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Rocca MA, Romanò F, Tedone N, Filippi M. Advanced neuroimaging techniques to explore the effects of motor and cognitive rehabilitation in multiple sclerosis. J Neurol 2024; 271:3806-3848. [PMID: 38691168 DOI: 10.1007/s00415-024-12395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Progress in magnetic resonance imaging (MRI) technology and analyses is improving our comprehension of multiple sclerosis (MS) pathophysiology. These advancements, which enable the evaluation of atrophy, microstructural tissue abnormalities, and functional plasticity, are broadening our insights into the effectiveness and working mechanisms of motor and cognitive rehabilitative treatments. AREAS COVERED This narrative review with selected studies discusses findings derived from the application of advanced MRI techniques to evaluate structural and functional neuroplasticity modifications underlying the effects of motor and cognitive rehabilitative treatments in people with MS (PwMS). Current applications as outcome measure in longitudinal trials and observational studies, their interpretation and possible pitfalls and limitations in their use are covered. Finally, we examine how the use of these techniques could evolve in the future to improve monitoring of motor and cognitive rehabilitative treatments. EXPERT COMMENTARY Despite substantial variability in study design and participant characteristics in rehabilitative studies for PwMS, improvements in motor and cognitive functions accompanied by structural and functional brain modifications induced by rehabilitation can be observed. However, significant enhancements to refine rehabilitation strategies are needed. Future studies in this field should strive to implement standardized methodologies regarding MRI acquisition and processing, possibly integrating multimodal measures. This will help identifying relevant markers of treatment response in PwMS, thus improving the use of rehabilitative interventions at individual level. The combination of motor and cognitive strategies, longer periods of treatment, as well as adequate follow-up assessments will contribute to enhance the quality of evidence in support of their routine use.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Rocca MA, Valsasina P, Romanò F, Tedone N, Amato MP, Brichetto G, Boccia VD, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell RA, Feys P, Freeman J, Inglese M, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Cognitive rehabilitation effects on grey matter volume and Go-NoGo activity in progressive multiple sclerosis: results from the CogEx trial. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333460. [PMID: 38754979 DOI: 10.1136/jnnp-2024-333460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Research on cognitive rehabilitation (CR) and aerobic exercise (EX) to improve cognition in progressive multiple sclerosis (PMS) remains limited. CogEx trial investigated the effectiveness of CR and EX in PMS: here, we present MRI substudy volumetric and task-related functional MRI (fMRI) findings. METHODS Participants were randomised to: 'CR plus EX', 'CR plus sham EX (EX-S)', 'EX plus sham CR (CR-S)' and 'CR-S plus EX-S' and attended 12-week intervention. All subjects performed physical/cognitive assessments at baseline, week 12 and 6 months post intervention (month 9). All MRI substudy participants underwent volumetric MRI and fMRI (Go-NoGo task). RESULTS 104 PMS enrolled at four sites participated in the CogEx MRI substudy; 84 (81%) had valid volumetric MRI and valid fMRI. Week 12/month 9 cognitive performances did not differ among interventions; however, 25-62% of the patients showed Symbol Digit Modalities Test improvements. Normalised cortical grey matter volume (NcGMV) changes at week 12 versus baseline were heterogeneous among interventions (p=0.05); this was mainly driven by increased NcGMV in 'CR plus EX-S' (p=0.02). Groups performing CR (ie, 'CR plus EX' and 'CR plus EX-S') exhibited increased NcGMV over time, especially in the frontal (p=0.01), parietal (p=0.04) and temporal (p=0.04) lobes, while those performing CR-S exhibited NcGMV decrease (p=0.008). In CR groups, increased NcGMV (r=0.36, p=0.01) at week 12 versus baseline correlated with increased California Verbal Learning Test (CVLT)-II scores. 'CR plus EX-S' patients exhibited Go-NoGo activity increase (p<0.05, corrected) at week 12 versus baseline in bilateral insula. CONCLUSIONS In PMS, CR modulated grey matter (GM) volume and insular activity. The association of GM and CVLT-II changes suggests GM plasticity contributes to cognitive improvements. TRIAL REGISTRATION NUMBER NCT03679468.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Vincenzo Daniele Boccia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rachel A Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- University MS Center, Hasselt University, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
