501
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Faizy TD, Thaler C, Ceyrowski T, Broocks G, Treffler N, Sedlacik J, Stürner K, Stellmann JP, Heesen C, Fiehler J, Siemonsen S. Reliability of cortical lesion detection on double inversion recovery MRI applying the MAGNIMS-Criteria in multiple sclerosis patients within a 16-months period. PLoS One 2017; 12:e0172923. [PMID: 28235075 PMCID: PMC5325582 DOI: 10.1371/journal.pone.0172923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/10/2017] [Indexed: 01/27/2023] Open
Abstract
PURPOSE In patients with multiple sclerosis (MS), Double Inversion Recovery (DIR) magnetic resonance imaging (MRI) can be used to identify cortical lesions (CL). We sought to evaluate the reliability of CL detection on DIR longitudinally at multiple subsequent time-points applying the MAGNIMs scoring criteria for CLs. METHODS 26 MS patients received a 3T-MRI (Siemens, Skyra) with DIR at 12 time-points (TP) within a 16 months period. Scans were assessed in random order by two different raters. Both raters separately marked all CLs on each scan and total lesion numbers were obtained for each scan-TP and patient. After a retrospective re-evaluation, the number of consensus CLs (conL) was defined as the total number of CLs, which both raters finally agreed on. CLs volumes, relative signal intensities and CLs localizations were determined. Both ratings (conL vs. non-consensus scoring) were compared for further analysis. RESULTS A total number of n = 334 CLs were identified by both raters in 26 MS patients with a first agreement of both raters on 160 out of 334 of the CLs found (κ = 0.48). After the retrospective re-evaluation, consensus agreement increased to 233 out of 334 CL (κ = 0.69). 93.8% of conL were visible in at least 2 consecutive TP. 74.7% of the conL were visible in all 12 consecutive TP. ConL had greater mean lesion volumes and higher mean signal intensities compared to lesions that were only detected by one of the raters (p<0.05). A higher number of CLs in the frontal, parietal, temporal and occipital lobe were identified by both raters than the number of those only identified by one of the raters (p<0.05). CONCLUSIONS After a first assessment, slightly less than a half of the CL were considered as reliably detectable on longitudinal DIR images. A retrospective re-evaluation notably increased the consensus agreement. However, this finding is narrowed, considering the fact that retrospective evaluation steps might not be practicable in clinical routine. Lesions that were not reliably identifiable by both raters seem to be characterized by lower signal intensity and smaller size, or located in distinct anatomical brain regions.
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Affiliation(s)
- Tobias Djamsched Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Ceyrowski
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natascha Treffler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klarissa Stürner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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502
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Sathiamoorthi S, Wingerchuk DM. Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice. Neurology 2017; 88:809-810. [PMID: 28100724 DOI: 10.1212/wnl.0000000000003639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Saraniya Sathiamoorthi
- From Mayo Medical School (S.S.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Dean M Wingerchuk
- From Mayo Medical School (S.S.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ.
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503
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Bryukhov VV, Popova EV, Krotenkova IA, Boyko AN. [Radiologically isolated syndrome - MRI criteria and management tactic]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:47-52. [PMID: 28139611 DOI: 10.17116/jnevro201611610247-52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of brain MRI for the diagnosis of neurological diseases has increased significantly over the past two decades. This has led to an increase in the discovery of chance findings, with asymptomatic lesions in the white matter being most frequent. Based on radiological criteria, these findings can be interpreted as demyelinating lesions in some cases. However, in the absence of clinical symptoms characteristic of multiple sclerosis (MS), a diagnosis of MS can't be made in the patients with these incidental findings. These patients now met a diagnosis of radiologically isolated syndrome (RIS). Diagnostic and clinical approaches to patients with RIS are discussed in this article.
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Affiliation(s)
- V V Bryukhov
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia
| | - E V Popova
- Pirogov Russian National Research Medical University, Moscow, Russia; Neurology Research Center, Moscow, Russia
| | - I A Krotenkova
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia; Neurology Research Center, Moscow, Russia
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504
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Popova EV, Bryukhov VV, Boyko AN, Krotenkova MV. [Primary-progressive multiple sclerosis as an atypical demyelinating process]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:42-46. [PMID: 28139610 DOI: 10.17116/jnevro201611610242-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents an overview of current data on primary-progressive multiple sclerosis (MS). In this aspect, the authors consider its characteristics in comparison to other MS forms as well as possible markers of the disease, criteria of diagnosis and therapeutic options in the present and the future times.
