectrum disorder. J Neuroimmunol 2021; 360:577702. [PMID: 34547512 DOI: 10.1016/j.jneuroim.2021.577702] [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: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) are generally considered to be relapsing disorders, without clinical progression or subclinical disease activity outside of clinical relapses, in contrast to multiple sclerosis (MS). With advances in the diagnosis and treatment of these conditions, prolonged periods of remission without relapses can be achieved, and the question of whether progressive disease courses can occur has re-emerged. In this review, we focus on studies exploring evidence for and against relapse-independent clinical progression and/or subclinical disease activity in patients with MOGAD and AQP4-IgG+ NMOSD.
Collapse
Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
3
|
Messina S, Mariano R, Roca-Fernandez A, Cavey A, Jurynczyk M, Leite MI, Calabrese M, Jenkinson M, Palace J. Contrasting the brain imaging features of MOG-antibody disease, with AQP4-antibody NMOSD and multiple sclerosis. Mult Scler 2021; 28:217-227. [PMID: 34048323 PMCID: PMC8795219 DOI: 10.1177/13524585211018987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Identifying magnetic resonance imaging (MRI) markers in myelin-oligodendrocytes-glycoprotein antibody-associated disease (MOGAD), neuromyelitis optica spectrum disorder-aquaporin-4 positive (NMOSD-AQP4) and multiple sclerosis (MS) is essential for establishing objective outcome measures. Objectives: To quantify imaging patterns of central nervous system (CNS) damage in MOGAD during the remission stage, and to compare it with NMOSD-AQP4 and MS. Methods: 20 MOGAD, 19 NMOSD-AQP4, 18 MS in remission with brain or spinal cord involvement and 18 healthy controls (HC) were recruited. Volumetrics, lesions and cortical lesions, diffusion-imaging measures, were analysed. Results: Deep grey matter volumes were lower in MOGAD (p = 0.02) and MS (p = 0.0001), compared to HC and were strongly correlated with current lesion volume (MOGAD R = −0.93, p < 0.001, MS R = −0.65, p = 0.0034). Cortical/juxtacortical lesions were seen in a minority of MOGAD, in a majority of MS and in none of NMOSD-AQP4. Non-lesional tissue fractional anisotropy (FA) was only reduced in MS (p = 0.01), although focal reductions were noted in NMOSD-AQP4, reflecting mainly optic nerve and corticospinal tract pathways. Conclusion: MOGAD patients are left with grey matter damage, and this may be related to persistent white matter lesions. NMOSD-AQP4 patients showed a relative sparing of deep grey matter volumes, but reduced non-lesional tissue FA. Observations from our study can be used to identify new markers of damage for future multicentre studies.
Collapse
Affiliation(s)
- Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adriana Roca-Fernandez
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ana Cavey
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Maciej Jurynczyk
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Massimiliano Calabrese
- Multiple Sclerosis Centre, Neurology Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Mark Jenkinson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/University of Adelaide, Adelaide, SA, Australia
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
| |
Collapse
|
4
|
Solomon JM, Paul F, Chien C, Oh J, Rotstein DL. A window into the future? MRI for evaluation of neuromyelitis optica spectrum disorder throughout the disease course. Ther Adv Neurol Disord 2021; 14:17562864211014389. [PMID: 34035837 PMCID: PMC8111516 DOI: 10.1177/17562864211014389] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, inflammatory disease of the central nervous system marked by relapses often associated with poor recovery and long-term disability. Magnetic resonance imaging (MRI) is recognized as an important tool for timely diagnosis of NMOSD as, in combination with serologic testing, it aids in distinguishing NMOSD from possible mimics. Although the role of MRI for disease monitoring after diagnosis is not as well established, MRI may provide important prognostic information and help differentiate between relapses and pseudorelapses. Increasing evidence of subclinical disease activity and the emergence of newly approved, highly effective immunotherapies for NMOSD adjure us to re-evaluate MRI as a tool to guide optimal treatment selection and escalation throughout the disease course. In this article we review the role of MRI in NMOSD diagnosis, prognostication, disease monitoring, and treatment selection.
Collapse
Affiliation(s)
- Jacqueline M. Solomon
- University of Toronto, Department of Medicine, Toronto, ON, Canada
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jiwon Oh
- University of Toronto, Department of Medicine, Toronto, ON, Canada
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Dalia L. Rotstein
- St. Michael’s Hospital, 30 Bond Street, Shuter 3-018, Toronto, ON, M5B 1W8, Canada
| |
Collapse
|
5
|
Reduced Myelin Signal in Normal-appearing White Matter in Neuromyelitis Optica Measured by 7T Magnetic Resonance Imaging. Sci Rep 2019; 9:14378. [PMID: 31591424 PMCID: PMC6779889 DOI: 10.1038/s41598-019-50928-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/18/2019] [Indexed: 12/22/2022] Open
Abstract
Whether the integrity of normal-appearing white matter (NAWM) is preserved in neuromyelitis optica spectrum disorders (NMOSD) is open to debate. To examine whether the tissue integrity of NAWM in NMOSD is compromised compared to that in healthy controls and patients with multiple sclerosis (MS), we prospectively enrolled 14 patients with NMOSD, 12 patients with MS, and 10 controls for clinical functional assessments and quantitative imaging, including T1 relaxation time (T1) and magnetization transfer ratio (MTR) at 7 Tesla. Cognitive performance on the Paced Auditory Serial Addition Test with a 3-second interstimulus interval (PASAT-3) was significantly lower in the NMOSD compared to the MS group (mean number of correct answers, 34.1 vs. 47.6; p = 0.006), but there were no differences in disease duration or disability. Histograms of T1 and MTR maps of NAWM demonstrated a decreased peak height in patients with NMOSD compared to the healthy controls, but not compared to patients with MS. Using 7T quantitative magnetic resonance imaging (MRI), this study showed that the NAWM in patients with NMOSD is abnormal, with reduced myelin signal; this was not previously observed using MRI at a lower field strength.
Collapse
|
6
|
Papadopoulou A, Oertel FC, Gaetano L, Kuchling J, Zimmermann H, Chien C, Siebert N, Asseyer S, Bellmann-Strobl J, Ruprecht K, Chakravarty MM, Scheel M, Magon S, Wuerfel J, Paul F, Brandt AU. Attack-related damage of thalamic nuclei in neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2019; 90:1156-1164. [PMID: 31127016 DOI: 10.1136/jnnp-2018-320249] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In neuromyelitis optica spectrum disorders (NMOSD) thalamic damage is controversial, but thalamic nuclei were never studied separately. We aimed at assessing volume loss of thalamic nuclei in NMOSD. We hypothesised that only specific nuclei are damaged, by attacks affecting structures from which they receive afferences: the lateral geniculate nucleus (LGN), due to optic neuritis (ON) and the ventral posterior nucleus (VPN), due to myelitis. METHODS Thirty-nine patients with aquaporin 4-IgG seropositive NMOSD (age: 50.1±14.1 years, 36 women, 25 with prior ON, 36 with prior myelitis) and 37 healthy controls (age: 47.8 ± 12.5 years, 32 women) were included in this cross-sectional study. Thalamic nuclei were assessed in magnetic resonance images, using a multi-atlas-based approach of automated segmentation. Retinal optical coherence tomography was also performed. RESULTS Patients with ON showed smaller LGN volumes (181.6±44.2 mm3) compared with controls (198.3±49.4 mm3; B=-16.97, p=0.004) and to patients without ON (206.1±50 mm3 ; B=-23.74, p=0.001). LGN volume was associated with number of ON episodes (Rho=-0.536, p<0.001), peripapillary retinal nerve fibre layer thickness (B=0.70, p<0.001) and visual function (B=-0.01, p=0.002). Although VPN was not smaller in patients with myelitis (674.3±67.5 mm3) than controls (679.7±68.33; B=-7.36, p=0.594), we found reduced volumes in five patients with combined myelitis and brainstem attacks (B=-76.18, p=0.017). Volumes of entire thalamus and other nuclei were not smaller in patients than controls. CONCLUSION These findings suggest attack-related anterograde degeneration rather than diffuse thalamic damage in NMOSD. They also support a potential role of LGN volume as an imaging marker of structural brain damage in these patients.
