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Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
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Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
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Zekibakhsh Mohammadi N, Kianimoghadam AS, Mikaeili N, Asgharian SS, Jafari M, Masjedi-Arani A. Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety. Neurol Res Int 2024; 2024:6776758. [PMID: 38322749 PMCID: PMC10843872 DOI: 10.1155/2024/6776758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/07/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P < 0.001), stress (r = 0.40; P < 0.001), and anxiety (r = 0.52; P < 0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = -0.001; P < 0.985), but age had a relationship with insomnia (r = -0.146; P < 0.021) and oversleeping (r = 0.153; P < 0.015). Age and fatigue did not have a significant relationship as well (r = -0.044; P < 0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P < 0.001), stress (r = 0.48; P < 0.001), and anxiety (r = 0.54; P < 0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P < 0.001) and 0.35% of the total variance of fatigue (F = 44.64; P < 0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.
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Affiliation(s)
- Nassim Zekibakhsh Mohammadi
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, Religion and Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Mikaeili
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | | | - Mahdieh Jafari
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sun D, Wang R, Du Q, Zhang Y, Chen H, Shi Z, Wang X, Zhou H. Causal relationship between multiple sclerosis and cortical structure: a Mendelian randomization study. J Transl Med 2024; 22:83. [PMID: 38245759 PMCID: PMC10800041 DOI: 10.1186/s12967-024-04892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Observational studies have suggested an association between multiple sclerosis (MS) and cortical structure, but the results have been inconsistent. OBJECTIVE We used two-sample Mendelian randomization (MR) to assess the causal relationship between MS and cortical structure. METHODS MS data as the exposure trait, including 14,498 cases and 24,091 controls, were obtained from the International Multiple Sclerosis Genetics Consortium. Genome-wide association study (GWAS) data for cortical surface area (SAw/nw) and thickness (THw/nw) in 51,665 individuals of European ancestry were obtained from the ENIGMA Consortium. The inverse-variance weighted (IVW) method was used as the primary analysis for MR. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. Enrichment analysis was performed on MR analyses filtered by sensitivity analysis. RESULTS After IVW and sensitivity analysis filtering, only six surviving MR results provided suggestive evidence supporting a causal relationship between MS and cortical structure, including lingual SAw (p = .0342, beta (se) = 5.7127 (2.6969)), parahippocampal SAw (p = .0224, beta (se) = 1.5577 (0.6822)), rostral middle frontal SAw (p = .0154, beta (se) = - 9.0301 (3.7281)), cuneus THw (p = .0418, beta (se) = - 0.0020 (0.0010)), lateral orbitofrontal THw (p = .0281, beta (se) = 0.0025 (0.0010)), and lateral orbitofrontal THnw (p = .0417, beta (se) = 0.0029 (0.0014)). Enrichment analysis suggested that leukocyte cell-related pathways, JAK-STAT signaling pathway, NF-kappa B signaling pathway, cytokine-cytokine receptor interaction, and prolactin signaling pathway may be involved in the effect of MS on cortical morphology. CONCLUSION Our results provide evidence supporting a causal relationship between MS and cortical structure. Enrichment analysis suggests that the pathways mediating brain morphology abnormalities in MS patients are mainly related to immune and inflammation-driven pathways.
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Affiliation(s)
- Dongren Sun
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
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Jakimovski D, Zivadinov R, Weinstock Z, Fuchs TA, Bartnik A, Dwyer MG, Bergsland N, Weinstock-Guttman B, Benedict RHB. Cortical thickness and cognition in older people with multiple sclerosis. J Neurol 2023; 270:5223-5234. [PMID: 37634161 DOI: 10.1007/s00415-023-11945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The structural changes associated with cognitive performance in older people with multiple sclerosis (PwMS; age ≥ 50 years old) remain unknown. OBJECTIVE To determine the relationship between whole-brain (WBV), thalamus as the largest deep gray matter nuclei, and cortex-specific volume measurements with both cognitive impairment and numerical performance in older PwMS. The main hypothesis is that cognitive impairment (CI) in older PwMS is explained by cortical thinning in addition to global and thalamic neurodegenerative changes. METHODS A total of 101 older PwMS underwent cognitive and neuroimaging assessment. Cognitive assessment included tests established as sensitive in MS samples (Minimal Assessment of Cognitive Function in MS; MACFIMS), as well as those tests often utilized in Alzheimer's dementia studies (Wechsler's Memory Scale, Boston Naming Test, Visual Motor Integration and language). Cognitive impairment (CI) was based on -1.5 standard deviations in at least 2 cognitive domains (executive function, learning and memory, spatial processing, processing speed and working memory and language) when compared to healthy controls. WBV and thalamic volume were calculated using SIENAX/FIRST and cortical thickness using FreeSurfer. Differences in cortical thickness between CI and cognitively preserved (CP) were determined using age, sex, education, depression and WBV-adjusted analysis of covariance (ANCOVA). The relationship between domain-specific cognitive performance and cortical thickness was analyzed by linear regression models adjusted for age, sex, education, depression, WBV and thalamic volume. Benjamini-Hochberg-adjusted p-values lower than 0.05 were considered significant. RESULTS The average age of the study population was 62.6 (5.9) years old. After adjustment, CI PwMS had significantly thinner left fusiform (p = 0.0003), left inferior (p = 0.0032), left transverse (p = 0.0013), and bilateral superior temporal gyri (p = 0.002 and p = 0.0011) when compared to CP PwMS. After adjusting for age, sex, education, depression WBV, and thalamic volume, CI status was additionally predicted by the thickness of the left fusiform (p = 0.001) and left cuneus gyri (p = 0.004). After the adjustment, SDMT scores were additionally associated with left fusiform gyrus (p < 0.001) whereas letter-based verbal fluency performance with left pars opercularis gyrus (p < 0.001). CONCLUSION In addition to global and thalamic neurodegenerative changes, the presence of CI in older PwMS is additionally explained by the thickness of multiple cortical regions.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA.
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Zachary Weinstock
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
| | - Tom A Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
| | - Alexander Bartnik
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St., Buffalo, NY, 14203, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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Xie L, Lv J, Saimaier K, Han S, Han M, Wang C, Liu G, Zhuang W, Jiang X, Du C. The novel small molecule TPN10518 alleviates EAE pathogenesis by inhibiting AP1 to depress Th1/Th17 cell differentiation. Int Immunopharmacol 2023; 123:110787. [PMID: 37591119 DOI: 10.1016/j.intimp.2023.110787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
Multiple sclerosis (MS) is one of the most common autoimmune diseases of central nervous system (CNS) demyelination. Experimental autoimmune encephalomyelitis (EAE) is the most classic animal model for simulating the onset of clinical symptoms in MS. Previous research has reported the anti-inflammatory effects of artemisinin on autoimmune diseases. In our study, we identified a novel small molecule, TPN10518, an artemisinin derivative, which plays a protective role on the EAE model. We found that TPN10518 reduced CNS inflammatory cell infiltration and alleviated clinical symptoms of EAE. In addition, TPN10518 downregulated the production of Th1 and Th17 cells in vivo and in vitro, and decrease the levels of related chemokines. RNA-seq assay combined with the experimental results demonstrated that TPN10518 lowered the mRNA and protein levels of the AP1 subunits c-Fos and c-Jun in EAE mice. It was further confirmed that TPN10518 was dependent on AP1 to inhibit the differentiation of Th1 and Th17 cells. The results suggest that TPN10518 reduces the production of Th1 and Th17 cells through inhibition of AP1 to alleviate the severity of EAE disease. It is expected to be a potential drug for the treatment of MS.
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Affiliation(s)
- Ling Xie
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Jie Lv
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Kaidireya Saimaier
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Sanxing Han
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Mengyao Han
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Chun Wang
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Guangyu Liu
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Wei Zhuang
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Xiangrui Jiang
- University of Chinese Academy of Sciences, Beijing, China; CAS Key Laboratory for Receptor Research, Shanghai Institute of Materia, Medica, Chinese Academy of Sciences, Shanghai, China
| | - Changsheng Du
- Putuo People's Hospital, Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai, China.
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Meijboom R, York EN, Kampaite A, Harris MA, White N, Valdés Hernández MDC, Thrippleton MJ, MacDougall NJJ, Connick P, Hunt DPJ, Chandran S, Waldman AD. Patterns of brain atrophy in recently-diagnosed relapsing-remitting multiple sclerosis. PLoS One 2023; 18:e0288967. [PMID: 37506096 PMCID: PMC10381059 DOI: 10.1371/journal.pone.0288967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Recurrent neuroinflammation in relapsing-remitting MS (RRMS) is thought to lead to neurodegeneration, resulting in progressive disability. Repeated magnetic resonance imaging (MRI) of the brain provides non-invasive measures of atrophy over time, a key marker of neurodegeneration. This study investigates regional neurodegeneration of the brain in recently-diagnosed RRMS using volumetry and voxel-based morphometry (VBM). RRMS patients (N = 354) underwent 3T structural MRI <6 months after diagnosis and 1-year follow-up, as part of the Scottish multicentre 'FutureMS' study. MRI data were processed using FreeSurfer to derive volumetrics, and FSL for VBM (grey matter (GM) only), to establish regional patterns of change in GM and normal-appearing white matter (NAWM) over time throughout the brain. Volumetric analyses showed a decrease over time (q<0.05) in bilateral cortical GM and NAWM, cerebellar GM, brainstem, amygdala, basal ganglia, hippocampus, accumbens, thalamus and ventral diencephalon. Additionally, NAWM and GM volume decreased respectively in the following cortical regions, frontal: 14 out of 26 regions and 16/26; temporal: 18/18 and 15/18; parietal: 14/14 and 11/14; occipital: 7/8 and 8/8. Left GM and NAWM asymmetry was observed in the frontal lobe. GM VBM analysis showed three major clusters of decrease over time: 1) temporal and subcortical areas, 2) cerebellum, 3) anterior cingulum and supplementary motor cortex; and four smaller clusters within the occipital lobe. Widespread GM and NAWM atrophy was observed in this large recently-diagnosed RRMS cohort, particularly in the brainstem, cerebellar GM, and subcortical and occipital-temporal regions; indicative of neurodegeneration across tissue types, and in accord with limited previous studies in early disease. Volumetric and VBM results emphasise different features of longitudinal lobar and loco-regional change, however identify consistent atrophy patterns across individuals. Atrophy measures targeted to specific brain regions may provide improved markers of neurodegeneration, and potential future imaging stratifiers and endpoints for clinical decision making and therapeutic trials.