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Affiliation(s)
- E V Popova
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - A N Boyko
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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505
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Puthenparampil M, Federle L, Miante S, Zito A, Toffanin E, Ruggero S, Ermani M, Pravato S, Poggiali D, Perini P, Rinaldi F, Gallo P. BAFF Index and CXCL13 levels in the cerebrospinal fluid associate respectively with intrathecal IgG synthesis and cortical atrophy in multiple sclerosis at clinical onset. J Neuroinflammation 2017; 14:11. [PMID: 28095856 PMCID: PMC5240243 DOI: 10.1186/s12974-016-0785-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/28/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND B lymphocytes are thought to play a relevant role in multiple sclerosis (MS) pathology. The in vivo analysis of intrathecally produced B cell-related cytokines may help to clarify the mechanisms of B cell recruitment and immunoglobulin production within the central nervous system (CNS) in MS. METHODS Paired cerebrospinal fluid (CSF) and serum specimens from 40 clinically isolated syndrome suggestive of MS or early-onset relapsing-remitting MS patients (CIS/eRRMS) and 17 healthy controls (HC) were analyzed for the intrathecal synthesis of IgG (quantitative formulae and IgG oligoclonal bands, IgGOB), CXCL13, BAFF, and IL-21. 3D-FLAIR, 3D-DIR, and 3D-T1 MRI sequences were applied to evaluate white matter (WM) and gray matter (GM) lesions and global cortical thickness (gCTh). RESULTS Compared to HC, CIS/eRRMS having IgGOB (IgGOB+, 26 patients) had higher intrathecal IgG indexes (p < 0.01), lower values of BAFF Index (11.9 ± 6.1 vs 17.5 ± 5.2, p < 0.01), and higher CSF CXCL13 levels (27.7 ± 33.5 vs 0.9 ± 1.5, p < 0.005). In these patients, BAFF Index but not CSF CXCL13 levels inversely correlated with the intrathecal IgG synthesis (r > 0.5 and p < 0.05 for all correlations). CSF leukocyte counts were significantly higher in IgGOB+ compared to IgGOB- (p < 0.05) and HC (p < 0.01), and correlated to CSF CXCL13 concentrations (r 0.77, p < 0.001). The gCTh was significantly lower in patients with higher CSF CXCL13 levels (2.41 ± 0.1 vs 2.49 ± 0.1 mm, p < 0.05), while no difference in MRI parameters of WM and GM pathology was observed between IgGOB+ and IgGOB-. CONCLUSIONS The intrathecal IgG synthesis inversely correlated with BAFF Index and showed no correlation with CSF CXCL13. These findings seem to indicate that intrathecally synthesized IgG are produced by long-term PCs that have entered the CNS from the peripheral blood, rather than produced by PCs developed in the meningeal follicle-like structures (FLS). In this study, CXCL13 identifies a subgroup of MS patients characterized by higher leukocyte counts in the CSF and early evidence of cortical thinning, further suggesting a role for this chemokine as a possible marker of disease severity.
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Affiliation(s)
- M. Puthenparampil
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - L. Federle
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - S. Miante
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - A. Zito
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - E. Toffanin
- Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - S. Ruggero
- Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - M. Ermani
- Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - S. Pravato
- Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - D. Poggiali
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - P. Perini
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - F. Rinaldi
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
| | - P. Gallo
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, via Giustiniani 5, 3518 Padova, Italy
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506
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Niino M, Miyazaki Y. Radiologically isolated syndrome and clinically isolated syndrome. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Masaaki Niino
- Department of Clinical Research; Hokkaido Medical Center; Sapporo Japan
| | - Yusei Miyazaki
- Department of Clinical Research; Hokkaido Medical Center; Sapporo Japan
- Department of Neurology; Hokkaido Medical Center; Sapporo Japan
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507
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Vågberg M, Axelsson M, Birgander R, Burman J, Cananau C, Forslin Y, Granberg T, Gunnarsson M, von Heijne A, Jönsson L, Karrenbauer VD, Larsson EM, Lindqvist T, Lycke J, Lönn L, Mentesidou E, Müller S, Nilsson P, Piehl F, Svenningsson A, Vrethem M, Wikström J. Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society. Acta Neurol Scand 2017; 135:17-24. [PMID: 27558404 PMCID: PMC5157754 DOI: 10.1111/ane.12667] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.