Collapse
Affiliation(s)
- Athina Papadopoulou
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Frederike Cosima Oertel
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laura Gaetano
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland.,F. Hoffmann-La Roche, Basel, Switzerland
| | - Joseph Kuchling
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hanna Zimmermann
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadja Siebert
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanna Asseyer
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klemens Ruprecht
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Québec, Canada.,Department of Psychiatry and Biomedical engineering, McGill University, Montreal, Québec, Canada
| | - Michael Scheel
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefano Magon
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Ulrich Brandt
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany .,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California Irvine, Irvine, California, USA
| |
Collapse
|
7
|
Cho EB, Han CE, Seo SW, Chin J, Shin JH, Cho HJ, Seok JM, Kim ST, Kim BJ, Na DL, Lee KH, Seong JK, Min JH. White Matter Network Disruption and Cognitive Dysfunction in Neuromyelitis Optica Spectrum Disorder. Front Neurol 2018; 9:1104. [PMID: 30619061 PMCID: PMC6304415 DOI: 10.3389/fneur.2018.01104] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background: In neuromyelitis optica spectrum disorder (NMOSD), brain involvement is common and cognitive dysfunction is frequently found. The study investigated alterations of white matter (WM) connectivity using graph theory and correlations with cognitive dysfunction in patients with NMOSD. Methods: We prospectively enrolled patients with NMOSD (N = 14) and age- and sex-matched healthy controls (N = 21). Structural connections between any pair of the 90 cortical and subcortical regions were established using diffusion tensor imaging and graph theory. Network-based statistics was employed to assess differences in WM connectivity between the NMOSD and healthy control groups. We further investigated the relationship between the topological network characteristics and cognitive test performances. Results: WM network analysis showed decreased total strength of brain networks and two disrupted sub-networks in patients with NMOSD. The first featured six hub nodes in the rectus, hippocampus, calcarine, cuneus, and precuneus with the left-sided predominance. The second had six hub nodes in the orbitomiddle frontal, post-central, superior parietal, superior, and middle temporal, and caudate with the right-sided predominance. Compared to healthy controls, NMOSD patients showed poor performance on tests for attention/working memory and processing speed, visuospatial processing, and executive function, which were associated with significant decreases in nodal clustering coefficient, local efficiency, and regional efficiency in the disrupted sub-networks (all p < 0.05). Conclusions: The data show the overall WM disruption and the relationship between poor cognitive function and sub-network alterations identified by the network analysis in NMOSD patients. We suggest that cognitive dysfunction is related to dysconnectivity of WM network including default mode network in NMOSD.
Collapse
Affiliation(s)
- Eun Bin Cho
- Department of Neurology, Gyeongsang Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Cheol E Han
- School of Biomedical Engineering, Korea University, Seoul, South Korea.,Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jeong-Hyeon Shin
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Hye-Jin Cho
- Department of Neurology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Kwang-Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| |
Collapse
|
8
|
Rueda-Lopes FC, Pessôa FM, Tukamoto G, Malfetano FR, Scherpenhuijzen SB, Alves-Leon S, Gasparetto EL. Default-mode network and deep gray-matter analysis in neuromyelitis optica patients. J Neuroradiol 2018; 45:256-260. [DOI: 10.1016/j.neurad.2018.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/19/2017] [Accepted: 01/19/2018] [Indexed: 11/16/2022]
|
9
|
Rocca MA, Savoldi F, Valsasina P, Radaelli M, Preziosa P, Comi G, Falini A, Filippi M. Cross-modal plasticity among sensory networks in neuromyelitis optica spectrum disorders. Mult Scler 2018; 25:968-979. [PMID: 29771186 DOI: 10.1177/1352458518778008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore resting-state (RS) functional connectivity (FC) of the main sensory/motor networks of patients with neuromyelitis optica spectrum disorders (NMOSDs), clinically isolated optic neuritis (ON), and myelitis. METHODS Clinical evaluation and RS fMRI were obtained from 28 NMOSD, 11 recurrent ON, and 12 recurrent myelitis patients and 30 healthy controls. Between-group RS FC comparisons and correlations with motor performance were assessed (SPM12) on the main sensory/motor RS networks (RSNs) identified by independent component analysis. Functional network connectivity analysis estimated inter-network connectivity. RESULTS Intra- and inter-network RS FCs were reduced in RSNs associated to somatosensory modalities affected by pathology: regions of the primary visual network in ON patients, of the sensorimotor networks in myelitis patients, and of the sensorimotor and secondary visual networks in NMOSD patients. The opposite trend was observed in regions of RSNs spared by pathology: the auditory and part of visual networks in NMOSD, the secondary visual and sensorimotor networks in ON, and the primary visual network in myelitis patients. Better motor performance correlated with higher RS FC of spared RSNs. CONCLUSION Sensory and motor RSN abnormalities occur in NMOSD. Loss of function within disease-target networks may elicit cross-modal plasticity across sensory networks potentially preserving clinical function.
Collapse
Affiliation(s)
- Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Savoldi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Radaelli
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
10
|
Kenkel D, Yamada Y, Weiger M, Wurnig MC, Jungraithmayr W, Boss A. Magnetisation transfer as a biomarker for chronic airway fibrosis in a mouse lung transplantation model. Eur Radiol Exp 2018; 2:3. [PMID: 29708209 PMCID: PMC5909363 DOI: 10.1186/s41747-017-0032-3] [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: 08/13/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022] Open
Abstract
Background Chronic airway fibrosis (CAF) is the most prevalent complication in human lung transplant recipients. The aim of the study is to evaluate magnetisation transfer (MT) as a biomarker of developing CAF of lung transplants in a mouse model. Methods Lung transplantation was performed in 48 mice, applying major or minor histocompatibility mismatches between strains for the induction of CAF. MT measurements were performed in vivo with systematic variation of off-resonance frequencies and flip angle of the MT prepulse. MT ratios (MTRs) were compared for lungs showing CAF and without CAF. Results Seven out of 24 animals (29%) showed a pattern of CAF at histology. All mice developing CAF also showed signs of acute rejection, whereas none of the lungs showed signs of other post-transplant complications. After lung transplantation, pulmonary infiltration was a frequent finding (14 out of 24) exhibiting a higher MTR (24.8% ± 4.5%) compared to well-ventilated lungs (12.3% ± 6.9%, p = 0.001) at 8000 Hz off-resonance frequency, 3000° flip angle. In infiltrated lung tissue exhibiting CAF, lower MTR values (21.8% ± 5.7%) were found compared to infiltrated lungs showing signs of acute rejection alone (26.5% ± 2.9%, p = 0.028), at 8000 Hz, 3000° flip angle. The highest MTR values were observed at 3000° flip angle, using a 1000 Hz off-resonance frequency. Conclusion MTR might serve as a tool for the detection of CAF in infiltrated lung tissue.
Collapse
Affiliation(s)
- David Kenkel
- 1Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Yoshito Yamada
- 2Division of Thoracic Surgery and Department, University Hospital Zurich, Zurich, Switzerland
| | - Markus Weiger
- 3Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Moritz C Wurnig
- 1Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- 2Division of Thoracic Surgery and Department, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Medical University Brandenburg, Neuruppin, Brandenburg Germany
| | - Andreas Boss
- 1Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
11
|
Wang KY, Chetta J, Bains P, Balzer A, Lincoln J, Uribe T, Lincoln CM. Spectrum of MRI brain lesion patterns in neuromyelitis optica spectrum disorder: a pictorial review. Br J Radiol 2018; 91:20170690. [PMID: 29388807 DOI: 10.1259/bjr.20170690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuromyelitis optica is a neurotropic autoimmune inflammatory disease of the central nervous system traditionally thought to exclusively involve the optic nerves and spinal cord. With the discovery of the disease-specific aquaporin-4 antibody and the increasing recognition of clinical and characteristic imaging patterns of brain involvement in what is now termed neuromyelitis optica spectrum disorder (NMOSD), MRI now plays a greater role in diagnosis of NMOSD based on the 2015 consensus criteria and in distinguishing it from other inflammatory disorders, particularly multiple sclerosis (MS). Several brain lesion patterns are highly suggestive of NMOSD, whereas others may serve as red flags. Specifically, long corticospinal lesions, hemispheric cerebral white matter lesions and periependymal lesions in the diencephalon, dorsal brainstem and white matter adjacent to lateral ventricles are typical of NMOSD. In contrast, juxtacortical, cortical, or lesions perpendicularly oriented to the surface of the lateral ventricle suggests MS as the diagnosis. Ultimately, a strong recognition of the spectrum of MRI brain findings in NMOSD is essential for accurate diagnosis, and particularly in differentiating from MS. This pictorial review highlights the spectrum of characteristic brain lesion patterns that may be seen in NMOSD and further delineates findings that may help distinguish it from MS.
Collapse
Affiliation(s)
- Kevin Yuqi Wang
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Justin Chetta
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Pavit Bains
- 2 Radiology Associates of North Texas , Fort Worth, TX , USA
| | - Anthony Balzer
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - John Lincoln
- 3 Department of Neurology, The University of Texas Health Science Center at Houston , Houston, TX , USA
| | - Tomas Uribe
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Christie M Lincoln
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| |
Collapse
|
12
|
Abnormal brain function in neuromyelitis optica: A fMRI investigation of mPASAT. Eur J Radiol 2017; 95:197-201. [DOI: 10.1016/j.ejrad.2017.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/17/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
|
13
|
Sun J, Sun X, Zhang N, Wang Q, Cai H, Qi Y, Li T, Qin W, Yu C. Analysis of brain and spinal cord lesions to occult brain damage in seropositive and seronegative neuromyelitis optica. Eur J Radiol 2017; 94:25-30. [PMID: 28941756 DOI: 10.1016/j.ejrad.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 04/29/2017] [Accepted: 07/07/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES According to aquaporin-4 antibody (AQP4-Ab), neuromyelitis optica (NMO) can be divided into seropositive and seronegative subgroups. The purpose of this study was to a) compare the distribution of spinal cord and brain magnetic resonance imaging (MRI) lesions between seropositive and seronegative NMO patients; b) explore occult brain damage in seropositive and seronegative NMO patients; and c) explore the contribution of visible lesions to occult grey and white matter damage in seropositive and seronegative NMO patients. MATERIALS AND METHODS Twenty-two AQP4-Ab seropositive and 14 seronegative NMO patients and 30 healthy controls were included in the study. Two neuroradiologists independently measured the brain lesion volume (BLV) and the length of spinal cord lesion (LSCL) and recorded the region of brain lesions. The normal-appearing grey matter volume (NAGM-GMV) and white matter fractional anisotropy (NAWM-FA) were calculated for each subject to evaluate occult brain damage. RESULTS The seropositive patients displayed more extensive damage in the spinal cord than the seronegative patients, and the seronegative group had a higher proportion of patients with brainstem lesions (28.57%) than the seropositive group (4.55%, P=0.064). Both NMO subgroups exhibited reduced NAGM-GMV and NAWM-FA compared with the healthy controls. NAGM-GMV was negatively correlated with LSCL in the seropositive group (rs=-0.444, P=0.044) and with BLV in the seronegative group (rs=-0.768, P=0.002). NAWM-FA was also negatively correlated with BLV in the seropositive group (rs=-0.682, P<0.001). CONCLUSION Our findings suggest that the occult brain damage in these two NMO subgroups may be due to different mechanisms, which need to be further clarified.