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Affiliation(s)
- Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Mathew A Harris
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole White
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - N J J MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
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Barile B, Ashtari P, Stamile C, Marzullo A, Maes F, Durand-Dubief F, Van Huffel S, Sappey-Marinier D. Classification of multiple sclerosis clinical profiles using machine learning and grey matter connectome. Front Robot AI 2022; 9:926255. [PMID: 36313252 PMCID: PMC9608344 DOI: 10.3389/frobt.2022.926255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: The main goal of this study is to investigate the discrimination power of Grey Matter (GM) thickness connectome data between Multiple Sclerosis (MS) clinical profiles using statistical and Machine Learning (ML) methods. Materials and Methods: A dataset composed of 90 MS patients acquired at the MS clinic of Lyon Neurological Hospital was used for the analysis. Four MS profiles were considered, corresponding to Clinical Isolated Syndrome (CIS), Relapsing-Remitting MS (RRMS), Secondary Progressive MS (SPMS), and Primary Progressive MS (PPMS). Each patient was classified in one of these profiles by our neurologist and underwent longitudinal MRI examinations including T1-weighted image acquisition at each examination, from which the GM tissue was segmented and the cortical GM thickness measured. Following the GM parcellation using two different atlases (FSAverage and Glasser 2016), the morphological connectome was built and six global metrics (Betweenness Centrality (BC), Assortativity (r), Transitivity (T), Efficiency (Eg), Modularity (Q) and Density (D)) were extracted. Based on their connectivity metrics, MS profiles were first statistically compared and second, classified using four different learning machines (Logistic Regression, Random Forest, Support Vector Machine and AdaBoost), combined in a higher level ensemble model by majority voting. Finally, the impact of the GM spatial resolution on the MS clinical profiles classification was analyzed. Results: Using binary comparisons between the four MS clinical profiles, statistical differences and classification performances higher than 0.7 were observed. Good performances were obtained when comparing the two early clinical forms, RRMS and PPMS (F1 score of 0.86), and the two neurodegenerative profiles, PPMS and SPMS (F1 score of 0.72). When comparing the two atlases, slightly better performances were obtained with the Glasser 2016 atlas, especially between RRMS with PPMS (F1 score of 0.83), compared to the FSAverage atlas (F1 score of 0.69). Also, the thresholding value for graph binarization was investigated suggesting more informative graph properties in the percentile range between 0.6 and 0.8. Conclusion: An automated pipeline was proposed for the classification of MS clinical profiles using six global graph metrics extracted from the GM morphological connectome of MS patients. This work demonstrated that GM morphological connectivity data could provide good classification performances by combining four simple ML models, without the cost of long and complex MR techniques, such as MR diffusion, and/or deep learning architectures.
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Affiliation(s)
- Berardino Barile
- CREATIS (UMR 5220 CNRS & U1294 INSERM), Université Claude Bernard Lyon1, INSA-Lyon, Université de Lyon, Lyon, France
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
| | - Pooya Ashtari
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
| | | | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - Frederik Maes
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
| | - Françoise Durand-Dubief
- CREATIS (UMR 5220 CNRS & U1294 INSERM), Université Claude Bernard Lyon1, INSA-Lyon, Université de Lyon, Lyon, France
- Hôpital Neurologique, Service de Neurologie, Hospices Civils de Lyon, Bron, France
| | | | - Dominique Sappey-Marinier
- CREATIS (UMR 5220 CNRS & U1294 INSERM), Université Claude Bernard Lyon1, INSA-Lyon, Université de Lyon, Lyon, France
- CERMEP–Imagerie du Vivant, Université de Lyon, Lyon, France
- *Correspondence: Dominique Sappey-Marinier,
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8
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Chitnis T, Vandercappellen J, King M, Brichetto G. Symptom Interconnectivity in Multiple Sclerosis: A Narrative Review of Potential Underlying Biological Disease Processes. Neurol Ther 2022; 11:1043-1070. [PMID: 35680693 PMCID: PMC9338216 DOI: 10.1007/s40120-022-00368-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Fatigue, cognitive impairment, depression, and pain are highly prevalent symptoms in multiple sclerosis (MS). These often co-occur and may be explained by a common etiology. By reviewing existing literature, we aimed to identify potential underlying biological processes implicated in the interconnectivity between these symptoms. Methods A literature search was conducted to identify articles reporting research into the biological mechanisms responsible for the manifestation of fatigue, cognitive impairment, depression, and pain in MS. PubMed was used to search for articles published from July 2011 to July 2021. We reviewed and assessed findings from the literature to identify biological processes common to the symptoms of interest. Results Of 693 articles identified from the search, 252 were selected following screening of titles and abstracts and assessing reference lists of review articles. Four biological processes linked with two or more of the symptoms of interest were frequently identified from the literature: (1) direct neuroanatomical changes to brain regions linked with symptoms of interest (e.g., thalamic injury associated with cognitive impairment, fatigue, and depression), (2) pro-inflammatory cytokines associated with so-called ‘sickness behavior,’ including manifestation of fatigue, transient cognitive impairment, depression, and pain, (3) dysregulation of monoaminergic pathways leading to depressive symptoms and fatigue, and (4) hyperactivity of the hypothalamic–pituitary-adrenal (HPA) axis as a result of pro-inflammatory cytokines promoting the release of brain noradrenaline, serotonin, and tryptophan, which is associated with symptoms of depression and cognitive impairment. Conclusion The co-occurrence of fatigue, cognitive impairment, depression, and pain in MS appears to be associated with a common set of etiological factors, namely neuroanatomical changes, pro-inflammatory cytokines, dysregulation of monoaminergic pathways, and a hyperactive HPA axis. This association of symptoms and biological processes has important implications for disease management strategies and, eventually, could help find a common therapeutic pathway that will impact both inflammation and neuroprotection. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00368-2.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Miriam King
- Novartis Pharma AG, Fabrikstrasse 12-2, 4056, Basel, Switzerland
| | - Giampaolo Brichetto
- Associazione Italiana Sclerosi Multipla Rehabilitation Center, Via Operai, 30, 16149, Genoa, GE, Italy
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9
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Yik JT, Becquart P, Gill J, Petkau J, Traboulsee A, Carruthers R, Kolind SH, Devonshire V, Sayao AL, Schabas A, Tam R, Moore GRW, Li DKB, Stukas S, Wellington C, Quandt JA, Vavasour IM, Laule C. Serum neurofilament light chain correlates with myelin and axonal magnetic resonance imaging markers in multiple sclerosis. Mult Scler Relat Disord 2022; 57:103366. [PMID: 35158472 DOI: 10.1016/j.msard.2021.103366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/08/2021] [Accepted: 11/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neurofilaments are cytoskeletal proteins that are detectable in the blood after neuroaxonal injury. Multiple sclerosis (MS) disease progression, greater lesion volume, and brain atrophy are associated with higher levels of serum neurofilament light chain (NfL), but few studies have examined the relationship between NfL and advanced magnetic resonance imaging (MRI) measures related to myelin and axons. We assessed the relationship between serum NfL and brain MRI measures in a diverse group of MS participants. METHODS AND MATERIALS 103 participants (20 clinically isolated syndrome, 33 relapsing-remitting, 30 secondary progressive, 20 primary progressive) underwent 3T MRI to obtain myelin water fraction (MWF), geometric mean T2 (GMT2), water content, T1; high angular resolution diffusion imaging (HARDI)-derived axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA); diffusion basis spectrum imaging (DBSI)-derived AD, RD, FA; restricted, hindered, water and fiber fractions; and volume measurements of normalized brain, lesion, thalamic, deep gray matter (GM), and cortical thickness. Multiple linear regressions assessed the strength of association between serum NfL (dependent variable) and each MRI measure in whole brain (WB), normal appearing white matter (NAWM) and T2 lesions (independent variables), while controlling for age, expanded disability status scale, and disease duration. RESULTS Serum NfL levels were significantly associated with metrics of axonal damage (FA: R2WB-HARDI = 0.29, R2NAWM-HARDI = 0.31, R2NAWM-DBSI = 0.30, R2Lesion-DBSI = 0.31; AD: R2WB-HARDI=0.31), myelin damage (MWF: R2WB = 0.29, R2NAWM = 0.30, RD: R2WB-HARDI = 0.32, R2NAWM-HARDI = 0.34, R2Lesion-DBSI = 0.30), edema and inflammation (T1: R2Lesion = 0.32; GMT2: R2WB = 0.31, R2Lesion = 0.31), and cellularity (restricted fraction R2WB = 0.30, R2NAWM = 0.32) across the entire MS cohort. Higher serum NfL levels were associated with significantly higher T2 lesion volume (R2 = 0.35), lower brain structure volumes (thalamus R2 = 0.31; deep GM R2 = 0.33; normalized brain R2 = 0.31), and smaller cortical thickness R2 = 0.31). CONCLUSION The association between NfL and myelin MRI markers suggest that elevated serum NfL is a useful biomarker that reflects not only acute axonal damage, but also damage to myelin and inflammation, likely due to the known synergistic myelin-axon coupling relationship.
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Affiliation(s)
- Jackie T Yik
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Becquart
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jasmine Gill
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Petkau
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Virginia Devonshire
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ana-Luiza Sayao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alice Schabas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G R Wayne Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sophie Stukas
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cheryl Wellington
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline A Quandt
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Vavasour
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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10
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Cruz-Gomez ÁJ, Forero L, Lozano-Soto E, Cano-Cano F, Sanmartino F, Rashid-López R, Paz-Expósito J, Gómez Ramirez JD, Espinosa-Rosso R, González-Rosa JJ. Cortical Thickness and Serum NfL Explain Cognitive Dysfunction in Newly Diagnosed Patients With Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1074. [PMID: 34465616 PMCID: PMC8409133 DOI: 10.1212/nxi.0000000000001074] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives To determine the relative importance of global or regional MRI and blood markers of neurodegeneration and neuroaxonal injury in predicting cognitive performance for recently diagnosed patients with multiple sclerosis (MS). Methods Thirty-five newly diagnosed patients with relapsing-remitting MS (RRMS) and 23 healthy controls (HCs) simultaneously completed a full clinical and neuropsychological assessment, structural brain MRI, and serum neurofilament light chain (sNfL) level test. Linear regression analyses were performed to determine which global or regional measures of gray matter (GM) atrophy and cortical thickness (CT), in combination with sNfL levels and clinical scores, are most strongly related to neuropsychological impairment. Results Compared with HCs, patients with MS showed bilateral thalamic GM atrophy (left, p = 0.033; right, p = 0.047) and diminished CT, particularly in the right superior and transverse temporal gyri (p = 0.045; p = 0.037). Regional atrophy failed to add predictive variance, whereas anxiety symptoms, sNfL, and global CT were the best predictors (R2 = 0.404; p < 0.001) of cognitive outcomes, with temporal thickness accounting for greater variance in cognitive deficits than global CT. Discussion Thalamic GM atrophy and thinning in temporal regions represent a distinctive MRI trait in the early stages of MS. Although sNfL levels alone do not clearly differentiate HCs and patients with RRMS, in combination with global and regional CT, sNfL levels can better explain the presence of underlying cognitive deficits. Hence, cortical thinning and sNfL increases can be considered 2 parallel neurodegenerative markers in the pathogenesis of progression in newly diagnosed patients with MS.
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Affiliation(s)
- Álvaro J Cruz-Gomez
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Lucía Forero
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Elena Lozano-Soto
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Fátima Cano-Cano
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Florencia Sanmartino
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Raúl Rashid-López
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Jsé Paz-Expósito
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Jaime D Gómez Ramirez
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Raúl Espinosa-Rosso
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain
| | - Javier J González-Rosa
- From the Institute of Biomedical Research and Innovation of Cadiz (INiBICA) (A.J.C.-G., L.F., E.L.-S., F.C.-C., F.S., R.R.-L., J.D.G.R., R.E.-R., J.J.G.-R.), Cadiz, Spain; Psychology Department (A.J.C.-G., E.L.-S., F.S., J.D.G.R., J.J.G.-R.), University of Cadiz, Spain; Neurology Department (L.F., R.R.-L., R.E.-R.), Puerta del Mar University Hospital, Cadiz, Spain; and Radiodiagnostic Department (J.P.-E.), Puerta del Mar Hospital, Cadiz, Spain.