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Affiliation(s)
- M. Vågberg
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience; Umeå University; Umeå Sweden
| | - M. Axelsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - C. Cananau
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Y. Forslin
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - T. Granberg
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - M. Gunnarsson
- Department of Neurology; School of Medical Sciences; Örebro University; Örebro Sweden
| | - A. von Heijne
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - L. Jönsson
- Department of Neuroradiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E.-M. Larsson
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
| | - T. Lindqvist
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Lycke
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Lönn
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E. Mentesidou
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - S. Müller
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - P. Nilsson
- Department of Clinical Sciences Lund, Neurology; Faculty of Medicine; Lund University; Lund Sweden
| | - F. Piehl
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A. Svenningsson
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - M. Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - J. Wikström
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
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508
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Dębska J, Kotulska-Józwiak K, Pawliszak P, Bilska M, Chmielewski D, Puzio I, Jurkiewicz E. Spinal cord lesions in children and adolescents with multiple sclerosis - Magnetic resonance imaging. Neurol Neurochir Pol 2017; 51:77-81. [PMID: 28038775 DOI: 10.1016/j.pjnns.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of our study was to determine the prevalence of spinal cord lesions revealed by magnetic resonance (MR) imaging in children and adolescents with clinically definite multiple sclerosis (MS). MATERIAL AND METHODS We retrospectively evaluated the spinal cord magnetic resonance examinations in a group of MS patients consisting of 58 children (37 girls and 21 boys) aged from 7 to 17.8 years (mean 13.7 years). All children met the criteria of clinically definite MS and had typical MS lesions revealed in the brain imaging. RESULTS Spinal cord lesions, regardless of localization, were identified in 36 (62%) patients. In 22 of 58 patients (38%) no lesions were observed. The plaques were found in the cervical spinal cord and the thoracic spinal cord in 30 out of 36 (86.1%) and in 31 out of 36 (88.6%) patients, respectively. Contrast enhancement was noticed in 10 out of 36 patients (27.7%) and was not correlated with the number of lesions present. We noticed a tendency to higher EDSS score in patients with lesions in more than 1 spinal cord region. Our study showed that spinal cord lesions are more frequently present in patients with complex neurological disability. CONCLUSION The prevalence of spinal cord lesions in children and adolescents with MS is high. Therefore, spinal cord MRI should be included in diagnostic program of MS.
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Affiliation(s)
- Joanna Dębska
- Department of Diagnostic Imaging, The Children's Health Memorial Institute, Warsaw, Poland.
| | | | - Piotr Pawliszak
- Department of Diagnostic Imaging, The Children's Health Memorial Institute, Warsaw, Poland
| | - Małgorzata Bilska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Chmielewski
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Iwona Puzio
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Jurkiewicz
- Department of Diagnostic Imaging, The Children's Health Memorial Institute, Warsaw, Poland
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509
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Habek M, Adamec I, Barun B, Crnošija L, Gabelić T, Krbot Skorić M. Clinical Neurophysiology of Multiple Sclerosis. MULTIPLE SCLEROSIS: BENCH TO BEDSIDE 2017; 958:129-139. [DOI: 10.1007/978-3-319-47861-6_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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510
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Abstract
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Magnetic resonance imaging (MRI) is sensitive to lesion formation both in the brain and spinal cord. Imaging plays a prominent role in the diagnosis and monitoring of MS. Over a dozen anti-inflammatory therapies are approved for MS and the development of many of these medications was made possible through the use of contrast-enhancing lesions on MRI as a phase II outcome. A similar phase II outcome method for the neurodegeneration that underlies progressive courses of the disease is still unavailable. Although magnetic resonance is an invaluable tool for the diagnosis and monitoring of treatment effects in MS, several imaging barriers still exist. In general, MRI is less sensitive to gray matter lesions, lacks pathological specificity, and does not provide quantitative data easily. Several advanced imaging methods including diffusion tensor imaging, magnetization transfer, functional MRI, myelin water fraction imaging, ultra-high field MRI, positron emission tomography, and optical coherence tomography of the retina study promising ways of overcoming the difficulties in MS imaging.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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511