Collapse
Affiliation(s)
- Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xianting Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiuhui Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Huanhuan Cai
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yuan Qi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ting Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
| |
Collapse
|
14
|
Duan Y, Liu Z, Liu Y, Huang J, Ren Z, Sun Z, Chen H, Dong H, Ye J, Li K. Metabolic changes in normal-appearing white matter in patients with neuromyelitis optica and multiple sclerosis: a comparative magnetic resonance spectroscopy study. Acta Radiol 2017; 58:1132-1137. [PMID: 28173728 DOI: 10.1177/0284185116683575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Previous studies with a small sample size have not reported metabolic changes in neuromyelitis optica (NMO). Metabolic changes, such as decreased N-acetylaspartate (NAA), are well-established in patients with multiple sclerosis (MS). It remains unknown whether different patterns of metabolic changes occur in NMO and MS. Purpose To investigate the metabolic changes in normal-appearing white matter (NAWM) in NMO, compared with MS patients and healthy controls (HC), and correlate these changes with clinical disability. Material and Methods We recruited 27 patients with NMO, 24 patients with MS, and 24 HC. Each participant underwent chemical shift imaging with a 1H-MR spectroscopy operating in a 1.5 T magnetic resonance imaging (MRI) scanner. The absolute concentrations of NAA, choline (Cho), creatine (Cr) as well as the metabolite ratios of NAA/Cr, Cho/Cr, and NAA/Cho were measured and compared among the groups. The correlations between the metabolic concentrations, disease duration, and clinical disability (Expanded Disability Status Scale, EDSS) were further explored. Results Compared with HC, a mild increase of Cho without significant NAA changes was observed in NMO patients, while both a significant reduction of NAA and an increase of Cho were observed in MS patients. The absolute concentration of NAA and NAA/Cho ratio were significantly decreased in MS patients in a direct comparison with NMO patients. In MS patients, the EDSS was correlated with the NAA/Cr and Cho/Cr ratios. Conclusion A reduction of NAA was not observed in NMO, implying axonal or neuronal damage may be absent in NAWM for NMO, which is different from MS. A mild increase in Cho was observed in NAWM of NMO patients, suggesting that subtle metabolic changes occur in NMO.
Collapse
Affiliation(s)
- Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zhuoqiong Ren
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| |
Collapse
|
15
|
Liu Y, Jiang X, Butzkueven H, Duan Y, Huang J, Ren Z, Dong H, Shi FD, Barkhof F, Li K, Wang J. Multimodal characterization of gray matter alterations in neuromyelitis optica. Mult Scler 2017; 24:1308-1316. [PMID: 28741987 DOI: 10.1177/1352458517721053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate structural and functional alterations of gray matter (GM) and examine their clinical relevance in neuromyelitis optica (NMO) using multimodal magnetic resonance imaging (MRI) techniques. METHODS A total of 35 NMO and 36 healthy controls (HC) were recruited in this study. Cortical lesions were investigated by double inversion recovery technique. Five voxel-wise MRI measurements were obtained for each participant in the GM including gray matter volume (GMV), fractional anisotropy (FA), mean diffusivity (MD), amplitude of low-frequency fluctuation (ALFF), and weighted functional connectivity strength (wFCS). Between-group differences, cross-modality relationships, and MRI-clinical correlations were examined. RESULTS No cortical lesions were found in NMO. Compared to HC, NMO patients exhibited significantly decreased GMV in deep GM and cortical regions involving visual function and cognition. Diffusion GM abnormalities were widespread in the patients. Decreased ALFF and wFCS were observed in the patients in sensorimotor, visual, cognition, and cerebellar sites. GM structural alterations were correlated with cognitive but not physical disability scores of the patients. CONCLUSION Despite the lack of focal cortical lesions, patients with NMO exhibit both structural and functional alterations of GM in cerebrum and cerebellum that predominantly involve deep GM, visual, motor, and cognitive regions. GM alterations are associated with cognitive impairment but not physical disability.
Collapse
Affiliation(s)
- Yaou Liu
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, P.R. China/Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China/Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Xueyan Jiang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, P.R. China/Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, P.R. China
| | - Helmut Butzkueven
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhuoqiong Ren
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Fu-Dong Shi
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Jinhui Wang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, P.R. China/Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, P.R. China
| |
Collapse
|
16
|
Wang Y, Zhang B, Dai Y, Yang Y, Lu Z. Cognitive dysfunction and behavioral abnormalities in neuromyelitis optica spectrum disorder: report of a case with cortical gray matter involvement and frontotemporal atrophy. Acta Neurol Belg 2017; 117:409-411. [PMID: 27515542 DOI: 10.1007/s13760-016-0685-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Yanqiang Wang
- Department of Neurology, The Affiliated Hospital of Weifang Medical University, No 2428 Yuhe Road, Weifang, 261031, Shandong, China.
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Dai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Yang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
17
|
Jeong IH, Choi JY, Kim SH, Hyun JW, Joung A, Lee J, Kim HJ. Normal-appearing white matter demyelination in neuromyelitis optica spectrum disorder. Eur J Neurol 2017; 24:652-658. [PMID: 28233435 DOI: 10.1111/ene.13266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/11/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Increasing evidence suggests the presence of demyelination in the normal-appearing white matter (NAWM) of patients with neuromyelitis optica spectrum disorder (NMOSD). The objective was to determine the presence of subclinical demyelination in the NAWM of patients with NMOSD using myelin water imaging (MWI). METHODS Whole brain and regions-of-interest (ROIs) analyses, including the centrum semiovale, corona radiata, genu and splenium of the corpus callosum, and optic radiation, were conducted in the NAWM of 28 NMOSD patients and 18 healthy controls (HCs) using two MWI modalities: conventional MWI and direct visualization of short transverse relaxation time component (ViSTa) MWI. RESULTS Conventional myelin water fractions (MWFs) of the global NAWM and three ROIs (centrum semiovale, corona radiata, and genu of the corpus callosum) were slightly lower in NMOSD patients than in HCs, although not statistically significant. On the other hand, ViSTa MWF values of the global NAWM and all ROIs except the genu of the corpus callosum were significantly lower in NMOSD patients relative to HCs. In particular, the MWF in the optic radiation was significantly reduced in NMOSD patients relative to HCs in both MWI methods, even in patients who had no brain involvement. Additionally, patients with optic neuritis showed lower MWF than patients without optic neuritis and a negative correlation was identified between the MWF of the optic radiation and visual functional system score. CONCLUSIONS This study identified the presence of widespread demyelination in the NAWM of NMOSD patients and highlighted the optic radiation as a site of marked demyelination.
Collapse
Affiliation(s)
- I H Jeong
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - J Y Choi
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - S-H Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - J-W Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - A Joung
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - J Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - H J Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| |
Collapse
|
18
|
Qian W, Chan KH, Hui ES, Lee CY, Hu Y, Mak HKF. Application of diffusional kurtosis imaging to detect occult brain damage in multiple sclerosis and neuromyelitis optica. NMR IN BIOMEDICINE 2016; 29:1536-1545. [PMID: 27602543 DOI: 10.1002/nbm.3607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Multiple sclerosis (MS) and neuromyelitis optica (NMO) are two common types of inflammatory demyelinating disease of the central nervous system. Early distinction of NMO from MS is crucial but quite challenging. In this study, 13 NMO spectrum disorder patients (Expanded Disability Status Scale (EDSS) of 3.0 ± 1.7, ranging from 2 to 6.5; disease duration of 5.3 ± 4.7 years), 17 relapsing-remitting MS patients (EDSS of 2.6 ± 1.4, ranging from 1 to 5.5; disease duration of 7.9 ± 7.8 years) and 18 healthy volunteers were recruited. Diffusional kurtosis imaging was employed to discriminate NMO and MS patients at the early or stable stage from each other, and from healthy volunteers. The presence of alterations in diffusion and diffusional kurtosis metrics in normal-appearing white matter (NAWM) and diffusely increased mean diffusivity (MD) in the cortical normal-appearing gray matter (NAGM) favors the diagnosis of MS rather than NMO. Meanwhile, normal diffusivities and kurtosis metrics in all NAWM as well as increases in MD in the frontal and temporal NAGM suggest NMO. Our results suggest that diffusion and diffusional kurtosis metrics may well aid in discriminating the two diseases.