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11
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Bross M, Hackett M, Bernitsas MM, Bao F, Carla-Santiago-Martinez, Bernitsas E. Cortical surface thickness, subcortical volumes and disability between races in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2021; 53:103025. [PMID: 34052742 DOI: 10.1016/j.msard.2021.103025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/25/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The interplay between cortical surface thickness (CTh), subcortical volumes (SCV) and disability in patients with relapsing remitting multiple sclerosis (RRMS) is still not clear. OBJECTIVE To examine the relationship between CTh, SCV, and disability and investigate differences in CTh, SCV and disability between African Americans (AA) and Caucasian Americans (CA). METHODS Sixty-five RRMS (33AA, 32 CA) participants underwent Expanded Disability Status Scale and Multiple Sclerosis Functional Composite (MSFC) assessments, including timed 25-foot walk (T25FW), nine-hole peg test (9HPT) on dominant (D) and non-dominant hand (ND) and paced auditory serial addition test (PASAT-3). Symbol digit modalities test (SDMT) was also administered. All participants underwent 3T brain MRI. CTh was measured in the Frontal (FA), Parietal (PA), Temporal (TA), Occipital (OA), Cingulate (CA), and Global (GA) cortical surface areas (CSA). SCV measurements included Thalamus (TV), Caudate (CV), Putamen (PV), Pallidum (PaV), Hippocampus (HV), Amygdala (AV), Accumbens (AcV), Brain Stem (BSV), and Deep Gray Matter Total Volume (DGMTV). A general linear model with multivariate analysis (MANOVA) was used to determine the differences between the two cohorts (SPSS vs 25). Spearman rank correlation analysis was performed to investigate the relationship between CTh and MSFC. RESULTS AA have significantly decreased FA, PA, TA, GA CTh compared to CA (p = 0.004, p = 0.018, p = 0.013, p = 0.015, respectively). SCV measurements were not significantly different. Only in CA, the MSFC measures correlate significantly with regional CSA CTh. In both races and in the entire group, T25FW correlates with TV, PV, AV, AcV and DGMTV (p < 0.05). Only in AA and the entire cohort, PASAT-3 correlates with TV and AcV(p = 0.041, p = 0.006, p = 0.006, p = 0.000 respectively). CONCLUSIONS Differences in CSA CTh reinforce the different disease pathobiology between AA and CA. Regional CTh may represent a useful biomarker related to multi-domain disability only in CA, while in AA DGM injury might be a more important contributor to disability. Longitudinal, large-scale studies are warranted to confirm our findings.
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Affiliation(s)
- Madeline Bross
- Wayne State University School of Medicine, Department of Neurology, USA
| | - Melody Hackett
- Wayne State University School of Medicine, Department of Neurology, USA
| | | | - Fen Bao
- Wayne State University School of Medicine, Department of Neurology, USA
| | | | - Evanthia Bernitsas
- Wayne State University School of Medicine, Department of Neurology, USA.
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12
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Imaging and depression in multiple sclerosis: a historical perspective. Neurol Sci 2021; 42:835-845. [PMID: 33411192 DOI: 10.1007/s10072-020-04951-z] [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: 02/28/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients affected with multiple sclerosis suffer from depression more frequently than the general population. Beyond psychosocial, genetic and immune-inflammatory factors, also the brain damage which is peculiar of multiple sclerosis has been claimed to have a role in the aetiology of depression in those patients. The study of this interesting relation has been implemented with both conventional and advanced magnetic resonance imaging techniques. The aim of this review is to provide a historical perspective on the link between multiple sclerosis-related depression and structural and functional brain damage. METHODS In this review, the results of the MRI studies regarding multiple sclerosis-related brain damage and the presence of depression are presented. RESULTS The findings of the reports reveal a link between brain pathology and depressive symptoms or the diagnosis of depression in multiple sclerosis. CONCLUSIONS Although a multifactorial aetiology has been theorized for depression and depressive symptoms in patients with multiple sclerosis, this review supports the hypothesis that the structural and functional brain impairment might substantially be amongst those factors. Thus, depression itself might be a symptom with a neuro-biological basis and not only the consequence of the disability derived from the neurological impairment.
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13
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Raimo S, Santangelo G, Trojano L. The emotional disorders associated with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:197-220. [PMID: 34389118 DOI: 10.1016/b978-0-12-822290-4.00009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is associated with a high prevalence of emotional and mood disorders. Emotional disorders may worsen during illness progression and affect the quality of life of patients and their families. MS is often associated with depression, with an increased risk of suicide, poor adherence to treatment, decreased functional status, and quality of life. The diagnosis and treatment of emotional and mood disorders in these patients is often challenging since several symptoms of these disorders overlap with those of MS. Other prevalent emotional disorders in MS include bipolar disorder, anxiety disorders, emotional blunting (apathy), and pseudobulbar affect. Early recognition and treatment of these comorbidities could contribute to the reduction of disability and even to decreased mortality. The aim of this chapter is to provide an up-to-date review of mood and emotional disorders that are often associated with MS, focusing on their epidemiology, clinical features, pathogenesis, assessment, and treatment. The interplay between the psychosocial impact of the chronic disability and the demyelinating structural lesions of the brain in precipitating emotional and mood disorders is discussed, as well as its implications for diagnosis and treatment.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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14
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Brune S, Høgestøl EA, Cengija V, Berg-Hansen P, Sowa P, Nygaard GO, Harbo HF, Beyer MK. LesionQuant for Assessment of MRI in Multiple Sclerosis-A Promising Supplement to the Visual Scan Inspection. Front Neurol 2020; 11:546744. [PMID: 33362682 PMCID: PMC7759639 DOI: 10.3389/fneur.2020.546744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Goals: Multiple sclerosis (MS) is a central nervous system inflammatory disease where magnetic resonance imaging (MRI) is an important tool for diagnosis and disease monitoring. Quantitative measurements of lesion volume, lesion count, distribution of lesions, and brain atrophy have a potentially significant value for evaluating disease progression. We hypothesize that utilizing software designed for evaluating MRI data in MS will provide more accurate and detailed analyses compared to the visual neuro-radiological evaluation. Methods: A group of 56 MS patients (mean age 35 years, 70% females and 96% relapsing-remitting MS) was examined with brain MRI one and 5 years after diagnosis. The T1 and FLAIR brain MRI sequences for all patients were analyzed using the LesionQuant (LQ) software. These data were compared with data from structured visual evaluations of the MRI scans performed by neuro-radiologists, including assessments of atrophy, and lesion count. The data from LQ were also compared with data from other validated research methods for brain segmentation, including assessments of whole brain volume and lesion volume. Correlations with clinical tests like the timed 25-foot walk test (T25FT) were performed to explore additional value of LQ analyses. Results: Lesion count assessments by LQ and by the neuro-radiologist were significantly correlated one year (cor = 0.92, p = 2.2 × 10−16) and 5 years (cor = 0.84, p = 2.7 × 10−16) after diagnosis. Analyzes of the intra- and interrater variability also correlated significantly (cor = 0.96, p < 0.001, cor = 0.97, p < 0.001). Significant positive correlation was found between lesion volume measured by LQ and by the software Cascade (cor = 0.7, p < 0.001. LQ detected a reduction in whole brain percentile >10 in 10 patients across the time-points, whereas the neuro-radiologist assessment identified six of these. The neuro-radiologist additionally identified five patients with increased atrophy in the follow-up period, all of them displayed decreasing low whole brain percentiles (median 11, range 8–28) in the LQ analysis. Significant positive correlation was identified between lesion volume measured by LQ and test performance on the T25FT both at 1 and 5 years after diagnosis. Conclusion: For the number of MS lesions at both time-points, we demonstrated strong correlations between the assessments done by LQ and the neuro-radiologist. Lesion volume evaluated with LQ correlated with T25FT performance. LQ-analyses classified more patients to have brain atrophy than the visual neuro-radiological evaluation. In conclusion, LQ seems like a promising supplement to the evaluation performed by neuro-radiologists, providing an automated tool for evaluating lesions in MS patients and also detecting early signs of atrophy in both a longitudinal and cross-sectional setting.
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Affiliation(s)
- Synne Brune
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Vanja Cengija
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Gro O Nygaard
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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15
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Ormstad H, Simonsen CS, Broch L, Maes DM, Anderson G, Celius EG. Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways. Mult Scler Relat Disord 2020; 46:102533. [PMID: 33010585 DOI: 10.1016/j.msard.2020.102533] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
Chronic fatigue and major depression (MDD)-like symptoms are common manifestations of multiple sclerosis (MS), both with huge impact on quality of life. Depression can manifest itself as fatigue, and depressive symptoms are often mistaken for fatigue, and vice versa. The two conditions are sometimes difficult to differentiate, and their relationship is unclear. Whether chronic fatigue and depression occur primarily, secondarily or coincidentally with activated immune-inflammatory pathways in MS is still under debate. We have carried out a descriptive review aiming to gain a deeper understanding of the relationship between chronic fatigue and depression in MS, and the shared pathways that underpin both conditions. This review focuses on immune-inflammatory pathways, the kynurenine pathway and the gut-brain axis. It seems likely that proinflammatory cytokines, tryptophan catabolites (the KYN pathway) and the gut-brain axis are involved in the mechanisms causing chronic fatigue and MDD-like symptoms in MS. However, the evidence base is weak, and more research is needed. In order to advance our understanding of the underlying pathological mechanisms, MS-related fatigue and depression should be examined using a longitudinal design and both immune-inflammatory and KYN pathway biomarkers should be measured, relevant clinical characteristics judiciously registered, and self-report instruments for both fatigue and depression should be used.
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Affiliation(s)
- Heidi Ormstad
- University of South-Eastern Norway and University Oslo Metropolitan University.
| | | | | | - Dr Michael Maes
- Chulalongkorn University, Bangkok, Thailand; Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Center, Deakin University, Australia
| | - George Anderson
- CRC Scotland & London, Eccleston Square, London, United Kingdom
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Al-Radaideh A, El-Haj N, Hijjawi N. Iron deposition and atrophy in cerebral grey matter and their possible association with serum iron in relapsing-remitting multiple sclerosis. Clin Imaging 2020; 69:238-242. [PMID: 32977196 DOI: 10.1016/j.clinimag.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The present study was carried out to investigate any possible linkage between cerebral grey matter volumetric, iron changes, white matter's lesions load and serum iron levels in a group of relapsing-remitting multiple sclerosis (RRMS) patients. MATERIALS AND METHODS Sixty-five RRMS patients along with thirty-four age-matched healthy controls (HCs) were recruited. Serum samples were isolated from blood samples which were collected in vacutainer plain tubes individually from both groups. Both groups were scanned at 1.5 T magnetic resonance imaging (MRI) using the following 3D sequences; T1-weighted gradient echo (MPRAGE), T2*-weighted gradient echo and T2-weighted fluid-attenuated inversion recovery (FLAIR). RESULTS Significant differences were observed between the RRMS patients and HCs for cortical and deep grey matter (dGM) volumes where cortical and dGM volumes in RRMS patient were significantly smaller than those in HCs. While iron deposition in the cortex, putamen (PT) and globus pallidus (GP) of RRMS patients were significantly higher than those of HCs, iron levels in thalamus (TH) and serum were significantly lower in RRMS compared to those in HCs. Except for T2 lesion load, none of volumetric measures showed any association with patients' disability status. Cerebral grey matter's iron changes did not show any association with those of serum. CONCLUSION Smaller cortical and subcortical grey matter volumes in RRMS patients compared to HCs were detected. None of the volumetric measures showed any association with patients' disability status. RRMS patients showed increased iron levels in the PT, GP and cortex and decreased levels in the TH and serum.
