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Noffs G, Boonstra FMC, Perera T, Butzkueven H, Kolbe SC, Maldonado F, Cofre Lizama LE, Galea MP, Stankovich J, Evans A, van der Walt A, Vogel AP. Speech metrics, general disability, brain imaging and quality of life in multiple sclerosis. Eur J Neurol 2020; 28:259-268. [PMID: 32916031 DOI: 10.1111/ene.14523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/30/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Objective measurement of speech has shown promising results to monitor disease state in multiple sclerosis. In this study, we characterize the relationship between disease severity and speech metrics through perceptual (listener based) and objective acoustic analysis. We further look at deviations of acoustic metrics in people with no perceivable dysarthria. METHODS Correlations and regression were calculated between speech measurements and disability scores, brain volume, lesion load and quality of life. Speech measurements were further compared between three subgroups of increasing overall neurological disability: mild (as rated by the Expanded Disability Status Scale ≤2.5), moderate (≥3 and ≤5.5) and severe (≥6). RESULTS Clinical speech impairment occurred majorly in people with severe disability. An experimental acoustic composite score differentiated mild from moderate (P < 0.001) and moderate from severe subgroups (P = 0.003), and correlated with overall neurological disability (r = 0.6, P < 0.001), quality of life (r = 0.5, P < 0.001), white matter volume (r = 0.3, P = 0.007) and lesion load (r = 0.3, P = 0.008). Acoustic metrics also correlated with disability scores in people with no perceivable dysarthria. CONCLUSIONS Acoustic analysis offers a valuable insight into the development of speech impairment in multiple sclerosis. These results highlight the potential of automated analysis of speech to assist in monitoring disease progression and treatment response.
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Affiliation(s)
- G Noffs
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - F M C Boonstra
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - T Perera
- The Bionics Institute, Melbourne, VIC, Australia.,Department of Medical Bionics, University of Melbourne, Melbourne, VIC, Australia
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - S C Kolbe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - F Maldonado
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia
| | - L Euardo Cofre Lizama
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Australia Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia.,School of Allied Health, Human Services and Sports, La Trobe University, Melbourne, VIC, Australia
| | - M P Galea
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Australia Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - A Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia
| | - A van der Walt
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia
| | - A P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, VIC, Australia.,The Bionics Institute, Melbourne, VIC, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Redenlab, Melbourne, VIC, Australia
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Van der Walt A, Buzzard K, Sung S, Spelman T, Kolbe SC, Marriott M, Butzkueven H, Evans A. The occurrence of dystonia in upper-limb multiple sclerosis tremor. Mult Scler 2015; 21:1847-55. [PMID: 26014602 DOI: 10.1177/1352458515577690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathophysiology of multiple sclerosis (MS) tremor is uncertain with limited phenotypical studies available. OBJECTIVE To investigate whether dystonia contributes to MS tremor and its severity. METHODS MS patients (n = 54) with and without disabling uni- or bilateral upper limb tremor were recruited (39 limbs per group). We rated tremor severity, writing and Archimedes spiral drawing; cerebellar dysfunction (SARA score); the Global Dystonia Scale (GDS) for proximal and distal upper limbs, dystonic posturing, mirror movements, geste antagoniste, and writer's cramp. RESULTS Geste antagoniste, mirror dystonia, and dystonic posturing were more frequent and severe (p < 0.001) and dystonia scores were correlated with tremor severity in tremor compared to non-tremor patients. A 1-unit increase in distal dystonia predicted a 0.52-Bain unit (95% confidence interval (CI) 0.08-0.97), p = 0.022) increase in tremor severity and a 1-unit (95% CI 0.48-1.6, p = 0.001) increase in drawing scores. A 1-unit increase in proximal dystonia predicted 0.93-Bain unit increase (95% CI 0.45-1.41, p < 0.001) in tremor severity and 1.5-units (95% CI 0.62-2.41, p = 0.002) increase in the drawing score. Cerebellar function in the tremor limb and tremor severity was correlated (p < 0.001). CONCLUSIONS Upper limb dystonia is common in MS tremor suggesting that MS tremor pathophysiology involves cerebello-pallido-thalamo-cortical network dysfunction.