Collapse
Affiliation(s)
- Wenshu Qian
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Koon Ho Chan
- Department of Medicine, The University of Hong Kong, Hong Kong.
| | - Edward S Hui
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Chi Yan Lee
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong.
| |
Collapse
|
19
|
Brain parenchymal damage in neuromyelitis optica spectrum disorder – A multimodal MRI study. Eur Radiol 2016; 26:4413-4422. [DOI: 10.1007/s00330-016-4282-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/22/2016] [Accepted: 02/11/2016] [Indexed: 01/10/2023]
|
20
|
Hollinger KR, Franke C, Arenivas A, Woods SR, Mealy MA, Levy M, Kaplin AI. Cognition, mood, and purpose in life in neuromyelitis optica spectrum disorder. J Neurol Sci 2016; 362:85-90. [DOI: 10.1016/j.jns.2016.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 12/19/2022]
|
21
|
Abstract
The advances in diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and functional magnetic resonance imaging (fMRI) over the last 20 years have vastly contributed to improving the understanding of the brain structure and function in patients with many diseases of the central nervous system (CNS). DWI is commonly used, for instance, in the diagnostic workup of stroke, CNS neoplasia, and rapidly progressive dementia cases. The new DTI methods provide more specific information about the most destructive aspects of tumors, neurodegenerative dementia, and multiple sclerosis pathology and give a more complete picture of the complex pathologic mechanisms of these conditions. More recently, fMRI has provided insight to the mechanisms of brain adaptation and plasticity to damage related to many neurologic conditions and has further extended our ability to understand the functional significance of pathologic changes in these diseases. Although at present fMRI does not have a role in the diagnosis, routine assessment, and monitoring of neurologic diseases, significant efforts are under way in order to achieve harmonization of both acquisition and postprocessing procedures, which are likely to contribute to a significant change of the clinical scenario.
Collapse
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
22
|
Hinson SR, Lennon VA, Pittock SJ. Autoimmune AQP4 channelopathies and neuromyelitis optica spectrum disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 133:377-403. [PMID: 27112688 DOI: 10.1016/b978-0-444-63432-0.00021-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Neuromyelitis optica (NMO) spectrum disorders (SD) represent an evolving group of central nervous system (CNS)-inflammatory autoimmune demyelinating diseases unified by a pathogenic autoantibody specific for the aquaporin-4 (AQP4) water channel. It was historically misdiagnosed as multiple sclerosis (MS), which lacks a distinguishing biomarker. The discovery of AQP4-IgG moved the focus of CNS demyelinating disease research from emphasis on the oligodendrocyte and myelin to the astrocyte. NMO is recognized today as a relapsing disease, extending beyond the optic nerves and spinal cord to include brain (especially in children) and skeletal muscle. Brain magnetic resonance imaging abnormalities, identifiable in 60% of patients at the second attack, are consistent with MS in 10% of cases. NMOSD-typical lesions (another 10%) occur in AQP4-enriched regions: circumventricular organs (causing intractable nausea and vomiting) and the diencephalon (causing sleep disorders, endocrinopathies, and syndrome of inappropriate antidiuresis). Advances in understanding the immunobiology of AQP4 autoimmunity have necessitated continuing revision of NMOSD clinical diagnostic criteria. Assays that selectively detect pathogenic AQP4-IgG targeting extracellular epitopes of AQP4 are promising prognostically. When referring to AQP4 autoimmunity, we suggest substituting the term "autoimmune aquaporin-4 channelopathy" for the term "NMO spectrum disorders." Randomized clinical trials are currently assessing the efficacy and safety of newer immunotherapies. Increasing therapeutic options based on understanding the molecular pathogenesis is anticipated to improve the outcome for patients with AQP4 channelopathy.
Collapse
Affiliation(s)
- Shannon R Hinson
- Departments of Laboratory Medicine/Pathology and Neurology, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Vanda A Lennon
- Departments of Laboratory Medicine/Pathology and Neurology, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Sean J Pittock
- Departments of Laboratory Medicine/Pathology and Neurology, Mayo Clinic, College of Medicine, Rochester, MN, USA.
| |
Collapse
|
23
|
Ota M, Sato N, Okamoto T, Noda T, Araki M, Yamamura T, Kunugi H. Neuromyelitis optica spectrum disorder and multiple sclerosis: Differentiation by a multimodal approach. Mult Scler Relat Disord 2015; 4:515-20. [DOI: 10.1016/j.msard.2015.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/28/2015] [Accepted: 08/17/2015] [Indexed: 11/26/2022]
|
24
|
Kremer S, Renard F, Achard S, Lana-Peixoto MA, Palace J, Asgari N, Klawiter EC, Tenembaum SN, Banwell B, Greenberg BM, Bennett JL, Levy M, Villoslada P, Saiz A, Fujihara K, Chan KH, Schippling S, Paul F, Kim HJ, de Seze J, Wuerfel JT, Cabre P, Marignier R, Tedder T, van Pelt D, Broadley S, Chitnis T, Wingerchuk D, Pandit L, Leite MI, Apiwattanakul M, Kleiter I, Prayoonwiwat N, Han M, Hellwig K, van Herle K, John G, Hooper DC, Nakashima I, Sato D, Yeaman MR, Waubant E, Zamvil S, Stüve O, Aktas O, Smith TJ, Jacob A, O'Connor K. Use of Advanced Magnetic Resonance Imaging Techniques in Neuromyelitis Optica Spectrum Disorder. JAMA Neurol 2015; 72:815-22. [PMID: 26010909 DOI: 10.1001/jamaneurol.2015.0248] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI) scans of patients with neuromyelitis optica (NMO) spectrum disorder, but the specific morphological and temporal patterns distinguishing them unequivocally from lesions caused by other disorders have not been identified. This literature review summarizes the literature on advanced quantitative imaging measures reported for patients with NMO spectrum disorder, including proton MR spectroscopy, diffusion tensor imaging, magnetization transfer imaging, quantitative MR volumetry, and ultrahigh-field strength MRI. It was undertaken to consider the advanced MRI techniques used for patients with NMO by different specialists in the field. Although quantitative measures such as proton MR spectroscopy or magnetization transfer imaging have not reproducibly revealed diffuse brain injury, preliminary data from diffusion-weighted imaging and brain tissue volumetry indicate greater white matter than gray matter degradation. These findings could be confirmed by ultrahigh-field MRI. The use of nonconventional MRI techniques may further our understanding of the pathogenic processes in NMO spectrum disorders and may help us identify the distinct radiographic features corresponding to specific phenotypic manifestations of this disease.
Collapse
Affiliation(s)
- Stephane Kremer
- ICube (UMR 7357, UdS, Centre National de la Recherche Scientifique), Fédération de médecine translationelle de Strasbourg, Université de Strasbourg, Strasbourg, France2Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Felix Renard
- Centre National de la Recherche Scientifique, Grenoble Image Parole Signal Automatique, Grenoble, France
| | - Sophie Achard
- Centre National de la Recherche Scientifique, Grenoble Image Parole Signal Automatique, Grenoble, France
| | | | - Jacqueline Palace
- Department of Neurology, Oxford University Hospital Trust, Oxford, England
| | - Nasrin Asgari
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense7Department of Neurology, Vejle Hospital, Vejle, Denmark
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Silvia N Tenembaum
- Department of Neurology and Neurophysiology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Brenda Banwell
- Department of Neurology, University of Pennsylvania, Philadelphia11Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin M Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas13Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey L Bennett
- Department of Neurology, University of Colorado Denver, Aurora15Department of Ophthalmology, University of Colorado Denver, Aurora
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Pablo Villoslada
- Institute of Biomedical Research August Pi Sunyer-Hospital Clínic de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Institute of Biomedical Research August Pi Sunyer-Hospital Clínic de Barcelona, Barcelona, Spain
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koon Ho Chan
- University Department of Medicine, Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, University Hospital Zurich, Zurich, Switzerland21Department of Neurology, University Hospital Zurich, Zurich, Switzerland22Neuroscience Center Zurich, Federal Technical High School Zurich, Zurich, S
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany25Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany26Department of Neurology, Charité University Medicine, Berlin, Ger
| | - Ho Jin Kim
- Department of Neurology, Research Institute, Goyang, Korea28Hospital of National Cancer Center, Goyang, Korea
| | - Jerome de Seze
- Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France30Clinical Investigation Center (INSERM 1434), Hôpitaux Universitaires de Strasbourg, Strasbourg, France31UMR INSERM 1119 and Fédération de médecine translationelle, Strasbourg
| | - Jens T Wuerfel
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany25Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany26Department of Neurology, Charité University Medicine, Berlin, Ger
| | | | | | | | - Thomas Tedder
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospital Trust, Oxford, England
| | | | | | | | - May Han
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - Ichiro Nakashima
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Douglas Sato
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | | | - Olaf Stüve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas13Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Orhan Aktas
- University of Düsseldorf, Düsseldorf, Germany
| | | | | | - Kevin O'Connor
- Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
25
|
Wang Q, Zhang N, Qin W, Li Y, Fu Y, Li T, Shao J, Yang L, Shi FD, Yu C. Gray Matter Volume Reduction Is Associated with Cognitive Impairment in Neuromyelitis Optica. AJNR Am J Neuroradiol 2015; 36:1822-9. [PMID: 26338914 DOI: 10.3174/ajnr.a4403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Whether gray matter impairment occurs in neuromyelitis optica is a matter of ongoing debate, and the association of gray matter impairment with cognitive deficits remains largely unknown. The purpose of this study was to investigate gray matter volume reductions and their association with cognitive decline in patients with neuromyelitis optica. MATERIALS AND METHODS This study included 50 patients with neuromyelitis optica and 50 sex-, age-, handedness-, and education-matched healthy subjects who underwent high-resolution structural MR imaging examinations and a battery of cognitive assessments. Gray matter volume and cognitive differences were compared between the 2 groups. The correlations of the regional gray matter volume with cognitive scores and clinical variables were explored in the patients with neuromyelitis optica. RESULTS Compared with healthy controls (635.9 ± 51.18 mL), patients with neuromyelitis optica (602.8 ± 51.03 mL) had a 5.21% decrease in the mean gray matter volume of the whole brain (P < .001). The significant gray matter volume reduction in neuromyelitis optica affected the frontal and temporal cortices and the right thalamus (false discovery rate correction, P < .05). The regional gray matter volumes in the frontal and temporal cortices were negatively correlated with disease severity in patients with neuromyelitis optica (Alphasim correction, P < .05). Patients with neuromyelitis optica had impairments in memory, information processing speed, and verbal fluency (P < .05), which were correlated with gray matter volume reductions in the medial prefrontal cortex and thalamus (Alphasim correction, P < .05). CONCLUSIONS Gray matter volume reduction is present in patients with neuromyelitis optica and is associated with cognitive impairment and disease severity in this group.