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Abstract
Due to the heterogeneous nature of the disease, it is a challenge to capture disease activity of multiple sclerosis (MS) in a reliable and valid way. Therefore, it can be difficult to assess the true efficacy of interventions in clinical trials. In phase III trials in MS, the traditionally used primary clinical outcome measures are the Expanded Disability Status Scale and the relapse rate. Secondary outcome measures in these trials are the number or volume of T2 hyperintense lesions and gadolinium-enhancing T1 lesions on magnetic resonance imaging (MRI) of the brain. These secondary outcome measures are often primary outcome measures in phase II trials in MS. Despite several limitations, the traditional clinical measures are still the mainstay for assessing treatment efficacy. Newer and potentially valuable outcome measures increasingly used or explored in MS trials are, clinically, the MS Functional Composite and patient-reported outcome measures, and on MRI, brain atrophy and the formation of persisting black holes. Several limitations of these measures have been addressed and further improvements will probably be proposed. Major improvements are the coverage of additional functional domains such as cognitive functioning and assessment of the ability to carry out activities of daily living. The development of multidimensional measures is promising because these measures have the potential to cover the full extent of MS activity and progression. In this review, we provide an overview of the historical background and recent developments of outcome measures in MS trials. We discuss the advantages and limitations of various measures, including newer assessments such as optical coherence tomography, biomarkers in body fluids and the concept of 'no evidence of disease activity'.
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Affiliation(s)
- Caspar E. P. van Munster
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
| | - Bernard M. J. Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
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512
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Boyko AN, Gusev EI. Current algorithms of diagnosis and treatment of multiple sclerosis based on the individual assessment of the patient. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:92-106. [DOI: 10.17116/jnevro20171172292-106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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513
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Havla J, Warnke C, Derfuss T, Kappos L, Hartung HP, Hohlfeld R. Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:879-886. [PMID: 28130920 PMCID: PMC5282476 DOI: 10.3238/arztebl.2016.0879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 06/20/2016] [Accepted: 10/05/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system. There are at least 150 000 persons with MS in Germany. Recent years have seen the approval of new drugs against. METHODS This article is based on pertinent literature retrieved by a selective search in PubMed as well as on documentation of relevant risks and adverse effects in "red hand letters" (information bulletins from pharmaceutical companies to physicians about adverse drug effects) and elsewhere, along with data provided by the German Multiple Sclerosis Competence Network. RESULTS In recent years, there have been major advances enabling better, more individualized treatment of patients with MS. Physicians must, however, give due consideration to potentially severe or even life-threatening adverse drug effects. These can include, for example, transaminase elevation (hepatotoxicity), cardio- and nephrotoxicity, or lympho- and leukopenia with a variable risk of infection. Among patients taking natalizumab, the cumulative risk of developing progressive multifocal leukencephalopathy (PML) may be 1:100 or higher, depending on the individual risk profile. Rare cases of PML have also been seen under treatment with fingolimod and dimethyl fumarate. Moreover, any type of immunosuppressive treatment can, at least theoretically, increase the risk of malignant disease. Secondary autoimmune diseases can arise as well: approximately 35% of patients treated with alemtuzumab develop autoimmune thyroid disease within two years, and 2% of patients who take daclizumab have severe autoimmune dermatological side effects. Teriflunomide, fingolimod, natalizumab, mitoxantrone, interferon β1-a/b, and daclizumab can all damage the liver. There are also psychiatric, reproductive, and vaccineassociated risks and side effects that must be considered. CONCLUSION Newer drugs for MS have enabled more effective treatment, but are also associated with a higher risk of side effects. Interdisciplinary risk management is needed.