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Affiliation(s)
- A Van der Walt
- Department of Neurology, Royal/Melbourne Hospital, Australia Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia/Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - K Buzzard
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S Sung
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - T Spelman
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S C Kolbe
- Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - M Marriott
- Department of Neurology, Royal Melbourne Hospital, Australia/Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - H Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Australia/Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia
| | - A Evans
- Department of Neurology, Royal Melbourne Hospital, Australia
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Liu Y, Mitchell PJ, Kilpatrick TJ, Stein MS, Harrison LC, Baker J, Ditchfield M, Li K, Egan GF, Butzkueven H, Kolbe SC. Diffusion tensor imaging of acute inflammatory lesion evolution in multiple sclerosis. J Clin Neurosci 2012; 19:1689-94. [PMID: 23084347 DOI: 10.1016/j.jocn.2012.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 03/28/2012] [Accepted: 03/31/2012] [Indexed: 10/27/2022]
Abstract
The initiating events in multiple sclerosis (MS) plaque formation are poorly understood. Retrospective analysis of serial imaging data can improve the understanding of tissue changes characterising acute MS lesion evolution. This study aimed to assess lesion evolution using diffusion tensor imaging data from serially acquired scans from 22 patients with MS. Mean diffusivity (MD) and fractional anisotropy (FA) were measured from 13 suitable plaques from five patients and carefully matched regions of contralateral normal-appearing white matter. Measurement times were on average: 5 months and 1 month prior to, during, and 1 month and 2 months post gadolinium-enhancement. A significant increase in MD (7.25%) but no change in FA was observed in white matter areas that exhibited enhancement 5 months later. The pre-lesional MD increase was significantly correlated with the MD increase 2 months subsequent to enhancement (R=0.73, p=0.04) but not to the MD increase during enhancement (R=0.11). These results suggest that MD is sensitive to tissue changes that precede blood-brain barrier (BBB) breakdown by at least 5 months and that MD assessments may predict injury following BBB restoration.
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Affiliation(s)
- Y Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Stein MS, Liu Y, Gray OM, Baker JE, Kolbe SC, Ditchfield MR, Egan GF, Mitchell PJ, Harrison LC, Butzkueven H, Kilpatrick TJ. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis. Neurology 2011; 77:1611-8. [PMID: 22025459 DOI: 10.1212/wnl.0b013e3182343274] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. We therefore evaluated the effects of high-dose vitamin D2 (D2) in MS. METHODS Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind placebo-controlled high-dose vitamin D2, 6,000 IU capsules, dose adjusted empirically aiming for a serum 25OHD 130-175 nM. All received daily low-dose (1,000 IU) D2 to prevent deficiency. Brain MRIs were performed at baseline, 4, 5, and 6 months. Primary endpoints were the cumulative number of new gadolinium-enhancing lesions and change in the total volume of T2 lesions. Secondary endpoints were Expanded Disability Status Scale (EDSS) score and relapses. RESULTS Twenty-three people were randomized, of whom 19 were on established interferon or glatiramer acetate (Copaxone) treatment. Median 25OHD rose from 54 to 69 nM (low-dose D2) vs 59 to 120 nM (high-dose D2) (p = 0.002). No significant treatment differences were detected in the primary MRI endpoints. Exit EDSS, after adjustment for entry EDSS, was higher following high-dose D2 than following low-dose D2 (p = 0.05). There were 4 relapses with high-dose D2 vs none with low-dose D2 (p = 0.04). CONCLUSION We did not find a therapeutic advantage in RRMS for high-dose D2 over low-dose D2 supplementation. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that high-dose vitamin D2 (targeting 25OHD 130-175 nM), compared to low-dose supplementation (1,000 IU/d), was not effective in reducing MRI lesions in patients with RRMS.
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Affiliation(s)
- M S Stein
- Department of Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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