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Affiliation(s)
- Ali Al-Radaideh
- Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan.
| | - Nawal El-Haj
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Nawal Hijjawi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
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Hidalgo de la Cruz M, Valsasina P, Gobbi C, Gallo A, Zecca C, Bisecco A, Tedeschi G, Filippi M, Rocca MA. Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study. Mult Scler 2020; 27:827-840. [DOI: 10.1177/1352458520940548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Longitudinal evolution of cortical thickness (CTh) in different MS phenotypes has been rarely studied. Aim: To investigate the regional pattern and 1-year progression of cortical thinning in relapsing-remitting (RR) and progressive (P) MS. Methods: 3T high-resolution T1-weighted magnetic resonance imaging (MRI) was obtained from 86 patients (75 RRMS, 11 PMS) and 34 healthy controls (HC) at three European sites at baseline and 1-year follow-up. Using FreeSurfer, baseline CTh between-group differences, longitudinal CTh changes and their correlations with clinical and MRI variables were assessed. Results: Baseline frontal, parietal and sensorimotor atrophy was found in MS versus HC. Such pattern was driven by RRMS, while PMS showed additional parietal, insular and sensorimotor cortical atrophy versus RRMS. At 1-year versus baseline, additional frontal and temporal cortical thinning was detected in RRMS patients, while a widespread CTh reduction was found in PMS patients (significant at time-by-group interaction vs RRMS). In MS, baseline fronto-parietal atrophy correlated with more severe disability and higher lesion volume. Baseline inferior parietal CTh decrease and 1-year temporal cortical thinning correlated with more severe disability. Conclusion: Parieto-temporal baseline CTh abnormalities and thinning pattern over time characterized the main MS clinical phenotypes and were associated with 1-year disability worsening.
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Affiliation(s)
- Milagros Hidalgo de la Cruz
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Buechler R, Wotruba D, Michels L, Theodoridou A, Metzler S, Walitza S, Hänggi J, Kollias S, Rössler W, Heekeren K. Cortical Volume Differences in Subjects at Risk for Psychosis Are Driven by Surface Area. Schizophr Bull 2020; 46:1511-1519. [PMID: 32463880 PMCID: PMC7846193 DOI: 10.1093/schbul/sbaa066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In subjects at risk for psychosis, the studies on gray matter volume (GMV) predominantly reported volume loss compared with healthy controls (CON). However, other important morphological measurements such as cortical surface area (CSA) and cortical thickness (CT) were not systematically compared. So far, samples mostly comprised subjects at genetic risk or at clinical risk fulfilling an ultra-high risk (UHR) criterion. No studies comparing UHR subjects with at-risk subjects showing only basic symptoms (BS) investigated the differences in CSA or CT. Therefore, we aimed to unravel the contribution of the 2 morphometrical measures constituting the cortical volume (CV) and to test whether these groups inhere different morphometric features. We conducted a surface-based morphometric analysis in 34 CON, 46 BS, and 39 UHR to examine between-group differences in CV, CSA, and CT vertex-wise across the whole cortex. Compared with BS and CON, UHR individuals presented increased CV in frontal and parietal regions, which was driven by larger CSA. These groups did not differ in CT. Yet, at-risk subjects who later developed schizophrenia showed thinning in the occipital cortex. Furthermore, BS presented increased CSA compared with CON. Our results suggest that volumetric differences in UHR subjects are driven by CSA while CV loss in converters seems to be based on cortical thinning. We attribute the larger CSA in UHR to aberrant pruning representing a vulnerability to develop psychotic symptoms reflected in different levels of vulnerability for BS and UHR, and cortical thinning to a presumably stress-related cortical decomposition.
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Affiliation(s)
- Roman Buechler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland,To whom correspondence should be addressed; UniversitätsSpital Zürich Klinik für Neuroradiologie Frauenklinikstrasse 10, Zurich 8091, Switzerland; tel: +41-44-255-56-00, fax +41-44-255-45-04, e-mail:
| | - Diana Wotruba
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sibylle Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Jürgen Hänggi
- Department of Psychology, Division of Neuropsychology, University of Zurich, Zurich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland,Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy I, LVR-Hospital, Cologne, Germany
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Oset M, Stasiolek M, Matysiak M. Cognitive Dysfunction in the Early Stages of Multiple Sclerosis-How Much and How Important? Curr Neurol Neurosci Rep 2020; 20:22. [PMID: 32444997 PMCID: PMC7244611 DOI: 10.1007/s11910-020-01045-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that mainly affects young adults and that is one of the leading causes of disability in this age group, with cognitive impairment occurring early in the course of the disease. This article summarizes the current knowledge about cognitive dysfunction in the early phase of MS, including biomarkers, MRI correlates, and its value as a prognostic marker. Recent Findings New sets of neuropsychological tests have been established to screen for cognitive dysfunction more easily and accurately. Moreover, structural changes detected by brain MRI and several biomarkers found in cerebrospinal fluid and blood serum have been recently correlated with decreased cognitive performance. Additionally, factors influencing cognition in MS, such as disease-modifying therapy, mood disorders, and lifestyle, are better described. Summary Cognitive impairment early in the course of MS is suggested as a prognostic factor for disease progression. However, clear-cut definitions of the early stage of MS as well as unified criteria for the diagnosis of cognitive impairment are still lacking. New and more reliable tools for evaluating cognition in MS patients should be developed and introduced into everyday practice to facilitate the implementation of effective disease-modifying therapy, cognitive rehabilitation, and lifestyle management.
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Affiliation(s)
- Magdalena Oset
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Mariusz Stasiolek
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
| | - Mariola Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
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20
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Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study. Mult Scler Relat Disord 2019; 30:265-276. [DOI: 10.1016/j.msard.2019.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
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Høgestøl EA, Kaufmann T, Nygaard GO, Beyer MK, Sowa P, Nordvik JE, Kolskår K, Richard G, Andreassen OA, Harbo HF, Westlye LT. Cross-Sectional and Longitudinal MRI Brain Scans Reveal Accelerated Brain Aging in Multiple Sclerosis. Front Neurol 2019; 10:450. [PMID: 31114541 PMCID: PMC6503038 DOI: 10.3389/fneur.2019.00450] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disorder of the central nervous system. By combining longitudinal MRI-based brain morphometry and brain age estimation using machine learning, we tested the hypothesis that MS patients have higher brain age relative to chronological age than healthy controls (HC) and that longitudinal rate of brain aging in MS patients is associated with clinical course and severity. Seventy-six MS patients [71% females, mean age 34.8 years (range 21-49) at inclusion] were examined with brain MRI at three time points with a mean total follow up period of 4.4 years (±0.4 years). We used additional cross-sectional MRI data from 235 HC for case-control comparison. We applied a machine learning model trained on an independent set of 3,208 HC to estimate individual brain age and to calculate the difference between estimated and chronological age, termed brain age gap (BAG). We also assessed the longitudinal change rate in BAG in individuals with MS. MS patients showed significantly higher BAG (4.4 ± 6.6 years) compared to HC (Cohen's D = 0.69, p = 4.0 × 10-6). Longitudinal estimates of BAG in MS patients showed high reliability and suggested an accelerated rate of brain aging corresponding to an annual increase of 0.41 (SE = 0.15) years compared to chronological aging (p = 0.008). Multiple regression analyses revealed higher rate of brain aging in patients with more brain atrophy (Cohen's D = 0.86, p = 4.3 × 10-15) and increased white matter lesion load (WMLL) (Cohen's D = 0.55, p = 0.015). On average, patients with MS had significantly higher BAG compared to HC. Progressive brain aging in patients with MS was related to brain atrophy and increased WMLL. No significant clinical associations were found in our sample, future studies are warranted on this matter. Brain age estimation is a promising method for evaluation of subtle brain changes in MS, which is important for predicting clinical outcome and guide choice of intervention.
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Affiliation(s)
| | - Tobias Kaufmann
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gro O. Nygaard
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K. Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Knut Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hanne F. Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Lars T. Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Symptoms of fatigue and depression is reflected in altered default mode network connectivity in multiple sclerosis. PLoS One 2019; 14:e0210375. [PMID: 30933977 PMCID: PMC6443168 DOI: 10.1371/journal.pone.0210375] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/19/2019] [Indexed: 01/08/2023] Open
Abstract
Background Fatigue and depression are frequent and often co-occurring symptoms in multiple sclerosis (MS). Resting-state functional magnetic resonance imaging (rs-fMRI) represents a promising tool for disentangling differential associations between depression and fatigue and brain network function and connectivity. In this study we tested for associations between symptoms of fatigue and depression and DMN connectivity in patients with MS. Materials and methods Seventy-four MS patients were included on average 14 months after diagnosis. They underwent MRI scanning of the brain including rs-fMRI, and symptoms of fatigue and depression were assessed with Fatigue Severity Scale (FSS) and Beck Depression Inventory II (BDI). A principal component analysis (PCA) on FSS and BDI scores was performed, and the component scores were analysed using linear regression models to test for associations with default mode network (DMN) connectivity. Results We observed higher DMN connectivity with higher scores on the primary principal component reflecting common symptom burden for fatigue and depression (Cohen’s f2 = 0.075, t = 2.17, p = 0.03). The secondary principal component reflecting a pattern of low fatigue scores with high scores of depression was associated with lower DMN connectivity (Cohen’s f2 = 0.067, t = -2.1, p = 0.04). Using continuous mean scores of FSS we also observed higher DMN connectivity with higher symptom burden (t = 3.1, p = 0.003), but no significant associations between continuous sum scores of BDI and DMN connectivity (t = 0.8, p = 0.4). Conclusion Multivariate decomposition of FSS and BDI data supported both overlapping and unique manifestation of fatigue and depression in MS patients. Rs-fMRI analyses showed that symptoms of fatigue and depression were reflected in altered DMN connectivity, and that higher DMN activity was seen in MS patients with fatigue even with low depression scores.
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Arm J, Ribbons K, Lechner-Scott J, Ramadan S. Evaluation of MS related central fatigue using MR neuroimaging methods: Scoping review. J Neurol Sci 2019; 400:52-71. [PMID: 30903860 DOI: 10.1016/j.jns.2019.03.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fatigue is a common and debilitating symptom in multiple sclerosis (MS). Over the past decade, a growing body of research has focussed on the pathophysiological mechanisms underlying central (cognitive and physical) fatigue in MS. The precise mechanisms causing fatigue in MS patients are complex and poorly understood, and may differ between patients. Advanced quantitative magnetic resonance imaging (MRI) techniques allow for objective assessment of disease pathology and have been used to characterise the pathophysiology of central fatigue in MS. OBJECTIVE To systematically review the existing literature of MRI-based studies assessing the pathophysiological mechanisms of MS-related central fatigue. METHODS A systematic literature search of four major databases (PubMed, Medline, Embase, Scopus and Google Scholar) was conducted to identify MRI-based studies of MS-related fatigue published in the past 20 years. Studies using the following MRI-based methods were included: structural (lesion load/atrophy), T1 relaxation time/magnetisation transfer ratio (MTR), diffusion tensor imaging (DTI), functional MRI (fMRI) and magnetic resonance spectroscopy (MRS). RESULTS A total of 92 studies were identified as meeting the search criteria and included for review. Structurally, regional gray/white matter atrophy, cortical thinning, decreased T1 relaxation times and reduced fractional anisotropy were associated with central fatigue in MS. Functionally, hyperactivity and reduced functional connectivity in several regional areas of frontal, parietal, occipital, temporal and cerebellum were suggested as causes of central fatigue. Biochemically, a reduction in N-acetyl aspartate/creatine and increased (glutamine+glutamate)/creatine ratios were correlated with fatigue severity in MS. CONCLUSION Several advanced quantitative MRI methods have been employed in the study of central fatigue in MS. Central fatigue in MS is associated with macro/microstructural and functional changes within specific brain regions (frontal, parietal, temporal and deep gray matter) and specific pathways/networks (cortico-cortical and cortico-subcortical). Alternations in the cortico-striatal-thalamocortical (CSTC) loop are correlated with the development of fatigue in MS patients.