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Elkhooly M, Bao F, Raghib M, Millis S, Bernitsas E. Role of white matter in cognitive impairment among relapsing remitting multiple sclerosis patients. Mult Scler Relat Disord 2023; 79:105030. [PMID: 37837669 DOI: 10.1016/j.msard.2023.105030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/14/2023] [Accepted: 09/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) associated cognitive impairment is believed to be mostly connected with damage to gray matter. The contribution of white matter is still poorly understood. We aim to examine the relationship between cognition and white matter tracts among relapsing remitting MS (RRMS) patients. METHODS Thirty RRMS patients were selected undergo the (3-seconds-interstimulus-interval paced auditory serial addition test) PASAT-3, the (symbol digit modalities test (SDMT) and full-brain MRI scans on a SIEMENS 3 Tesla Verio scanner. Diffusion Tensor Imaging (DTI) parameters, such as fractional anisotropy (FA) and mean diffusivity (MD) were examined in 37 white matter (WM) tracts. WM tracts were selected from the association pathways, projection pathways, commissural pathways by applying Human Connectome project (HCP)842 tractography atlas after DTI data reconstruction and registration to HCP1065 diffusion template in DSI Studio (version March 2021) In SPSS v26, Spearman's rank correlation analysis was used to examine the connection between DTI WM tracts and cognitive scores. The power of the study was increased by using false discovery rate (FDR) software. RESULTS The mean scores on the PASAT-3 and SDMT were 31.5 ± 12.8 and 46.9 ± 16.7 respectively. Better cognitive performance was correlated to higher FA values, while lower cognitive function was correlated to higher MD values. There was a positive correlation between FA values in the right medial lemniscus and superior cerebellar peduncle and SDMT scores (p 0.05). Additionally, there was a trend for significance between the FA values in the left corticothalamic tract and SDMT scores. MD values in the superior cerebellar peduncle, left arcuate Fasciculus and left extreme capsule were negatively correlated with SDMT scores (p<0.05). PASAT-3 scores were negatively correlated with MD values in the right cerebellum, however, there was no significant correlation between PASAT-3 and FA values. CONCLUSIONS White matter tracts, particularly the superior cerebellar peduncle, contribute to the cognitive impairment in RRMS. Larger sample sizes for longitudinal research are necessary.
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Affiliation(s)
- Mahmoud Elkhooly
- Neurology Department, Wayne State University, Detroit, MI 48201, USA; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Fen Bao
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Muhammad Raghib
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Scott Millis
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
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Mistri D, Cacciaguerra L, Valsasina P, Pagani E, Filippi M, Rocca MA. Cognitive function in primary and secondary progressive multiple sclerosis: A multiparametric magnetic resonance imaging study. Eur J Neurol 2023; 30:2801-2810. [PMID: 37246467 DOI: 10.1111/ene.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND PURPOSE The differences in cognitive function between primary progressive and secondary progressive multiple sclerosis (MS) remain unclear. We compared cognitive performance between primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS), and explored the structural and functional magnetic resonance imaging (MRI) correlates of their cognitive functions. METHODS Seventy-five healthy controls and 183 MS patients (60 PPMS and 123 SPMS) underwent 3.0-T MRI. MS patients were administered the Brief Repeatable Battery of Neuropsychological Tests; cognitive domain z-scores were calculated and then averaged to obtain a measure of global cognition. Using hierarchical linear regression analysis, the contribution of lesion volumes, normalized brain volumes, white matter (WM) fractional anisotropy (FA) and mean diffusivity abnormalities, and resting state (RS) functional connectivity (FC) alterations to global cognition in PPMS and SPMS was investigated. RESULTS PPMS and SPMS had similar z-scores in all investigated cognitive domains. Poor global cognitive function was associated with decreased FA of the medial lemniscus (ΔR 2 = 0.11, p = 0.011) and lower normalized gray matter volume (ΔR 2 = 0.29, p < 0.001) in PPMS, and with decreased FA of the fornix (ΔR 2 = 0.35, p < 0.001) and lower normalized WM volume (ΔR 2 = 0.05; p = 0.034) in SPMS. CONCLUSIONS PPMS and SPMS had similar neuropsychological performance. Cognitive dysfunction in PPMS and SPMS was related to distinct patterns of structural MRI abnormalities and involvement of different WM tracts, whereas RS FC alterations did not contribute to explaining their global cognitive functioning.