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Affiliation(s)
- Joachim Havla
- Institute for Clinical Neuroimmunology, Biomedical Center and Hospital, Ludwig-Maximilians Universität München, Munich
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, Heinrich Heine University Düsseldorf
| | | | | | - Hans-Peter Hartung
- Department of Neurology, Faculty of Medicine, Heinrich Heine University Düsseldorf
| | - Reinhard Hohlfeld
- Institute for Clinical Neuroimmunology, Biomedical Center and Hospital, Ludwig-Maximilians Universität München, Munich
- Munich Cluster for Systems Neurology (SyNergy)
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514
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Volpe G, Bernstock JD, Peruzzotti-Jametti L, Pluchino S. Modulation of host immune responses following non-hematopoietic stem cell transplantation: Translational implications in progressive multiple sclerosis. J Neuroimmunol 2016; 331:11-27. [PMID: 28034466 DOI: 10.1016/j.jneuroim.2016.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 12/12/2022]
Abstract
There exists an urgent need for effective treatments for those patients suffering from chronic/progressive multiple sclerosis (MS). Accordingly, it has become readily apparent that different classes of stem cell-based therapies must be explored at both the basic science and clinical levels. Herein, we provide an overview of the basic mechanisms underlying the pre-clinical benefits of exogenously delivered non-hematopoietic stem cells (nHSCs) in animal models of MS. Further, we highlight a number of early clinical trials in which nHSCs have been used to treat MS. Finally, we identify a series of challenges that must be met and ultimately overcome if such promising therapeutics are to be advanced from the bench to the bedside.
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Affiliation(s)
- Giulio Volpe
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK; University of Cambridge, Clifford Allbutt Building - Cambridge Biosciences Campus, Hills Road, CB2 0AH Cambridge, UK.
| | - Joshua D Bernstock
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK; Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA.
| | - Luca Peruzzotti-Jametti
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK; University of Cambridge, Clifford Allbutt Building - Cambridge Biosciences Campus, Hills Road, CB2 0AH Cambridge, UK.
| | - Stefano Pluchino
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Wellcome Trust-MRC Stem Cell Institute, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
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515
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Increasing the sensitivity of MRI for the detection of multiple sclerosis lesions by long axial coverage of the spinal cord: a prospective study in 119 patients. J Neurol 2016; 264:341-349. [DOI: 10.1007/s00415-016-8353-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/11/2023]
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516
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Díaz Sánchez M, Jiménez Hernández M. Tratamiento de las enfermedades desmielinizantes. Esclerosis múltiple. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.med.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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517
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Lutz T, Bellenberg B, Schneider R, Weiler F, Köster O, Lukas C. Central Atrophy Early in Multiple Sclerosis: Third Ventricle Volumetry versus Planimetry. J Neuroimaging 2016; 27:348-354. [PMID: 27897360 DOI: 10.1111/jon.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/13/2016] [Accepted: 10/29/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral atrophy has been suggested to be a reliable magnetic resonance imaging (MRI) predictor of subsequent disability in all stages of multiple sclerosis (MS). However, no accepted methodology for routine clinical use exists to date. We sought an easy to apply and fast technique to evaluate cerebral ventricular volume in patients with MS with similar accuracy as a semiautomatic volumetric method. METHODS The study included 104 patients, 61 diagnosed with MS and 43 with clinically isolated syndrome. In addition, 30 healthy controls were enrolled. Physical disability was assessed with the expanded disability status scale and cognitive disability with the Multiple Sclerosis Inventory Cognition (MUSIC) test. All subjects received standardized 3-dimensional (3D) MR-imaging on a 3 T scanner. Third ventricle volume (3VV) was obtained from 3D T1-weighted images using a semiautomated technique, and compared against planimetric assessment of the width of the third ventricle aligned (a3VW) and unaligned (u3VW) to anatomical landmarks. RESULTS a3VW was obtained within seconds with excellent intra- and interrater agreement, and outperformed volumetric measurements regarding the differentiation of MS patients from healthy controls. a3VW had the strongest correlations with 3VV (r = .78, P < .001) and showed moderate inverse correlation with MUSIC cognition score (r = -.310, P < .005). CONCLUSIONS a3VW is a time-effective and robust biomarker that has strong correlations with volumetric measurements and can be established as standard in the MRI quantification of central brain atrophy in patients with early MS.