Collapse
Affiliation(s)
- Q Wang
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Q.W., N.Z., W.Q., C.Y.)
| | - N Zhang
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Q.W., N.Z., W.Q., C.Y.)
| | - W Qin
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Q.W., N.Z., W.Q., C.Y.)
| | - Y Li
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China
| | - Y Fu
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China
| | - T Li
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China
| | - J Shao
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China
| | - L Yang
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China
| | - F-D Shi
- Department of Neurology and Tianjin Neurological Institute (Y.L., Y.F., T.L., J.S., L.Y., F.-D.S.), Tianjin Medical University General Hospital, Tianjin, China Department of Neurology (F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - C Yu
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging (Q.W., N.Z., W.Q., C.Y.)
| |
Collapse
|
26
|
Pittock SJ, Lucchinetti CF. Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: a decade later. Ann N Y Acad Sci 2015. [PMID: 26096370 DOI: 10.1111/nyas.12794.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The discovery of AQP4-IgG (a pathogenic antibody that targets the astrocytic water channel aquaporin-4), as the first sensitive and specific biomarker for any inflammatory central nervous system demyelinating disease (IDD), has shifted emphasis from the oligodendrocyte and myelin to the astrocyte as a central immunopathogenic player. Neuromyelitis optica (NMO) spectrum disorders (SDs) represent an evolving spectrum of IDDs extending beyond the optic nerves and spinal cord to include the brain (especially in children) and, rarely, muscle. NMOSD typical brain lesions are located in areas that highly express the target antigen, AQP4, including the circumventricular organs (accounting for intractable nausea and vomiting) and the diencephalon (accounting for sleep disorders, endocrinopathies, and syndrome of inappropriate antidiuresis). Magnetic resonance imaging brain abnormalities fulfill Barkoff criteria for multiple sclerosis in up to 10% of patients. As the spectrum broadens, the importance of highly specific assays that detect pathogenic AQP4-IgG targeting extracellular epitopes of AQP4 cannot be overemphasized. The rapid evolution of our understanding of the immunobiology of AQP4 autoimmunity necessitates continuing revision of NMOSD diagnostic criteria. Here, we describe scientific advances that have occurred since the discovery of NMO-IgG in 2004 and review novel targeted immunotherapies. We also suggest that NMOSDs should now be considered under the umbrella term autoimmune aquaporin-4 channelopathy.
Collapse
Affiliation(s)
- Sean J Pittock
- Department of Laboratory Medicine/Pathology, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, College of Medicine, Rochester, Minnesota
| | | |
Collapse
|
27
|
Kawachi I, Nishizawa M. Significance of gray matter brain lesions in multiple sclerosis and neuromyelitis optica. Neuropathology 2015; 35:481-6. [DOI: 10.1111/neup.12216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/05/2015] [Accepted: 04/05/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Izumi Kawachi
- Department of Neurology, Brain Research Institute; Niigata University; Niigata Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute; Niigata University; Niigata Japan
| |
Collapse
|
28
|
Pittock SJ, Lucchinetti CF. Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: a decade later. Ann N Y Acad Sci 2015; 1366:20-39. [PMID: 26096370 DOI: 10.1111/nyas.12794] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The discovery of AQP4-IgG (a pathogenic antibody that targets the astrocytic water channel aquaporin-4), as the first sensitive and specific biomarker for any inflammatory central nervous system demyelinating disease (IDD), has shifted emphasis from the oligodendrocyte and myelin to the astrocyte as a central immunopathogenic player. Neuromyelitis optica (NMO) spectrum disorders (SDs) represent an evolving spectrum of IDDs extending beyond the optic nerves and spinal cord to include the brain (especially in children) and, rarely, muscle. NMOSD typical brain lesions are located in areas that highly express the target antigen, AQP4, including the circumventricular organs (accounting for intractable nausea and vomiting) and the diencephalon (accounting for sleep disorders, endocrinopathies, and syndrome of inappropriate antidiuresis). Magnetic resonance imaging brain abnormalities fulfill Barkoff criteria for multiple sclerosis in up to 10% of patients. As the spectrum broadens, the importance of highly specific assays that detect pathogenic AQP4-IgG targeting extracellular epitopes of AQP4 cannot be overemphasized. The rapid evolution of our understanding of the immunobiology of AQP4 autoimmunity necessitates continuing revision of NMOSD diagnostic criteria. Here, we describe scientific advances that have occurred since the discovery of NMO-IgG in 2004 and review novel targeted immunotherapies. We also suggest that NMOSDs should now be considered under the umbrella term autoimmune aquaporin-4 channelopathy.
Collapse
Affiliation(s)
- Sean J Pittock
- Department of Laboratory Medicine/Pathology, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, College of Medicine, Rochester, Minnesota
| | | |
Collapse
|
29
|
Zhang LJ, Zhao N, Fu Y, Zhang DQ, Wang J, Qin W, Zhang N, Wood K, Liu Y, Yu C, Shi FD, Yang L. Olfactory dysfunction in neuromyelitis optica spectrum disorders. J Neurol 2015; 262:1890-8. [DOI: 10.1007/s00415-015-7787-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/04/2015] [Accepted: 05/14/2015] [Indexed: 12/18/2022]
|
30
|
Eshaghi A, Riyahi-Alam S, Saeedi R, Roostaei T, Nazeri A, Aghsaei A, Doosti R, Ganjgahi H, Bodini B, Shakourirad A, Pakravan M, Ghana'ati H, Firouznia K, Zarei M, Azimi AR, Sahraian MA. Classification algorithms with multi-modal data fusion could accurately distinguish neuromyelitis optica from multiple sclerosis. Neuroimage Clin 2015; 7:306-14. [PMID: 25610795 PMCID: PMC4297886 DOI: 10.1016/j.nicl.2015.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/13/2014] [Accepted: 01/03/2015] [Indexed: 12/15/2022]
Abstract
Neuromyelitis optica (NMO) exhibits substantial similarities to multiple sclerosis (MS) in clinical manifestations and imaging results and has long been considered a variant of MS. With the advent of a specific biomarker in NMO, known as anti-aquaporin 4, this assumption has changed; however, the differential diagnosis remains challenging and it is still not clear whether a combination of neuroimaging and clinical data could be used to aid clinical decision-making. Computer-aided diagnosis is a rapidly evolving process that holds great promise to facilitate objective differential diagnoses of disorders that show similar presentations. In this study, we aimed to use a powerful method for multi-modal data fusion, known as a multi-kernel learning and performed automatic diagnosis of subjects. We included 30 patients with NMO, 25 patients with MS and 35 healthy volunteers and performed multi-modal imaging with T1-weighted high resolution scans, diffusion tensor imaging (DTI) and resting-state functional MRI (fMRI). In addition, subjects underwent clinical examinations and cognitive assessments. We included 18 a priori predictors from neuroimaging, clinical and cognitive measures in the initial model. We used 10-fold cross-validation to learn the importance of each modality, train and finally test the model performance. The mean accuracy in differentiating between MS and NMO was 88%, where visible white matter lesion load, normal appearing white matter (DTI) and functional connectivity had the most important contributions to the final classification. In a multi-class classification problem we distinguished between all of 3 groups (MS, NMO and healthy controls) with an average accuracy of 84%. In this classification, visible white matter lesion load, functional connectivity, and cognitive scores were the 3 most important modalities. Our work provides preliminary evidence that computational tools can be used to help make an objective differential diagnosis of NMO and MS.