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Affiliation(s)
- Jameen Arm
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Karen Ribbons
- Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia; Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
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Paul S, Mukherjee S, Bhattacharyya S. Network organization of co-opetitive genetic influences on morphologies of the human cerebral cortex. J Neural Eng 2019; 16:026028. [PMID: 30654334 DOI: 10.1088/1741-2552/aaff85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The brain can be represented as a network, where anatomical regions are nodes and relations between regions are edges. Within a network, the co-existence of co-operative and competitive relationships between different nodes is called co-opetition. Inter-regional genetic influences on morphological phenotypes (thickness, surface area) of the cerebral cortex display such co-opetitive relationships. However, whether these co-operative and competitive genetic influences are organized similarly has remained elusive. How the collective organization of the co-operative and competitive genetic influences is related to the inter-individual variations of cortical morphological phenotypes has also remained unexplored. APPROACH We constructed inter-regional genetic influence networks underlying the morphologies (thickness, surface area) of the human cerebral cortex combining the T1 weighted MRI of genetically confirmed 593 siblings and twin-study design. Graph theory was used to characterize the genetic influence networks and the collective organizations of genetic influences were characterized using the theory of structural balance. Principal component (PC) analysis was used to estimate the principal modes of morphological phenotype variations. MAIN RESULTS The inter-regional co-operative genetic influences are assortative, while competitive influences are disassortative. Co-operative genetic influences are more cohesive and less diverse than the competitive influences. The collective organization of co-opetitive genetic influences partially explains the fifth principal modes of inter-individual variation of cortical morphological phenotypes. Other principal modes were not significantly associated with collective genetic influences. SIGNIFICANCE Our study furnishes fundamental insight regarding the organization of co-opetitive genetic influences underlying the morphologies of the human cerebral cortex. In future studies, investigation of the alterations of co-opetitive genetic network properties in brain disorders may furnish disorder-specific insight that may be associated with the disease state or lead to vulnerability to those conditions.
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Affiliation(s)
- Subhadip Paul
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Andreasen AK, Iversen P, Marstrand L, Siersma V, Siebner HR, Sellebjerg F. Structural and cognitive correlates of fatigue in progressive multiple sclerosis. Neurol Res 2018; 41:168-176. [PMID: 30513278 DOI: 10.1080/01616412.2018.1547813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue in multiple sclerosis (MS) is a debilitating symptom and experienced by most patients. In recent studies investigating this phenomenon, the majority of patients had a relapsing-remitting disease course. METHODS Patients with progressive MS participating in one of three treatment trials during a period from 2010 to 2014 were included. Fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions (FSMC) and patients were further examined with a cognitive test battery, including Symbol Digit Modalities Test (SDMT), and 3 T MRI with subsequent quantitative analyses of 13 cortical regions of interest, deep grey matter and lesion volume. RESULTS Twenty-two patients were enrolled. The thickness of the pre-central gyrus correlated significantly with motor fatigue. We found only a non-significant trend towards a correlation between cognitive fatigue and the thickness of the pre-central gyrus, the parietal inferior supra-marginal gyrus and the opercular part of the inferior frontal gyrus. 36% of participants had impaired processing speed and 9% had normal function on all tests. The scores on the FSMC-cognitive scale were related to performance on SDMT. CONCLUSION In this exploratory study of patients with progressive MS, fatigue was related to processing speed. Motor fatigue was also related to the cortical thickness of the primary motor cortex and there was a trend towards a relationship between cognitive fatigue and the thickness of cortical areas involved in attentional processes. Additional studies are needed to further elucidate the relationship between regional cortical atrophy, cognitive functioning and the perception of fatigue. ABBREVIATIONS FSMC: Motor and Cognitive Functions; MS: Multiple Sclerosis; SDMT: Symbol Digit Modalities Test; MRI: Magnetic Resonance Imaging; RRMS: Relapsing-Remitting Disease Course; EDSS: Kurtzke Expanded Disability Status Scale; FLAIR: Fluid Attenuated Inversion Recovery; NAWM: Normal-Appearing White Matter; CGM: Cortical Grey Matter; CTh: Cortical Thickness; ROIs: Regions of Interest; Raven: Raven Progressive Matrices; TM A: Trail Making A; TM B: Trail Making B; Rey: Rey Complex Figure; Similarities: WAIS III Similarities; Stroop: Stroop Colour Naming Test; BDI: Becks Depression Inventory II.
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Affiliation(s)
- Anne Katrine Andreasen
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Pernille Iversen
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Lisbet Marstrand
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Volkert Siersma
- c The Research Unit for General Practice and Section of General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Hartwig Roman Siebner
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Finn Sellebjerg
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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Hyncicova E, Kalina A, Vyhnalek M, Nikolai T, Martinkovic L, Lisy J, Hort J, Meluzinova E, Laczó J. Health-related quality of life, neuropsychiatric symptoms and structural brain changes in clinically isolated syndrome. PLoS One 2018; 13:e0200254. [PMID: 29979757 PMCID: PMC6034869 DOI: 10.1371/journal.pone.0200254] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Neuropsychiatric symptoms and reduced health-related quality of life (HRQoL) are frequent in multiple sclerosis, where are associated with structural brain changes, but have been less studied in clinically isolated syndrome (CIS). Objective To characterize HRQoL, neuropsychiatric symptoms (depressive symptoms, anxiety, apathy and fatigue), their interrelations and associations with structural brain changes in CIS. Methods Patients with CIS (n = 67) and demographically matched healthy controls (n = 46) underwent neurological and psychological examinations including assessment of HRQoL, neuropsychiatric symptoms and cognitive functioning, and MRI brain scan with global, regional and lesion load volume measurement. Results The CIS group had more, mostly mild, depressive symptoms and anxiety, and lower HRQoL physical and social subscores (p≤0.037). Neuropsychiatric symptoms were associated with most HRQoL subscores (β≤-0.34, p≤0.005). Cognitive functioning unlike clinical disability was associated with depressive symptoms and lower HRQoL emotional subscores (β≤-0.29, p≤0.019). Depressive symptoms and apathy were associated with right temporal, left insular and right occipital lesion load (ß≥0.29, p≤0.032). Anxiety was associated with lower white matter volume (ß = -0.25, p = 0.045). Conclusion Mild depressive symptoms and anxiety with decreased HRQoL are present in patients with CIS. Neuropsychiatric symptoms contributing to decreased HRQoL are the result of structural brain changes and require complex therapeutic approach in patients with CIS.
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Affiliation(s)
- Eva Hyncicova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Adam Kalina
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnalek
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Tomas Nikolai
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Lukas Martinkovic
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jiri Lisy
- Department of Radiology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Eva Meluzinova
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jan Laczó
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
- * E-mail:
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Oriolo G, Egmond E, Mariño Z, Cavero M, Navines R, Zamarrenho L, Solà R, Pujol J, Bargallo N, Forns X, Martin-Santos R. Systematic review with meta-analysis: neuroimaging in hepatitis C chronic infection. Aliment Pharmacol Ther 2018. [PMID: 29536563 DOI: 10.1111/apt.14594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C is considered a systemic disease because of extra-hepatic manifestations. Neuroimaging has been employed in hepatitis C virus-infected patients to find in vivo evidence of central nervous system alterations. AIMS Systematic review and meta-analysis of neuroimaging research in chronic hepatitis C treatment naive patients, or patients previously treated without sustained viral response, to study structural and functional brain impact of hepatitis C. METHODS Using PRISMA guidelines a database search was conducted from inception up until 1 May 2017 for peer-reviewed studies on structural or functional neuroimaging assessment of chronic hepatitis C patients without cirrhosis or encephalopathy, with control group. Meta-analyses were performed when possible. RESULTS The final sample comprised 25 studies (magnetic resonance spectroscopy [N = 12], perfusion weighted imaging [N = 1], positron emission tomography [N = 3], single-photon emission computed tomography [N = 4], functional connectivity in resting state [N = 1], diffusion tensor imaging [N = 2] and structural magnetic resonance imaging [N = 2]). The whole sample was of 509 chronic hepatitis C patients, with an average age of 41.5 years old and mild liver disease. A meta-analysis of magnetic resonance spectroscopy studies showed increased levels of choline/creatine ratio (mean difference [MD] 0.12, 95% confidence interval [CI] 0.06-0.18), creatine (MD 0.85, 95% CI 0.42-1.27) and glutamate plus glutamine (MD 1.67, 95% CI 0.39-2.96) in basal ganglia and increased levels of choline/creatine ratio in centrum semiovale white matter (MD 0.13, 95% CI 0.07-0.19) in chronic hepatitis C patients compared with healthy controls. Photon emission tomography studies meta-analyses did not find significant differences in PK11195 binding potential in cortical and subcortical regions of chronic hepatitis C patients compared with controls. Correlations were observed between various neuroimaging alterations and neurocognitive impairment, fatigue and depressive symptoms in some studies. CONCLUSIONS Patients with chronic hepatitis C exhibit cerebral metabolite alterations and structural or functional neuroimaging abnormalities, which sustain the hypothesis of hepatitis C virus involvement in brain disturbances.
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Affiliation(s)
- G Oriolo
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - E Egmond
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Department of Health and Clinical Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Z Mariño
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - M Cavero
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - L Zamarrenho
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - R Solà
- Liver Unit, Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, CIBERSAM, Barcelona, Spain
| | - N Bargallo
- Center of Diagnostic Image (CDIC), Hospital Clinic, Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - X Forns
- Liver Unit, Hospital Clinic, IDIBAPS, Centro Investigación Biomédica en Red de Enfermedades hepáticas y digestivas, (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigació Biomèdica Arthur Pi I Sunyer (IDIBAPS), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
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Abstract
SUMMARYMultiple sclerosis (MS), an immune-mediated demyelinating condition, is the most common neurological disease affecting young adults in the UK. It has a high psychiatric comorbidity and over half of patients have some degree of cognitive impairment that adds to the burden of disability. This article reviews the psychiatric and cognitive manifestations of MS and their detection and treatment. Recent advances in the treatment of the disease are briefly reviewed and the impact of disease-modifying therapies on psychiatric morbidity and cognitive impairment is discussed.LEARNING OBJECTIVES•Understand the psychiatric morbidity in MS and its biological counterparts•Understand the cognitive impairment and its biological counterparts•Become familiar with the detection and treatment of the psychiatric and cognitive manifestations of MSDECLARATION OF INTERESTNone.