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Affiliation(s)
- Theodor Lutz
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Odo Köster
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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518
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Alshamrani F, Alnajashi H, Freedman M. Radiologically isolated syndrome: watchful waiting vs. active treatment. Expert Rev Neurother 2016; 17:441-447. [DOI: 10.1080/14737175.2017.1259568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Hind Alnajashi
- King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - M Freedman
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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519
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Cohen Aubart F, Galanaud D, Haroche J, Psimaras D, Mathian A, Hié M, Le-Thi Huong Boutin D, Charlotte F, Maillart E, Maisonobe T, Amoura Z. [Neurosarcoidosis: Diagnosis and therapeutic issues]. Rev Med Interne 2016; 38:393-401. [PMID: 27884456 DOI: 10.1016/j.revmed.2016.10.392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/17/2016] [Accepted: 10/24/2016] [Indexed: 12/15/2022]
Abstract
Neurological localizations of sarcoidosis are heterogeneous and may affect virtually every part of the central or peripheral nervous system. They are often the inaugural manifestation of sarcoidosis. The diagnosis may be difficult due to the lack of extra-neurological localization. Diagnosis may be discussed in the presence of an inflammatory neurological disease, in particular in case of suggestive radiological or biological pattern. Cerebrospinal fluid analysis shows lymphocytic pleiocytosis, often with low glucose level. The diagnosis relies on a clinical, biological and radiological presentation consistent with neurosarcoidosis, the presence of non-caseating granuloma and exclusion of differential diagnoses. Screening for other localizations of sarcoidosis, in particular cardiac disease may be obtained during neurosarcoidosis. The treatment of neurosarcoidosis relies on corticosteroids although immunosuppressive drugs are usually added because of the chronic course of this condition and to limit the side effects of steroids. Treatments and follow-up may be prolonged because of the high rate of relapses.
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Affiliation(s)
- F Cohen Aubart
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI, Sorbonnes universités, 75013 Paris, France.
| | - D Galanaud
- Université Paris VI, Sorbonnes universités, 75013 Paris, France; Service de neuroradiologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - J Haroche
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI, Sorbonnes universités, 75013 Paris, France
| | - D Psimaras
- Service de neurologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - A Mathian
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - M Hié
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - D Le-Thi Huong Boutin
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - F Charlotte
- Service d'anatomo-pathologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - E Maillart
- Fédération des maladies du système nerveux, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - T Maisonobe
- Départements de neurophysiologie et neuropathologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Z Amoura
- Service de médecine interne 2, institut e3M, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Paris VI, Sorbonnes universités, 75013 Paris, France
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520
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Sati P, Oh J, Constable RT, Evangelou N, Guttmann CRG, Henry RG, Klawiter EC, Mainero C, Massacesi L, McFarland H, Nelson F, Ontaneda D, Rauscher A, Rooney WD, Samaraweera APR, Shinohara RT, Sobel RA, Solomon AJ, Treaba CA, Wuerfel J, Zivadinov R, Sicotte NL, Pelletier D, Reich DS. The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol 2016; 12:714-722. [DOI: 10.1038/nrneurol.2016.166] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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521
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A review on brain structures segmentation in magnetic resonance imaging. Artif Intell Med 2016; 73:45-69. [DOI: 10.1016/j.artmed.2016.09.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022]
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522
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Schlemm L, Chien C, Bellmann-Strobl J, Dörr J, Wuerfel J, Brandt AU, Paul F, Scheel M. Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients. Mult Scler 2016; 23:963-972. [PMID: 27679460 DOI: 10.1177/1352458516670738] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Previous studies have postulated an association between dentate nucleus T1 hyperintensity and multiple sclerosis (MS)-related progressive neurodegeneration. Therefore, MS patients have been excluded from most studies investigating brain deposition of gadolinium-based contrast agents (GBCAs). Objective: To study the hypothesis that dentate nucleus T1 hyperintensity in MS patients is associated with GBCA administration. Methods: In a cohort of 97 MS patients, the dentate-to-pons signal intensity ratio (DPSIR) was calculated for 265 consecutive T1-weighted magnetic resonance (MR) scans (including sessions with and without the administration of GBCA). Patients exclusively received either gadopentetate dimeglumine (Gd-DTPA, linear) or gadobutrol (Gd-BT-DO3A, macrocyclic). Results: In patients receiving Gd-DTPA, DPSIR increased significantly between the first and the last scan (+0.009, p < 0.001), and following magnetic resonance imaging (MRI) with Gd-DTPA administration as compared to following an MRI without Gd-DTPA administration (+0.005 vs −0.001; p = 0.022). Additionally, there was a positive linear relationship between the number of Gd-DTPA administrations and the increase in DPSIR ( p = 0.017). No DPSIR increase was observed after Gd-BT-DO3A administration. Conclusion: Dentate nucleus T1 hyperintensity in MS patients is associated with Gd-DTPA (but not Gd-BT-DO3A) administration, suggesting an alternative explanation for the association of T1 hyperintensity with disease duration and severity.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Medical Image Analysis Center (MIAC AG), Basel, Switzerland