Collapse
Affiliation(s)
- Arman Eshaghi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Sadjad Riyahi-Alam
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghayyeh Saeedi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tina Roostaei
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Nazeri
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Aghsaei
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Doosti
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Ganjgahi
- National Brain Mapping Center, Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Benedetta Bodini
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Pinire, Universitat Pierre et Marie Curie, Inserm, Paris U975, France
| | - Ali Shakourirad
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Center of Neurological Research, Neuroscience Institute, University of Medical Sciences, Tehran, Iran
| | - Manijeh Pakravan
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghana'ati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Zarei
- National Brain Mapping Center, Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Center of Neurological Research, Neuroscience Institute, University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Sherman MA, Ardashev IV. A case of recurrent Devic’s opticomyelitis. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:38-44. [DOI: 10.17116/jnevro20151152238-44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Weier K, Eshaghi A, Magon S, Andelova M, Radue EW, Kappos L, Azimi AR, Sahraian MA, Sprenger T. The role of cerebellar abnormalities in neuromyelitis optica – a comparison with multiple sclerosis and healthy controls. Mult Scler 2014; 21:757-66. [DOI: 10.1177/1352458514554051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/26/2014] [Indexed: 11/15/2022]
Abstract
Background: In relapsing–remitting multiple sclerosis (RRMS), the cerebellum is a known predilection site for atrophy. Neuromyelitis optica (NMO) is characterized by extensive lesions in the spinal cord and optic nerve; however, cerebellar involvement has been less studied. Secondary degeneration of the spinocerebellar tract could impact the cerebellum in NMO. Objective: We aimed to investigate whether spinal cord and cerebellar volume measures differ between patients with NMO and RRMS. Methods: Volumetric analyses of the cerebellum (TCV), the upper cervical cord (UCV) as well as the whole brain (NBV) of age- and gender-matched patients with NMO ( n=30; 56% AQP4 +ve) and RRMS ( n=25) were performed on 3T brain magnetic resonance imaging (MRI) and compared with 34 healthy controls (HC). Results: UCV was significantly reduced in NMO patients (6.3 cm3) as compared with HC (6.7 cm3), while patients with MS had reduced brain volumes compared with HC (NBV=1482 cm3; p<0.001; TCV=188 cm3; p=0.042), but UCV close to normal values. Patients with RRMS and NMO differed in NBV ( p=0.001; lower in RRMS) and by trend (towards reduction in RRMS) in cerebellar volume ( p=0.06). Conclusions: While atrophy seems to be diffuse in MS patients, a rather focussed pattern with predominant involvement of the UCV was observed in NMO patients.
Collapse
Affiliation(s)
- Katrin Weier
- Department of Neurology, University Hospital Basel, Switzerland
| | - Arman Eshaghi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Stefano Magon
- Department of Neurology, University Hospital Basel, Switzerland
| | | | - Ernst-Wilhelm Radue
- Medical Image Analysis Center (MIAC) AG, c/o University Hospital Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Switzerland/Medical Image Analysis Center (MIAC) AG, c/o University Hospital Basel, Switzerland/Department of Radiology and Nuclear Medicine, Division of Neuroradiology, University Hospital Basel, Switzerland
| |
Collapse
|
33
|
Lucchinetti CF, Guo Y, Popescu BFG, Fujihara K, Itoyama Y, Misu T. The pathology of an autoimmune astrocytopathy: lessons learned from neuromyelitis optica. Brain Pathol 2014; 24:83-97. [PMID: 24345222 DOI: 10.1111/bpa.12099] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 12/13/2022] Open
Abstract
Neuromyelitis optica (NMO) is a disabling autoimmune astrocytopathy characterized by typically severe and recurrent attacks of optic neuritis and longitudinally extensive myelitis. Until recently, NMO was considered an acute aggressive variant of multiple sclerosis (MS), despite the fact that early studies postulated that NMO and MS may be two distinct diseases with a common clinical picture. With the discovery of a highly specific serum autoantibody (NMO-IgG), Lennon and colleagues provided the first unequivocal evidence distinguishing NMO from MS and other central nervous system (CNS) inflammatory demyelinating disorders. The target antigen of NMO-IgG was confirmed to be aquaporin-4 (AQP4), the most abundant water channel protein in the CNS, mainly expressed on astrocytic foot processes at the blood-brain barrier, subpial and subependymal regions. Pathological studies demonstrated that astrocytes were selectively targeted in NMO as evidenced by the extensive loss of immunoreactivities for the astrocytic proteins, AQP4 and glial fibrillary acidic protein (GFAP), as well as perivascular deposition of immunoglobulins and activation of complement even within lesions with a relative preservation of myelin. In support of these pathological findings, GFAP levels in the cerebrospinal fluid (CSF) during acute NMO exacerbations were found to be remarkably elevated in contrast to MS where CSF-GFAP levels did not substantially differ from controls. Additionally, recent experimental studies showed that AQP4 antibody is pathogenic, resulting in selective astrocyte destruction and dysfunction in vitro, ex vivo and in vivo. These findings strongly suggest that NMO is an autoimmune astrocytopathy where damage to astrocytes exceeds both myelin and neuronal damage. This chapter will review recent neuropathological studies that have provided novel insights into the pathogenic mechanisms, cellular targets, as well as the spectrum of tissue damage in NMO.
Collapse
|
34
|
Barnett Y, Sutton IJ, Ghadiri M, Masters L, Zivadinov R, Barnett MH. Conventional and advanced imaging in neuromyelitis optica. AJNR Am J Neuroradiol 2014; 35:1458-66. [PMID: 23764723 DOI: 10.3174/ajnr.a3592] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Myelitis and optic neuritis are prototypic clinical presentations of both multiple sclerosis and neuromyelitis optica. Once considered a subtype of multiple sclerosis, neuromyelitis optica, is now known to have a discrete pathogenesis in which antibodies to the water channel, aquaporin 4, play a critical role. Timely differentiation of neuromyelitis optica from MS is imperative, determining both prognosis and treatment strategy. Early, aggressive immunosuppression is required to prevent the accrual of severe disability in neuromyelitis optica; conversely, MS-specific therapies may exacerbate the disease. The diagnosis of neuromyelitis optica requires the integration of clinical, MR imaging, and laboratory data, but current criteria are insensitive and exclude patients with limited clinical syndromes. Failure to recognize the expanding spectrum of cerebral MR imaging patterns associated with aquaporin 4 antibody seropositivity adds to diagnostic uncertainty in some patients. We present the state of the art in conventional and nonconventional MR imaging in neuromyelitis optica and review the place of neuroimaging in the diagnosis, management, and research of the condition.
Collapse
Affiliation(s)
- Y Barnett
- From the Sydney Neuroimaging Analysis Centre (Y.B., M.H.B.), Sydney, AustraliaBrain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, AustraliaDepartment of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia
| | - I J Sutton
- Department of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia
| | - M Ghadiri
- Brain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
| | - L Masters
- Brain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (R.Z.), Department of Neurology, University of Buffalo, Buffalo, New York
| | - M H Barnett
- From the Sydney Neuroimaging Analysis Centre (Y.B., M.H.B.), Sydney, AustraliaBrain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
| |
Collapse
|
35
|
Kimura MCG, Doring TM, Rueda FC, Tukamoto G, Gasparetto EL. In vivo assessment of white matter damage in neuromyelitis optica: a diffusion tensor and diffusion kurtosis MR imaging study. J Neurol Sci 2014; 345:172-5. [PMID: 25091453 DOI: 10.1016/j.jns.2014.07.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE In patients with neuromyelitis optica (NMO), damage to extensive regions of normal-appearing WM has been observed. To investigate the possibility that microstructural alterations are present in these WM tracts, DTI and diffusion kurtosis imaging (DKI) techniques were applied and compared. MATERIAL AND METHODS Thirteen patients with NMO and 13 demographically and gender-matched controls underwent MRI using a 3T MR scanner, with DTI/DKI sequence acquired jointly fitted. Parametric fractional anisotropy maps were derived from diffusion tensor (FADTI) values using b-values of 0s/mm(2) and 1000s/mm(2). Parametric fractional anisotropy maps derived from diffusion kurtosis tensor (FADKI) values were also acquired using b-values of 0, 1000, and 2000s/mm(2). Mean FADTI and FADKI values were also calculated. A ROI analysis of the genu and splenium of the corpus callosum (CC), cerebral peduncle (CP), and optic radiation (OR) was also performed. Student's t-test and corrections for multiple comparisons were used to evaluate the data obtained. RESULTS A significant decrease in the FADTI values obtained for NMO patients versus controls was observed for the splenium of the CC and the left OR (p<0.05). However, just a positive trend was observed for the FADKI values associated with the same WM tracts. CONCLUSIONS To our knowledge, this is the first study to analyze WM tracts of NMO patients using DTI and DKI. These data indicate that DKI could have limitations in evaluating the WM integrity in NMO patients. Furthermore, the results obtained are consistent with the hypothesis that diffuse brain involvement characterizes NMO.
Collapse
Affiliation(s)
| | - Thomas Martin Doring
- Radiology Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Fernanda Cristina Rueda
- MRI Department of Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Rio de Janeiro, Brazil; Radiology Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Gustavo Tukamoto
- Radiology Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Emerson Leandro Gasparetto
- MRI Department of Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Rio de Janeiro, Brazil; Radiology Department of Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
36
|
Cortical thinning correlates with cognitive change in multiple sclerosis but not in neuromyelitis optica. Eur Radiol 2014; 24:2334-43. [PMID: 24906701 DOI: 10.1007/s00330-014-3239-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/02/2014] [Accepted: 05/13/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare spatial patterns of cortical thickness alterations in neuromyelitis optica (NMO) and multiple sclerosis (MS); and to investigate the correlations between cortical thinning and clinical variables in NMO and MS. METHODS We studied 23 patients with NMO, 27 patients with MS and 26 healthy controls (HCs). The global, brain region and vertex-based cortical thickness (CTh) were analysed and compared among the three groups. A general linear model was used to investigate the correlations between cortical thinning and clinical measures. RESULTS A limited number of cortical regions in visual cortex were found to be significantly thinner in NMO patients than in HCs. The MS patients exhibited more widespread cortical thinning compared with HCs, and significantly greater cortical thinning in the insula and the parahippocampus compared with NMO. The extent of cortical thinning in several brain regions correlated with cognitive measures in MS, but not in NMO. CONCLUSIONS Neocortical thinning in NMO mainly affects visual cortex, while MS patients show much more extensive cortical thinning. Cognitive changes are correlated with cortical atrophy in MS not in NMO. The substrates of cognitive changes in MS and NMO could therefore be different. KEY POINTS MS patients show much more extensive cortical thinning than NMO. Cortical thinning of insula and parahippocampus particularly distinguishes MS from NMO. Cognitive changes are correlated with cortical atrophy in MS but not in NMO.