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Zhong J, Chen DQ, Nantes JC, Holmes SA, Hodaie M, Koski L. Combined structural and functional patterns discriminating upper limb motor disability in multiple sclerosis using multivariate approaches. Brain Imaging Behav 2018; 11:754-768. [PMID: 27146291 DOI: 10.1007/s11682-016-9551-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A structural or functional pattern of neuroplasticity that could systematically discriminate between people with impaired and preserved motor performance could help us to understand the brain networks contributing to preservation or compensation of behavior in multiple sclerosis (MS). This study aimed to (1) investigate whether a machine learning-based technique could accurately classify MS participants into groups defined by upper extremity function (i.e. motor function preserved (MP) vs. motor function impaired (MI)) based on their regional grey matter measures (GMM, cortical thickness and deep grey matter volume) and inter-regional functional connection (FC), (2) investigate which features (GMM, FC, or GMM + FC) could classify groups more accurately, and (3) identify the multivariate patterns of GMM and FCs that are most discriminative between MP and MI participants, and between each of these groups and the healthy controls (HCs). With 26 MP, 25 MI, and 21 HCs (age and sex matched) underwent T1-weighted and resting-state functional MRI at 3 T, we applied support vector machine (SVM) based classification to learn discriminant functions indicating regions in which GMM or between which FCs were most discriminative between groups. This study demonstrates that there exist structural and FC patterns sufficient for correct classification of upper limb motor ability of people with MS. The classifier with GMM + FC features yielded the highest accuracy of 85.61 % (p < 0.001) to distinguish between the MS groups using leave-one-out cross-validation. It suggests that a machine-learning approach combining structural and functional features is useful for identifying the specific neural substrates that are necessary and sufficient to preserve motor function among people with MS.
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Affiliation(s)
- Jidan Zhong
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada. .,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada. .,Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
| | - David Qixiang Chen
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour-Systems, Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Julia C Nantes
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Scott A Holmes
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Mojgan Hodaie
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour-Systems, Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Toronto Western Hospital & University of Toronto, Toronto, ON, Canada
| | - Lisa Koski
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
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30
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Sowa P, Harbo HF, White NS, Celius EG, Bartsch H, Berg-Hansen P, Moen SM, Bjørnerud A, Westlye LT, Andreassen OA, Dale AM, Beyer MK. Restriction spectrum imaging of white matter and its relation to neurological disability in multiple sclerosis. Mult Scler 2018. [PMID: 29542336 DOI: 10.1177/1352458518765671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Restriction spectrum imaging (RSI) is a recently introduced magnetic resonance imaging diffusion technique. The utility of RSI in multiple sclerosis (MS) is unknown. OBJECTIVE To investigate the association between RSI-derived parameters and neurological disability in MS. METHODS Seventy-seven relapsing-remitting MS patients were scanned with RSI on a 3-T scanner. RSI-derived parameters: fast and slow apparent diffusion coefficient (sADC), fractional anisotropy, restricted fractional anisotropy, neurite density (ND), cellularity, extracellular water fraction, and free water fraction, were obtained in white matter lesions (WML) and normal appearing white matter (NAWM). Patients were divided into three groups according to their expanded disability status scale (EDSS): with minimal, low, and substantial disability (<2.5, 2.5-3, and >3, respectively). Group comparisons and correlation analyses were performed. RESULTS All tested RSI-derived parameters differed between WML and NAWM ( p < 0.001 for all pairwise comparisons). The sADC in WML showed largest difference across disability subgroups (analysis of variance (ANOVA): F = 5.1, η2 = 0.12, p = 0.008). ND in NAWM showed strongest correlation with disability (ϱ = -0.39, p < 0.001). CONCLUSION The strongest correlation with EDSS of ND obtained in NAWM indicates that processes outside lesions are important for disability in MS. Our study suggests that RSI-derived parameters may help understand the "clinico-radiological paradox" and improve disease monitoring in MS.
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Affiliation(s)
- Piotr Sowa
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Nathan S White
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway/Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hauke Bartsch
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Pål Berg-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Stine M Moen
- Department of Neurology, Oslo University Hospital, Oslo, Norway/MS Centre Hakadal, Hakadal, Norway
| | - Atle Bjørnerud
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Department of Physics, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway/NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA/Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mona K Beyer
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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31
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Abstract
Depressive disorders are common in patients with multiple sclerosis, influencing their quality of life and adherence to treatments, as well as becoming more frequent with the progression of the disease and in the secondary progressive form of multiple sclerosis. Patients with multiple sclerosis often experience a typical cluster of symptoms in association with depression, such as fatigue, pain and cognitive impairment. However, the pathogenesis of multiple sclerosis-related depression remains partially unclear, even though genetic, immune-inflammatory and psychosocial factors might be seen to play a role, in addition to the brain structural alterations documented by magnetic resonance imaging studies. The high incidence and burden of depression in people affected with multiple sclerosis are matters of crucial importance. Despite such importance, the efficacy of pharmacologic treatments has been poorly studied and, for the most part, the access to non-pharmacological treatments is partially dependent on the local health system availability. It has been determined that interferon-beta and glatiramer acetate do not cause depressive symptoms; however, no definitive data in this regard are avaible for the newer disease-modifyng medications. In this review, we discuss the diagnosis, prevalence, pathogenesis, clinical aspects, magnetic resonance imaging findings and treatments available in patients experiencing multiple sclerosis-related depression.
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32
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Al-Radaideh A, Athamneh I, Alabadi H, Hbahbih M. Cortical and Subcortical Morphometric and Iron Changes in Relapsing-Remitting Multiple Sclerosis and Their Association with White Matter T2 Lesion Load. Clin Neuroradiol 2018; 29:51-64. [DOI: 10.1007/s00062-017-0654-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/08/2017] [Indexed: 01/05/2023]
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33
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Orbach L, Menascu S, Hoffmann C, Miron S, Achiron A. Focal cortical thinning in patients with stable relapsing-remitting multiple sclerosis: cross-sectional-based novel estimation of gray matter kinetics. Neuroradiology 2017; 60:179-187. [PMID: 29285552 DOI: 10.1007/s00234-017-1964-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of our study is to identify radiological patterns of cortical gray matter atrophy (CGMA) that correlate with disease duration in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS RRMS patients were randomly selected from the Sheba Multiple Sclerosis (MS) center computerized data registry based on stratification of disease duration up to 10 years. Patients were scanned by 3.0 T (Signa, GE) MRI, using a T1 weighted 3D high resolution, FSPGR, MS protocol. Neurological disability was assessed by the Expanded Disability Status Scale (EDSS). FreeSurfer was used to obtain brain volumetric segmentation and to perform cortical thickness surface-based analysis. Clusters of change in cortical thickness with correlation to disease duration were produced. RESULTS Two hundred seventy-one RRMS patients, mean ± SD age 33.0 ± 7.0 years, EDSS 1.6 ± 1.2, disease duration 5.0 ± 3.4 years. Cortical thickness analysis demonstrated focal areas of cerebral thinning that correlated with disease duration. Seven clusters accounting for 11.7% of the left hemisphere surface and eight clusters accounting for 10.6% of the right hemisphere surface were identified, with cluster-wise probability of p < 0.002 and p < 0.02, respectively.The clusters included bilateral involvement of areas within the cingulate, precentral, postcentral, paracentral, superior-parietal, superior-frontal gyri and insular cortex. Mean and cluster-wise cortical thickness negatively correlated with EDSS score, p < 0.001, with stronger Spearman rho for cluster-wise measurements. CONCLUSIONS We identified CGMA patterns in sensitive brain regions which give insight and better understanding of the progression of cortical gray matter loss in relation to dissemination in space and time. These patterns may serve as markers to modulate therapeutic interventions to improve the management of MS patients.
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Affiliation(s)
- Lior Orbach
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chen Hoffmann
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Miron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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34
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Gaede G, Tiede M, Lorenz I, Brandt AU, Pfueller C, Dörr J, Bellmann-Strobl J, Piper SK, Roth Y, Zangen A, Schippling S, Paul F. Safety and preliminary efficacy of deep transcranial magnetic stimulation in MS-related fatigue. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e423. [PMID: 29259998 PMCID: PMC5730816 DOI: 10.1212/nxi.0000000000000423] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/06/2017] [Indexed: 11/23/2022]
Abstract
Objective: To conduct a randomized, sham-controlled phase I/IIa study to evaluate the safety and preliminary efficacy of deep brain H-coil repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC) and the primary motor cortex (MC) in patients with MS with fatigue or depression (NCT01106365). Methods: Thirty-three patients with MS were recruited to undergo 18 consecutive rTMS sessions over 6 weeks, followed by follow-up (FU) assessments over 6 weeks. Patients were randomized to receive high-frequency stimulation of the left PFC, MC, or sham stimulation. Primary end point was the safety of stimulation. Preliminary efficacy was assessed based on changes in Fatigue Severity Scale (FSS) and Beck Depression Inventory scores. Randomization allowed only analysis of preliminary efficacy for fatigue. Results: No serious adverse events were observed. Five patients terminated participation during treatment due to mild side effects. Treatment resulted in a significant median FSS decrease of 1.0 point (95%CI [0.45,1.65]), which was sustained during FU. Conclusions: H-coil rTMS is safe and well tolerated in patients with MS. The observed sustained reduction in fatigue after subthreshold MC stimulation warrants further investigation. ClinicalTrials.gov identifier: NCT01106365. Classification of evidence: This study provides Class III evidence that rTMS of the prefrontal or primary MC is not associated with serious adverse effects, although this study is underpowered to state this with any precision.