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
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523
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Brownlee WJ, Miszkiel KA, Altmann DR, Ciccarelli O, Miller DH. Periventricular lesions and MS diagnostic criteria in young adults with typical clinically isolated syndromes. Mult Scler 2016; 23:1031-1034. [DOI: 10.1177/1352458516667565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In patients who present with a clinically isolated syndrome (CIS), whose features are suggestive of multiple sclerosis (MS), fulfilling McDonald 2010 magnetic resonance imaging (MRI) criteria for dissemination in space (DIS) and dissemination in time (DIT) enables a diagnosis of MS. While ⩾1 periventricular lesion is included in the 2010 DIS criteria, earlier McDonald criteria required ⩾3 periventricular lesions to confirm DIS and recent Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS)-recommended DIS criteria also require ⩾3 lesions. We investigated the effect of varying the required number of periventricular lesions and found that the best combination of specificity and sensitivity for clinically definite MS was seen for ⩾1 periventricular lesion using both the McDonald 2010 and MAGNIMS 2016 criteria.
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Affiliation(s)
- Wallace J Brownlee
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/National Hospital for Neurology and Neurosurgery, London, UK
| | - Katherine A Miszkiel
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Daniel R Altmann
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - David H Miller
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/NIHR University College London Hospitals Biomedical Research Centre, London, UK
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524
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Chen J, Carletti F, Young V, Mckean D, Quaghebeur G. MRI differential diagnosis of suspected multiple sclerosis. Clin Radiol 2016; 71:815-27. [DOI: 10.1016/j.crad.2016.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/08/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
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525
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Mainero C, Granberg T. Visualization of cortical MS lesions with MRI need not be further improved - NO. Mult Scler 2016; 23:17-19. [PMID: 27566449 DOI: 10.1177/1352458516666336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA/Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
| | - Tobias Granberg
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA/Department of Radiology, Massachusetts General Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA
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526
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Hardy TA, Reddel SW, Barnett MH, Palace J, Lucchinetti CF, Weinshenker BG. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 2016; 15:967-981. [DOI: 10.1016/s1474-4422(16)30043-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/02/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023]
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527
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Brownlee WJ, Swanton JK, Miszkiel KA, Miller DH, Ciccarelli O. Should the symptomatic region be included in dissemination in space in MRI criteria for MS? Neurology 2016; 87:680-3. [PMID: 27421541 DOI: 10.1212/wnl.0000000000002975] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate whether inclusion of lesions in the symptomatic region influences the performance of dissemination in space (DIS) criteria for a diagnosis of clinically definite multiple sclerosis (CDMS) in patients with a clinically isolated syndrome (CIS). METHODS We studied 30 patients with CIS with brainstem/cerebellar and spinal cord syndromes who had MRI scans at the time of CIS and were followed up for the development of CDMS. We retrospectively applied the McDonald 2010 DIS criteria (excluding all lesions in the symptomatic region) to baseline MRI scans and 2 modified DIS criteria: (1) the inclusion of asymptomatic lesions in the symptomatic region in DIS, and (2) the inclusion of any lesion in the symptomatic region in DIS. The performance of the McDonald 2010 DIS criteria and the 2 modified criteria for the development of CDMS was compared. RESULTS The sensitivity, specificity, and accuracy of the DIS criteria was, respectively, 73%, 73%, and 73% for the McDonald 2010 criteria, 80%, 73%, and 77% when asymptomatic lesions in the symptomatic region were included, and 87%, 73%, and 80% when any lesion in the symptomatic region was included in DIS. CONCLUSIONS Including lesions in the symptomatic region in DIS increases the sensitivity of MRI criteria for diagnosing multiple sclerosis without compromising specificity. These findings may help inform future revisions of the diagnostic criteria for multiple sclerosis. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with CIS, including lesions in the symptomatic region as part of the criteria for DIS does not significantly increase the accuracy for predicting the development of CDMS. The study lacks the precision to detect an important change in accuracy.