Collapse
|
37
|
Duan Y, Liu Y, Liang P, Jia X, Ye J, Dong H, Li K. White matter atrophy in brain of neuromyelitis optica: a voxel-based morphometry study. Acta Radiol 2014; 55:589-93. [PMID: 23966367 DOI: 10.1177/0284185113501815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown that tissue damage in neuromyelitis optica (NMO) is not limited to the spinal cord and optic nerve but can also appear in the brain. Previous magnetic resonance imaging (MRI) studies have reported controversial findings regarding the presence of white matter atrophy in NMO patients. PURPOSE To investigate regional white matter changes in NMO using voxel-based morphometry (VBM). MATERIAL AND METHODS Conventional MRI and T1-weighted three-dimensional MRI were performed on 20 patients with NMO and 20 age- and sex-matched normal controls (NCs). The data were analyzed by statistical parametric mapping 5 (SPM5) to generate white matter concentration maps, and regional white matter concentrations were compared between the two groups. Relationships between the white matter concentration in regions with significant group differences and the Expanded Disability Status Scale (EDSS) and disease duration were further explored. RESULTS Compared to NCs, NMO patients had decreased white matter volumes in the right precentral gyrus, right postcentral gyrus, left middle and medial frontal gyrus, right superior frontal gyrus, bilateral inferior and superior parietal lobule, right angular gyrus, right middle occipital gyrus, and left precuneus. No significant correlation was found between white matter regions with volume reduction and the EDSS and disease duration in NMO. CONCLUSION We found white matter atrophy in several brain regions in the frontal, parietal, and occipital lobes in NMO, suggesting that subtle white matter damage relevant to the motor, vision, and cognition systems exists in NMO patients. The pattern of white matter atrophy in NMO is different from that in multiple sclerosis (MS).
Collapse
Affiliation(s)
- Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Peipeng Liang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Xiuqin Jia
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
38
|
Tackley G, Kuker W, Palace J. Magnetic resonance imaging in neuromyelitis optica. Mult Scler 2014; 20:1153-64. [DOI: 10.1177/1352458514531087] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/16/2014] [Indexed: 12/18/2022]
Abstract
Neuromyelitis optica (NMO), or Devic’s disease, is a rare demyelinating disorder of the central nervous system that has a predilection for the optic nerve and spinal cord. Magnetic resonance imaging (MRI) is required to diagnose NMO. Longitudinally extensive transverse myelitis is NMO’s imaging hallmark and the presence of a brain MRI that is not diagnostic of multiple sclerosis (MS) also remains part of the diagnostic criteria. It is increasingly recognised that MS and NMO brain imaging can, however, have similar appearances but differences do exist: hypothalamic, periaqueductal grey and area postrema lesions implicate NMO whilst cortical, U-fibre or Dawson’s finger lesions are suggestive of MS. The timing of image acquisition, age, ethnicity and aquaporin-4 antibody status are all likely to alter the findings at MRI. This review therefore aims to overview and update the reader on NMO imaging, to provide clinically relevant guidance for diagnosing NMO and differentiating it from MS in order to guide management, and to highlight recent research insights.
Collapse
|
39
|
Matthews LA, Palace JA. The role of imaging in diagnosing neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2014; 3:284-93. [DOI: 10.1016/j.msard.2013.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/31/2013] [Accepted: 11/14/2013] [Indexed: 12/16/2022]
|
40
|
Colpak AI, Kurne AT, Oguz KK, Has AC, Dolgun A, Kansu T. White matter involvement beyond the optic nerves in CRION as assessed by diffusion tensor imaging. Int J Neurosci 2014; 125:10-7. [PMID: 24588222 DOI: 10.3109/00207454.2014.896912] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic relapsing inflammatory optic neuropathy (CRION) is an inflammatory optic neuropathy, characterized by relapses and remissions in patients with normal brain and spinal magnetic resonance imaging (MRI). Discrepancy from other demyelinating diseases is important, and it is still uncertain whether CRION is restricted to the optic pathways or it affects other brain white matter (WM) structures. OBJECTIVE To assess WM structure in patients with CRION by using diffusion tensor imaging (DTI). METHODS DTI was performed in six CRION patients and six age- and sex-matched healthy controls on a 3 T scanner. Tract-based spatial statistics (TBSS) was used for voxelwise statistical analysis of DTI data. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) measures were obtained. RESULTS TBSS analysis revealed two different patterns of WM alterations in patients with CRION. The optic chiasm and connected structures had significantly higher FA and lower RD, AD and MD in the patients than in the healthy controls. On the other hand, anterior frontal bundles of inferior fronto-occipital tracts, left uncinate fascicule and internal capsule showed decreased FA and increased RD. No correlation was found between the clinical variables and diffusion measures. CONCLUSION WM appearing normal on brain MRI shows widespread abnormalities in a cohort of CRION patients as assessed by DTI.
Collapse
|
41
|
Kawachi I, Nishizawa M. Gray matter involvement in multiple sclerosis and neuromyelitis optica. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cen3.12077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Izumi Kawachi
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
| | - Masatoyo Nishizawa
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
| |
Collapse
|
42
|
von Glehn F, Jarius S, Cavalcanti Lira RP, Alves Ferreira MC, von Glehn FHR, Costa E Castro SM, Beltramini GC, Bergo FP, Farias AS, Brandão CO, Wildemann B, Damasceno BP, Cendes F, Santos LMB, Yasuda CL. Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders. Mult Scler 2014; 20:1189-97. [PMID: 24477120 DOI: 10.1177/1352458513519838] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO. OBJECTIVE This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness. METHODS Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed. RESULTS We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease. CONCLUSIONS Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.
Collapse
Affiliation(s)
- Felipe von Glehn
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany
| | | | | | | | | | - Guilherme Coco Beltramini
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil Institute of Physics "Gleb Wataghin", University of Campinas, Brazil
| | - Felipe Pg Bergo
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Alessandro S Farias
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil
| | - Carlos Otávio Brandão
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany
| | - Benito P Damasceno
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Leonilda M B Santos
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| |
Collapse
|
43
|
Vanotti S, Cores EV, Eizaguirre B, Melamud L, Rey R, Villa A. Cognitive performance of neuromyelitis optica patients: comparison with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:357-61. [PMID: 23828523 DOI: 10.1590/0004-282x20130038] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 11/21/2022]
Abstract
UNLABELLED The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO) and to compare it with multiple sclerosis (MS) patients' performance. METHODS Fourteen NMO, 14 relapsing remitting multiple sclerosis (RRMS), and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency. RESULTS Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT). However, no difference was found between NMO and RRMS patients. CONCLUSIONS The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found. O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO) e compará-lo com o desempenho de pacientes com esclerose múltipla (EM). Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR) e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, com maiores déficits de atenção. Pacientes com NMO superaram os controles saudáveis em PASAT. No entanto, não foi encontrada diferença entre os pacientes com NMO e aqueles com EMRR. Conclusões: O Grupo NMO mostrou mais disfunção nas fluências de atenção e verbais do que nas memórias verbal e visual. Quando comparados com os pacientes com EM, um padrão de disfunção semelhante foi encontrado.
Collapse
Affiliation(s)
- Sandra Vanotti
- Neuroimmunology and Electrophysiology Section, J. M. Ramos Mejia Hospital, Buenos Aires, Argentina.
| | | | | | | | | | | |
Collapse
|
44
|
Sánchez-Catasús CA, Cabrera-Gomez J, Almaguer Melián W, Giroud Benítez JL, Rodríguez Rojas R, Bayard JB, Galán L, Sánchez RG, Fuentes NP, Valdes-Sosa P. Brain Tissue Volumes and Perfusion Change with the Number of Optic Neuritis Attacks in Relapsing Neuromyelitis Optica: A Voxel-Based Correlation Study. PLoS One 2013; 8:e66271. [PMID: 23824339 PMCID: PMC3688888 DOI: 10.1371/journal.pone.0066271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/03/2013] [Indexed: 12/16/2022] Open
Abstract
Recent neuroimaging studies show that brain abnormalities in neuromyelitis optica (NMO) are more frequent than earlier described. Yet, more research considering multiple aspects of NMO is necessary to better understand these abnormalities. A clinical feature of relapsing NMO (RNMO) is that the incremental disability is attack-related. Therefore, association between the attack-related process and neuroimaging might be expected. On the other hand, the immunopathological analysis of NMO lesions has suggested that CNS microvasculature could be an early disease target, which could alter brain perfusion. Brain tissue volume changes accompanying perfusion alteration could also be expected throughout the attack-related process. The aim of this study was to investigate in RNMO patients, by voxel-based correlation analysis, the assumed associations between regional brain white (WMV) and grey matter volumes (GMV) and/or perfusion on one side, and the number of optic neuritis (ON) attacks, myelitis attacks and/or total attacks on the other side. For this purpose, high resolution T1-weighted MRI and perfusion SPECT imaging were obtained in 15 RNMO patients. The results showed negative regional correlations of WMV, GMV and perfusion with the number of ON attacks, involving important components of the visual system, which could be relevant for the comprehension of incremental visual disability in RNMO. We also found positive regional correlation of perfusion with the number of ON attacks, mostly overlapping the brain area where the WMV showed negative correlation. This provides evidence that brain microvasculature is an early disease target and suggests that perfusion alteration could be important in the development of brain structural abnormalities in RNMO.