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Affiliation(s)
- Gunnar Gaede
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Marina Tiede
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Ina Lorenz
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Alexander U Brandt
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Caspar Pfueller
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Jan Dörr
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Sophie K Piper
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Yiftach Roth
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Abraham Zangen
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Sven Schippling
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Friedemann Paul
- NeuroCure Clinical Research Center (G.G., A.U.B., C.P., J.D., J.B.-S., S.K.P., F.P.), Center for Stroke Research Berlin (CSB) (S.K.P.), Experimental and Clinical Research Center (J.B.-S., F.P.), and Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Institute of Neuroimmunology and Multiple Sclerosis (M.T., I.L., S.S.), University Medical Centre Hamburg-Eppendorf, Germany; Department of Life Sciences (Y.R., A.Z.), Ben-Gurion University, Beer-Sheva, Israel; and Max-Delbrück Center for Molecular Medicine (F.P.), Berlin, Germany. G.G. and C.P. are now with St. Joseph Krankenhaus-Berlin-Weissensee, Germany. S.S. is now with Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
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Granberg T, Fan Q, Treaba CA, Ouellette R, Herranz E, Mangeat G, Louapre C, Cohen-Adad J, Klawiter EC, Sloane JA, Mainero C. In vivo characterization of cortical and white matter neuroaxonal pathology in early multiple sclerosis. Brain 2017; 140:2912-2926. [PMID: 29053798 DOI: 10.1093/brain/awx247] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/05/2017] [Indexed: 12/12/2022] Open
Abstract
Neuroaxonal pathology is a main determinant of disease progression in multiple sclerosis; however, its underlying pathophysiological mechanisms, including its link to inflammatory demyelination and temporal occurrence in the disease course are still unknown. We used ultra-high field (7 T), ultra-high gradient strength diffusion and T1/T2-weighted myelin-sensitive magnetic resonance imaging to characterize microstructural changes in myelin and neuroaxonal integrity in the cortex and white matter in early stage multiple sclerosis, their distribution in lesional and normal-appearing tissue, and their correlations with neurological disability. Twenty-six early stage multiple sclerosis subjects (disease duration ≤5 years) and 24 age-matched healthy controls underwent 7 T T2*-weighted imaging for cortical lesion segmentation and 3 T T1/T2-weighted myelin-sensitive imaging and neurite orientation dispersion and density imaging for assessing microstructural myelin, axonal and dendrite integrity in lesional and normal-appearing tissue of the cortex and the white matter. Conventional mean diffusivity and fractional anisotropy metrics were also assessed for comparison. Cortical lesions were identified in 92% of early multiple sclerosis subjects and they were characterized by lower intracellular volume fraction (P = 0.015 by paired t-test), lower myelin-sensitive contrast (P = 0.030 by related-samples Wilcoxon signed-rank test) and higher mean diffusivity (P = 0.022 by related-samples Wilcoxon signed-rank test) relative to the contralateral normal-appearing cortex. Similar findings were observed in white matter lesions relative to normal-appearing white matter (all P < 0.001), accompanied by an increased orientation dispersion (P < 0.001 by paired t-test) and lower fractional anisotropy (P < 0.001 by related-samples Wilcoxon signed-rank test) suggestive of less coherent underlying fibre orientation. Additionally, the normal-appearing white matter in multiple sclerosis subjects had diffusely lower intracellular volume fractions than the white matter in controls (P = 0.029 by unpaired t-test). Cortical thickness did not differ significantly between multiple sclerosis subjects and controls. Higher orientation dispersion in the left primary motor-somatosensory cortex was associated with increased Expanded Disability Status Scale scores in surface-based general linear modelling (P < 0.05). Microstructural pathology was frequent in early multiple sclerosis, and present mainly focally in cortical lesions, whereas more diffusely in white matter. These results suggest early demyelination with loss of cells and/or cell volumes in cortical and white matter lesions, with additional axonal dispersion in white matter lesions. In the cortex, focal lesion changes might precede diffuse atrophy with cortical thinning. Findings in the normal-appearing white matter reveal early axonal pathology outside inflammatory demyelinating lesions.
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Affiliation(s)
- Tobias Granberg
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Qiuyun Fan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Constantina Andrada Treaba
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Russell Ouellette
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elena Herranz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Gabriel Mangeat
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Céline Louapre
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - Julien Cohen-Adad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Eric C Klawiter
- Harvard Medical School, Cambridge, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jacob A Sloane
- Harvard Medical School, Cambridge, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Cambridge, MA, USA
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Hammonds SK, Lauvsnes MB, Dalen I, Beyer MK, Kurz KD, Greve OJ, Norheim KB, Omdal R. No structural cerebral MRI changes related to fatigue in patients with primary Sjögren's syndrome. Rheumatol Adv Pract 2017; 1:rkx007. [PMID: 31431945 PMCID: PMC6649952 DOI: 10.1093/rap/rkx007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/27/2017] [Indexed: 12/19/2022] Open
Abstract
Objective Whether or not chronic fatigue is reflected in structural changes in the brain is a matter of debate. Primary SS (pSS) is characterized by dryness of the mouth and eyes, migrating muscle and joint pain and prominent fatigue. We aimed to investigate whether the severity of fatigue in pSS was associated with cerebral MRI findings. Methods Fatigue was measured with the fatigue visual analog scale in 65 patients with pSS. Global grey matter (GM) and white matter volumes were estimated from magnetic resonance T1 images, and associations between fatigue and brain volumes were assessed in regression models. Voxel-based morphometric analyses of GM were performed to investigate possible associations between fatigue and GM volume changes in particular brain regions. Results The fatigue scores in the patient group were spread across a wide range. Global volume analyses showed no significant effect of GM volumes and white matter volumes on fatigue. Voxel-wise analyses of GM did not identify any particular brain region associated with fatigue. Conclusion Fatigue is a dominant phenomenon in pSS patients but is not reflected in structural abnormalities in the brain as visualized by conventional MRI. Our findings support the hypothesis of fatigue as a physiological phenomenon that does not lead to vascular changes or neuronal or glial death or damage.
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Affiliation(s)
- Solveig K Hammonds
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger.,Department of Research, Stavanger University Hospital, Stavanger
| | - Maria B Lauvsnes
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo.,Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Kathinka D Kurz
- Department of Radiology, Stavanger University Hospital, Stavanger.,Department of Electrical and Computer Engineering, University of Stavanger, Stavanger
| | - Ole J Greve
- Department of Radiology, Stavanger University Hospital, Stavanger
| | - Katrine B Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger.,Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
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37
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Wall J, Xie H, Wang X. An Exploration Into Short-Interval Maintenance of Adult Hemispheric Cortical Thickness at an Individual Brain Level. J Exp Neurosci 2017; 11:1179069517733453. [PMID: 28989284 PMCID: PMC5624352 DOI: 10.1177/1179069517733453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/28/2017] [Indexed: 12/24/2022] Open
Abstract
Adult cerebral cortical structure is thought to be statically maintained over short intervals. This view is based on group average findings but has never been studied at the individual level. This issue was examined with an unconventional longitudinal magnetic resonance imaging design which measured hemispheric mean cortical thickness of an adult man repeatedly at week intervals over 6 months. These measures were compared with measurement error estimates to test the current prediction that thickness measures would be statically maintained within measurement error variation. The results did not support this prediction. Thickness underwent incremental and decremental fluctuations which ranged up to 0.12 mm and 5.83% over week and multiweek intervals and which differed from measurement error variation. These exploratory analyses suggest a working hypothesis that short-interval cortical structural maintenance in an individual can involve fluctuations in thickness. If confirmed, this hypothesis has potential implications for cortical maintenance mechanisms and precision medicine approaches.
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Affiliation(s)
- John Wall
- William R. Bauer Human Brain MRI Laboratory, Department of Neurosciences, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Hong Xie
- William R. Bauer Human Brain MRI Laboratory, Department of Neurosciences, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Xin Wang
- William R. Bauer Human Brain MRI Laboratory, Departments of Psychiatry, Radiology, and Neurosciences, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
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38
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Brain cortical characteristics of lifetime cognitive ageing. Brain Struct Funct 2017; 223:509-518. [PMID: 28879544 PMCID: PMC5772145 DOI: 10.1007/s00429-017-1505-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/20/2017] [Indexed: 12/02/2022]
Abstract
Regional cortical brain volume is the product of surface area and thickness. These measures exhibit partially distinct trajectories of change across the brain’s cortex in older age, but it is unclear which cortical characteristics at which loci are sensitive to cognitive ageing differences. We examine associations between change in intelligence from age 11 to 73 years and regional cortical volume, surface area, and thickness measured at age 73 years in 568 community-dwelling older adults, all born in 1936. A relative positive change in intelligence from 11 to 73 was associated with larger volume and surface area in selective frontal, temporal, parietal, and occipital regions (r < 0.180, FDR-corrected q < 0.05). There were no significant associations between cognitive ageing and a thinner cortex for any region. Interestingly, thickness and surface area were phenotypically independent across bilateral lateral temporal loci, whose surface area was significantly related to change in intelligence. These findings suggest that associations between regional cortical volume and cognitive ageing differences are predominantly driven by surface area rather than thickness among healthy older adults. Regional brain surface area has been relatively underexplored, and is a potentially informative biomarker for identifying determinants of cognitive ageing differences.
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Mohammadyfar MA, Azizpour M, Najafi M, Nooripour R. Comparison of audio-visual short-term and active memory in multiple sclerosis patients and non-patients regarding their depression, stress and anxiety level. NORDIC PSYCHOLOGY 2017. [DOI: 10.1080/19012276.2017.1362989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Mahmood Najafi
- Department of Psychology, Semnan University, Semnan, Iran
| | - Roghieh Nooripour
- Faculty of Education & Psychology, Department of Counseling, Alzahra University, Tehran, Iran
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40
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Rocca MA, Comi G, Filippi M. The Role of T1-Weighted Derived Measures of Neurodegeneration for Assessing Disability Progression in Multiple Sclerosis. Front Neurol 2017; 8:433. [PMID: 28928705 PMCID: PMC5591328 DOI: 10.3389/fneur.2017.00433] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration in vivo using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients. Methods A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between “black holes” and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years. Results A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations. Conclusion The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Murphy R, O'Donoghue S, Counihan T, McDonald C, Calabresi PA, Ahmed MA, Kaplin A, Hallahan B. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:697-708. [PMID: 28285265 DOI: 10.1136/jnnp-2016-315367] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 01/13/2023]
Abstract
Neuropsychiatric signs and symptoms occur frequently in individuals with multiple sclerosis (MS), either as the initial presenting complaint prior to a definitive neurological diagnosis or more commonly with disease progression. However, the pathogenesis of these comorbid conditions remains unclear and it remains difficult to accurately elucidate if neuropsychiatric symptoms or conditions are indicators of MS illness severity. Furthermore, both the disease process and the treatments of MS can adversely impact an individual's mental health. In this review, we discuss the common neuropsychiatric syndromes that occur in MS and describe the clinical symptoms, aetiology, neuroimaging findings and management strategies for these conditions.
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Affiliation(s)
- Ruth Murphy
- Department of Psychiatry, University College Hospital Galway, Galway, Ireland
| | - Stefani O'Donoghue
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Timothy Counihan
- Department of Neurology, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohammed As Ahmed
- Departments of Medical Education and Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Adam Kaplin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
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de Rodez Benavent SA, Nygaard GO, Harbo HF, Tønnesen S, Sowa P, Landrø NI, Wendel-Haga M, Etholm L, Nilsen KB, Drolsum L, Kerty E, Celius EG, Laeng B. Fatigue and cognition: Pupillary responses to problem-solving in early multiple sclerosis patients. Brain Behav 2017; 7:e00717. [PMID: 28729927 PMCID: PMC5516595 DOI: 10.1002/brb3.717] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION In early multiple sclerosis (MS) patients, cognitive changes and fatigue are frequent and troublesome symptoms, probably related to both structural and functional brain changes. Whether there is a common cause of these symptoms in MS is unknown. In theory, an altered regulation of central neuropeptides can lead to changes in regulation of autonomic function, cognitive difficulties, and fatigue. Direct measurements of central neuropeptides are difficult to perform, but measurements of the eye pupil can be used as a reliable proxy of function. METHODS This study assesses pupil size during problem-solving in early MS patients versus controls. A difference in pupil size to a cognitive challenge could signal altered activity within the autonomic system because of early functional brain changes associated with cognitive load. We recruited MS patients (mean disease duration: 2.6 years, N = 41) and age-matched healthy controls (N = 43) without eye pathology. Neurological impairment, magnetic resonance imaging, visual evoked potentials, depression, and fatigue were assessed in all of the patients. In both groups, we assessed processing speed and retinal imaging. Pupil size was recorded with an eye-tracker during playback of multiplication tasks. RESULTS Both groups performed well on the cognitive test. The groups showed similar pupillary responses with a mean of 0.55 mm dilation in patients and 0.54 mm dilation in controls for all the tasks collapsed together. However, controls (N = 9) with low cognitive scores (LCS) had an increased pupillary response to cognitive tasks, whereas LCS MS patients (N = 6) did not (p < .05). There was a tendency toward a smaller pupillary response in patients with fatigue. CONCLUSIONS This is the first study to investigate pupillary responses to cognitive tasks in MS patients. Our results suggest that MS-related changes in cognition and fatigue may be associated with changes in arousal and the autonomic regulation of task-related pupillary responses. This supports the theory of a link between cognition and fatigue in MS.