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Affiliation(s)
- Wallace J Brownlee
- From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK.
| | - Josephine K Swanton
- From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK
| | - Katherine A Miszkiel
- From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK
| | - David H Miller
- From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK
| | - Olga Ciccarelli
- From the Queen Square Multiple Sclerosis Centre (W.J.B., J.K.S., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology, London; Lysholm Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery, London; and NIHR University College London Hospitals Biomedical Research Centre (D.H.M., O.C.), London, UK
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528
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Pérez-Cerdá F, Sánchez-Gómez MV, Matute C. The link of inflammation and neurodegeneration in progressive multiple sclerosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40893-016-0012-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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529
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Leocani L, Rocca MA, Comi G. MRI and neurophysiological measures to predict course, disability and treatment response in multiple sclerosis. Curr Opin Neurol 2016; 29:243-53. [DOI: 10.1097/wco.0000000000000333] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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530
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531
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Abstract
Over the past few decades, MRI-based visualization of demyelinated CNS lesions has become pivotal to the diagnosis and monitoring of multiple sclerosis (MS). In this Review, we outline current efforts to correlate imaging findings with the pathology of lesion development in MS, and the pitfalls that are being encountered in this research. Multimodal imaging at high and ultra-high magnetic field strengths is yielding biologically relevant insights into the pathophysiology of blood-brain barrier dynamics and both active and chronic inflammation, as well as mechanisms of lesion healing and remyelination. Here, we parallel the results in humans with advances in imaging of a primate model of MS - experimental autoimmune encephalomyelitis (EAE) in the common marmoset - in which demyelinated lesions resemble their human counterparts far more closely than do EAE lesions in the rodent. This approach holds promise for the identification of innovative biological markers, and for next-generation clinical trials that will focus more on tissue protection and repair.
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532
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Killestein J, Uitdehaag BM. CSF examination still has value in the diagnosis of MS - NO. Mult Scler 2016; 22:995-7. [PMID: 27059062 DOI: 10.1177/1352458516641777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joep Killestein
- MS Center Amsterdam, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- MS Center Amsterdam, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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533
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Fox RJ. Refining diagnosis of multiple sclerosis with revised MRI criteria. Lancet Neurol 2016; 15:238-40. [PMID: 26822747 DOI: 10.1016/s1474-4422(16)00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Robert J Fox
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH 44195, USA.
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534
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Moen SM, Harbo HF, Sowa P, Celius EG, Nygaard GO, Beyer MK. MR-undersøkelser ved multippel sklerose. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1373-6. [DOI: 10.4045/tidsskr.15.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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535
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Abstract
Pediatric neurology relies on ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging. CT prevails in acute neurologic presentations, including traumatic brain injury (TBI), nontraumatic coma, stroke, and status epilepticus, because of easy availability, with images of diagnostic quality, e.g., to exclude hemorrhage, usually completed quickly enough to avoid sedation. Concerns over the risks of ionizing radiation mean re-imaging and higher-dose procedures, e.g., arteriography and venography, require justification. T1/T2-weighted imaging (T1/T2-WI) MR with additional sequences (arteriography, venography, T2*, spectroscopy, diffusion tensor, perfusion, diffusion- (DWI) and susceptibility-weighted imaging (SWI)) often clarifies the diagnosis, which may alter management in acute settings, as well as chronic conditions, e.g., epilepsy. Clinical acumen remains essential to avoid imaging, e.g., in genetic epilepsies or migrainous headaches responding to treatment, or to target sequences to specific diagnosis, e.g., T1/T2-WI for shunt dysfunction (with SWI for TBI); DWI, arteriography including neck vessels, and venography for acute hemiplegia or coma; coronal temporal cuts for partial epilepsy; or muscle imaging for motor delay. The risk of general anesthesia is low; "head-only" scanners may allow rapid MRI without sedation. Timely and accurate reporting, with discrepancy discussion between expert neuroradiologists, is important for management of the child and the family's expectations.
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