Collapse
|
45
|
Popescu BFG, Lucchinetti CF. Pathology of demyelinating diseases. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2013; 7:185-217. [PMID: 22313379 DOI: 10.1146/annurev-pathol-011811-132443] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There has been significant progress in our understanding of the pathology and pathogenesis of central nervous system inflammatory demyelinating diseases. Neuropathological studies have provided fundamental new insights into the pathogenesis of these disorders and have led to major advances in our understanding of multiple sclerosis (MS) heterogeneity, the substrate of irreversible progressive disability in MS, the relationship between inflammation and neurodegeneration in MS, the neuroimaging correlates of MS lesions, and the pathogenesis of other central nervous system inflammatory disorders, including neuromyelitis optica, acute disseminated encephalomyelitis, and Balo's concentric sclerosis. Herein, we review the pathological features of these central nervous system inflammatory demyelinating disorders and discuss neuropathological studies that have yielded novel insights into potential mechanisms involved in the formation of the demyelinated lesion.
Collapse
Affiliation(s)
- Bogdan F Gh Popescu
- Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Saskatchewan S7K 0M7, Canada.
| | | |
Collapse
|
46
|
Saji E, Arakawa M, Yanagawa K, Toyoshima Y, Yokoseki A, Okamoto K, Otsuki M, Akazawa K, Kakita A, Takahashi H, Nishizawa M, Kawachi I. Cognitive impairment and cortical degeneration in neuromyelitis optica. Ann Neurol 2013; 73:65-76. [PMID: 23378324 DOI: 10.1002/ana.23721] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/09/2012] [Accepted: 07/30/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Neuromyelitis optica spectrum disorder (NMOsd) is an inflammatory and demyelinating syndrome characterized by optic neuritis and myelitis. Several magnetization transfer magnetic resonance imaging (MRI) studies have revealed abnormalities in normal-appearing gray matter in NMOsd. The aim of this study is to elucidate the characteristics and pathogenesis of cognitive impairment and neurodegeneration in NMOsd brains. METHODS Fourteen Japanese patients with serologically verified NMOsd, 17 patients with multiple sclerosis (MS), and 37 healthy controls were assessed with the Rao's Brief Repeatable Battery of Neuropsychological Tests (BRBN). Using 128 tissue blocks from 6 other cases of NMOsd, 3 cases of MS, and 4 controls without central nervous system involvement, we performed quantitative analysis of cortical neuronal loss and layer-specific changes in NMOsd. RESULTS In BRBN assessments, 57% of NMOsd patients and 47% of MS patients had impaired performance on at least 3 cognitive tests. Cognitive impairment in NMOsd was common even in the limited form of disease, indicating that NMOsd may progress insidiously from early stages of disease. Neuropathological assessments showed neuronal loss in cortical layers II, III, and IV, with nonlytic reaction of aquaporin-4 (AQP4)-negative astrocytes in layer I, massive activated microglia in layer II, and meningeal inflammation in NMOsd brains. All NMO cases showed no evidence of cortical demyelination. INTERPRETATION We demonstrate cognitive impairment and substantial cortical neuronal loss with unique AQP4 dynamics in astrocytes in NMOsd. These data indicate pathological processes consisting not only of inflammatory demyelinating events characterized by pattern-specific loss of AQP4 immunoreactivity but also cortical neurodegeneration in NMOsd brains.
Collapse
Affiliation(s)
- Etsuji Saji
- Department of Neurology, Niigata University, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Jeantroux J, Kremer S, Lin X, Collongues N, Chanson JB, Bourre B, Fleury M, Blanc F, Dietemann JL, de Seze J. Diffusion tensor imaging of normal-appearing white matter in neuromyelitis optica. J Neuroradiol 2012; 39:295-300. [DOI: 10.1016/j.neurad.2011.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 10/16/2011] [Accepted: 10/19/2011] [Indexed: 11/29/2022]
|
48
|
Liu Y, Duan Y, He Y, Wang J, Xia M, Yu C, Dong H, Ye J, Butzkueven H, Li K, Shu N. Altered topological organization of white matter structural networks in patients with neuromyelitis optica. PLoS One 2012; 7:e48846. [PMID: 23144994 PMCID: PMC3492259 DOI: 10.1371/journal.pone.0048846] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the topological alterations of the whole-brain white-matter (WM) structural networks in patients with neuromyelitis optica (NMO). Methods The present study involved 26 NMO patients and 26 age- and sex-matched healthy controls. WM structural connectivity in each participant was imaged with diffusion-weighted MRI and represented in terms of a connectivity matrix using deterministic tractography method. Graph theory-based analyses were then performed for the characterization of brain network properties. A multiple linear regression analysis was performed on each network metric between the NMO and control groups. Results The NMO patients exhibited abnormal small-world network properties, as indicated by increased normalized characteristic path length, increased normalized clustering and increased small-worldness. Furthermore, largely similar hub distributions of the WM structural networks were observed between NMO patients and healthy controls. However, regional efficiency in several brain areas of NMO patients was significantly reduced, which were mainly distributed in the default-mode, sensorimotor and visual systems. Furthermore, we have observed increased regional efficiency in a few brain regions such as the orbital parts of the superior and middle frontal and fusiform gyri. Conclusion Although the NMO patients in this study had no discernible white matter T2 lesions in the brain, we hypothesize that the disrupted topological organization of WM networks provides additional evidence for subtle, widespread cerebral WM pathology in NMO.
Collapse
Affiliation(s)
- Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, P.R. China
| | - Jun Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, P.R. China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, P.R. China
| | - Chunshui Yu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
- * E-mail: (NS); (KL)
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, P.R. China
- * E-mail: (NS); (KL)
| |
Collapse
|
49
|
Awad A, Stüve O. Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. Curr Neuropharmacol 2012; 9:417-28. [PMID: 22379456 PMCID: PMC3151596 DOI: 10.2174/157015911796557948] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 04/18/2010] [Accepted: 04/19/2010] [Indexed: 12/05/2022] Open
Abstract
Transverse myelitis is a focal inflammatory disorder of the spinal cord which may arise due to different etiologies. Transverse myelitis may be idiopathic or related/secondary to other diseases including infections, connective tissue disorders and other autoimmune diseases. It may be also associated with optic neuritis (neuromyelitis optica), which may precede transverse myelitis. In this manuscript we review the pathophysiology of different types of transverse myelitis and neuromyelitis optica and discuss diagnostic criteria for idiopathic transverse myelitis and risk of development of multiple sclerosis after an episode of transverse myelitis. We also discuss treatment options including corticosteroids, immunosuppressives and monoclonal antibodies, plasma exchange and intravenous immunoglobulins.
Collapse
Affiliation(s)
- Amer Awad
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | | |
Collapse
|
50
|
White matter atrophy and cognitive dysfunctions in neuromyelitis optica. PLoS One 2012; 7:e33878. [PMID: 22509264 PMCID: PMC3317931 DOI: 10.1371/journal.pone.0033878] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 02/20/2012] [Indexed: 11/19/2022] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory disease of central nervous system characterized by optic neuritis and longitudinally extensive acute transverse myelitis. NMO patients have cognitive dysfunctions but other clinical symptoms of brain origin are rare. In the present study, we aimed to investigate cognitive functions and brain volume in NMO. The study population consisted of 28 patients with NMO and 28 healthy control subjects matched for age, sex and educational level. We applied a French translation of the Brief Repeatable Battery (BRB-N) to the NMO patients. Using SIENAx for global brain volume (Grey Matter, GM; White Matter, WM; and whole brain) and VBM for focal brain volume (GM and WM), NMO patients and controls were compared. Voxel-level correlations between diminished brain concentration and cognitive performance for each tests were performed. Focal and global brain volume of NMO patients with and without cognitive impairment were also compared. Fifteen NMO patients (54%) had cognitive impairment with memory, executive function, attention and speed of information processing deficits. Global and focal brain atrophy of WM but not Grey Matter (GM) was found in the NMO patients group. The focal WM atrophy included the optic chiasm, pons, cerebellum, the corpus callosum and parts of the frontal, temporal and parietal lobes, including superior longitudinal fascicle. Visual memory, verbal memory, speed of information processing, short-term memory and executive functions were correlated to focal WM volumes. The comparison of patients with, to patients without cognitive impairment showed a clear decrease of global and focal WM, including brainstem, corticospinal tracts, corpus callosum but also superior and inferior longitudinal fascicles. Cognitive impairment in NMO patients is correlated to the decreased of global and focal WM volume of the brain. Further studies are needed to better understand the precise origin of cognitive impairment in NMO patients, particularly in the WM.
Collapse
|