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Affiliation(s)
- Sigrid A de Rodez Benavent
- Department of Ophthalmology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Gro O Nygaard
- Department of Neurology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Hanne F Harbo
- Department of Neurology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | - Piotr Sowa
- Department of Radiology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Nils I Landrø
- Department of Psychology University of Oslo Oslo Norway
| | - Marte Wendel-Haga
- Department of Neurology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Lars Etholm
- Department of Neurophysiology Oslo University Hospital Oslo Norway
| | - Kristian B Nilsen
- Department of Neurophysiology Oslo University Hospital Oslo Norway.,Department of Neuroscience Norwegian University of Science and Technology Trondheim Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Emilia Kerty
- Department of Neurology Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | - Bruno Laeng
- Department of Psychology University of Oslo Oslo Norway
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Magnetic resonance imaging perfusion is associated with disease severity and activity in multiple sclerosis. Neuroradiology 2017; 59:655-664. [PMID: 28585082 DOI: 10.1007/s00234-017-1849-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE The utility of perfusion-weighted imaging in multiple sclerosis (MS) is not well investigated. The purpose of this study was to compare baseline normalized perfusion measures in subgroups of newly diagnosed MS patients. We wanted to test the hypothesis that this method can differentiate between groups defined according to disease severity and disease activity at 1 year follow-up. METHODS Baseline magnetic resonance imaging (MRI) including a dynamic susceptibility contrast perfusion sequence was performed on a 1.5-T scanner in 66 patients newly diagnosed with relapsing-remitting MS. From the baseline MRI, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were generated. Normalized (n) perfusion values were calculated by dividing each perfusion parameter obtained in white matter lesions by the same parameter obtained in normal-appearing white matter. Neurological examination was performed at baseline and at follow-up approximately 1 year later to establish the multiple sclerosis severity score (MSSS) and evidence of disease activity (EDA). RESULTS Baseline normalized mean transit time (nMTT) was lower in patients with MSSS >3.79 (p = 0.016), in patients with EDA (p = 0.041), and in patients with both MSSS >3.79 and EDA (p = 0.032) at 1-year follow-up. Baseline normalized cerebral blood flow and normalized cerebral blood volume did not differ between these groups. CONCLUSION Lower baseline nMTT was associated with higher disease severity and with presence of disease activity 1 year later in newly diagnosed MS patients. Further longitudinal studies are needed to confirm whether baseline-normalized perfusion measures can differentiate between disease severity and disease activity subgroups over time.
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44
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Pravatà E, Rocca MA, Valsasina P, Riccitelli GC, Gobbi C, Comi G, Falini A, Filippi M. Gray matter trophism, cognitive impairment, and depression in patients with multiple sclerosis. Mult Scler 2017; 23:1864-1874. [PMID: 28169581 DOI: 10.1177/1352458517692886] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive impairment and depression frequently affects patients with multiple sclerosis (MS). However, the relationship between the occurrence of depression and cognitive impairment and the development of cortical atrophy has not been fully elucidated yet. OBJECTIVES To investigate the association of cortical and deep gray matter (GM) volume with depression and cognitive impairment in MS. METHODS Three-dimensional (3D) T1-weighted scans were obtained from 126 MS patients and 59 matched healthy controls. Cognitive impairment was assessed using the Brief Repeatable Battery of Neuropsychological Tests and depression with the Montgomery-Asberg Depression Rating Scale (MADRS). Using FreeSurfer and FIRST software, we assessed cortical thickness (CTh) and deep GM volumetry. Magnetic resonance imaging (MRI) variables explaining depression and cognitive impairment were investigated using factorial and classification analysis. Multivariate regression models correlated GM abnormalities with symptoms severity. RESULTS Compared with controls, MS patients exhibited widespread bilateral cortical thinning involving all brain lobes. Depressed MS showed selective CTh decrease in fronto-temporal regions, whereas cognitive impairment MS exhibited widespread fronto-parietal cortical and subcortical GM atrophy. Frontal cortical thinning was the best predictor of depression ( C-statistic = 0.7), whereas thinning of the right precuneus and high T2 lesion volume best predicted cognitive impairment ( C-statistic = 0.8). MADRS severity correlated with right entorhinal cortex thinning, whereas cognitive impairment severity correlated with left entorhinal and thalamus atrophy. CONCLUSION MS-related depression is linked to circumscribed CTh changes in areas deputed to emotional behavior, whereas cognitive impairment is correlated with cortical and subcortical GM atrophy of circuits involved in cognition.
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Affiliation(s)
- Emanuele Pravatà
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neuroradiology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Maria A 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, 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
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland
| | - Giancarlo Comi
- Department of Neurology, 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, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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45
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Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: A scoping review. J Neurol Sci 2017; 373:307-320. [PMID: 28131211 DOI: 10.1016/j.jns.2017.01.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fatigue is one of the most common and most disabling symptoms of multiple sclerosis (MS). It is a multidimensional and complex symptom with multifaceted origins, involving both central and peripheral fatigue mechanisms. Exercise has proven to be safe for people with MS, with cumulating evidence supporting significant reductions in fatigue. However, the potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in MS remain elusive. OBJECTIVES The objectives were, in PwMS (1) to update the knowledge on the pathophysiology underlying primary and secondary fatigue, and (2) to discuss potential pathophysiological pathways that can explain the positive effects of exercise on MS fatigue. METHODS A comprehensive literature search of six databases (PubMed, Embase, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to 1) enroll participants with definite MS according to defined criteria, 2) assess explicit pathophysiological mechanisms related to MS fatigue, 3) be available in English, Danish or French, and 4) had undergone peer-review. RESULTS A total of 234 studies fulfilled the inclusion criteria. Primary MS fatigue mainly originated from a dysfunction of central nervous system neuronal circuits secondary to increased inflammation, reduced glucose metabolism, brain atrophy and diffuse demyelination and axonal lesions. Secondary MS fatigue was linked with sleep disturbances, depression, cognitive impairments, and deconditioning. Cardiovascular, immunologic, neuroendocrine, and neurotrophic changes associated with exercise may alleviate primary MS fatigue while exercise may improve secondary MS fatigue through symptomatic improvement of deconditioning, sleep disorders, and depression. CONCLUSIONS >30 primary and secondary pathophysiological fatigue pathways were identified underlining the multidimensionality and complexity of MS fatigue. Though the underlying key cellular and molecular cascades still have to be fully elucidated, exercise holds the potential to alleviate MS fatigue, through both primary and secondary fatigue pathways.
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Hoekzema E, Barba-Müller E, Pozzobon C, Picado M, Lucco F, García-García D, Soliva JC, Tobeña A, Desco M, Crone EA, Ballesteros A, Carmona S, Vilarroya O. Pregnancy leads to long-lasting changes in human brain structure. Nat Neurosci 2016; 20:287-296. [DOI: 10.1038/nn.4458] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 11/15/2016] [Indexed: 12/14/2022]
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Stuke H, Hanken K, Hirsch J, Klein J, Wittig F, Kastrup A, Hildebrandt H. Cross-Sectional and Longitudinal Relationships between Depressive Symptoms and Brain Atrophy in MS Patients. Front Hum Neurosci 2016; 10:622. [PMID: 28018194 PMCID: PMC5159697 DOI: 10.3389/fnhum.2016.00622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/22/2016] [Indexed: 01/12/2023] Open
Abstract
Introduction: Depressive symptoms are a frequent and distressing phenomenon in Multiple Sclerosis (MS) patients. Cross-sectional research links these symptoms to reduced brain gray matter volumes in parts of the prefrontal and temporal lobe as well as subcortical structures like the hippocampus, nucleus caudatus and globus pallidus. Nevertheless, prospective relationships between regional gray matter volume and the course of depressive symptoms are poorly understood. Methods: Forty-four patients with relapsing–remitting or secondary progressive MS participated in a prospective study with two assessments of depressive symptoms and high-resolution MRI with an inter-test-interval of 17 months. Relationships between baseline gray matter volume and baseline depressive symptoms, as well as prospective associations between the development of atrophy and depression were assessed using voxel-based morphometry (VBM). Results: Cross-sectional analyses revealed an association between depressive symptoms and gray matter loss in the left temporal lobe. Prospective analysis showed that gray matter losses in the right middle cingulate and middle frontal gyrus at baseline predicted increasing depressive symptoms during follow-up. Increase in depressive symptoms was related to a concomitant increase in atrophy in the left thalamus and right globus pallidus. Discussion: Our results fit well into the concept of a disturbed cortico–striatal–pallido–thalamic loop in depression. In this framework, progressive gray matter loss in limbic basal ganglia structures including globus pallidus and thalamus may lead to depression-typical deficits in hedonic motivation, whereas atrophy of the prefrontal cortex may contribute to maladaptive coping strategies, promoting an unfavorable development of depressive symptoms.
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Affiliation(s)
- Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Katrin Hanken
- Department of Psychology, University of OldenburgOldenburg, Germany; Department of Neurology, Klinikum Bremen-OstBremen, Germany
| | - Jochen Hirsch
- Fraunhofer MEVIS Institute for Medical Image Computing Bremen, Germany
| | - Jan Klein
- Fraunhofer MEVIS Institute for Medical Image Computing Bremen, Germany
| | - Fabian Wittig
- Department of Psychology, University of OldenburgOldenburg, Germany; Fraunhofer MEVIS Institute for Medical Image ComputingBremen, Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost Bremen, Germany
| | - Helmut Hildebrandt
- Department of Psychology, University of OldenburgOldenburg, Germany; Department of Neurology, Klinikum Bremen-OstBremen, Germany
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Veauthier C, Hasselmann H, Gold SM, Paul F. The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue. EPMA J 2016; 7:25. [PMID: 27904656 PMCID: PMC5121967 DOI: 10.1186/s13167-016-0073-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helge Hasselmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany ; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany ; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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van Ettinger-Veenstra H. Cumulative evidence for MS as a neural network disconnection syndrome consistent with cognitive impairment mechanisms and the confounding role of fatigue and depression-outlook from the Fourth Nordic MS symposium. Acta Neurol Scand 2016; 134 Suppl 200:4-7. [PMID: 27580899 DOI: 10.1111/ane.12655] [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] [Accepted: 07/07/2016] [Indexed: 12/14/2022]
Abstract
The Fourth Nordic MS symposium served as a platform to present an overview over the rise and impact of cognitive impairment in people with MS, from early stages on, impairing their quality of life. After discussing MS and cognitive impairment symptoms, a review on the pathophysiology underlying cognitive impairment was given, followed by a talk on neuroimaging highlighting cortical reorganization in MS-affected brains. As a conclusion, therapy and treatment options were discussed. The symposium presented several cutting-edge research studies providing or testing working models that appear successful in predicting and explaining cognitive impairment in MS, such as the disconnection syndrome.
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Affiliation(s)
- H. van Ettinger-Veenstra
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
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Paul F. Pathology and MRI: exploring cognitive impairment in MS. Acta Neurol Scand 2016; 134 Suppl 200:24-33. [PMID: 27580903 DOI: 10.1111/ane.12649] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/24/2023]
Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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