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Affiliation(s)
- Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cipriano L, Troisi Lopez E, Liparoti M, Minino R, Romano A, Polverino A, Ciaramella F, Ambrosanio M, Bonavita S, Jirsa V, Sorrentino G, Sorrentino P. Reduced clinical connectome fingerprinting in multiple sclerosis predicts fatigue severity. Neuroimage Clin 2023; 39:103464. [PMID: 37399676 PMCID: PMC10329093 DOI: 10.1016/j.nicl.2023.103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Brain connectome fingerprinting is progressively gaining ground in the field of brain network analysis. It represents a valid approach in assessing the subject-specific connectivity and, according to recent studies, in predicting clinical impairment in some neurodegenerative diseases. Nevertheless, its performance, and clinical utility, in the Multiple Sclerosis (MS) field has not yet been investigated. METHODS We conducted the Clinical Connectome Fingerprint (CCF) analysis on source-reconstructed magnetoencephalography signals in a cohort of 50 subjects: twenty-five MS patients and twenty-five healthy controls. RESULTS All the parameters of identifiability, in the alpha band, were reduced in patients as compared to controls. These results implied a lower similarity between functional connectomes (FCs) of the same patient and a reduced homogeneity among FCs in the MS group. We also demonstrated that in MS patients, reduced identifiability was able to predict, fatigue level (assessed by the Fatigue Severity Scale). CONCLUSION These results confirm the clinical usefulness of the CCF in both identifying MS patients and predicting clinical impairment. We hope that the present study provides future prospects for treatment personalization on the basis of individual brain connectome.
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Affiliation(s)
- Lorenzo Cipriano
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Emahnuel Troisi Lopez
- Institute of Applied Sciences and Intelligent Systems, National Research Council, Italy
| | - Marianna Liparoti
- Department of Social and Developmental Psychology, Sapienza University of Rome, Italy
| | - Roberta Minino
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Antonella Romano
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | | | - Francesco Ciaramella
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Michele Ambrosanio
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Viktor Jirsa
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France
| | - Giuseppe Sorrentino
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy; Institute of Applied Sciences and Intelligent Systems, National Research Council, Italy; Institute for Diagnosis and Cure Hermitage Capodimonte, Italy.
| | - Pierpaolo Sorrentino
- Institute of Applied Sciences and Intelligent Systems, National Research Council, Italy; Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Lopez-Soley E, Martinez-Heras E, Solana E, Solanes A, Radua J, Vivo F, Prados F, Sepulveda M, Cabrera-Maqueda JM, Fonseca E, Blanco Y, Alba-Arbalat S, Martinez-Lapiscina EH, Villoslada P, Saiz A, Llufriu S. Diffusion tensor imaging metrics associated with future disability in multiple sclerosis. Sci Rep 2023; 13:3565. [PMID: 36864113 PMCID: PMC9981711 DOI: 10.1038/s41598-023-30502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
The relationship between brain diffusion microstructural changes and disability in multiple sclerosis (MS) remains poorly understood. We aimed to explore the predictive value of microstructural properties in white (WM) and grey matter (GM), and identify areas associated with mid-term disability in MS patients. We studied 185 patients (71% female; 86% RRMS) with the Expanded Disability Status Scale (EDSS), timed 25-foot walk (T25FW), nine-hole peg test (9HPT), and Symbol Digit Modalities Test (SDMT) at two time-points. We used Lasso regression to analyse the predictive value of baseline WM fractional anisotropy and GM mean diffusivity, and to identify areas related to each outcome at 4.1 years follow-up. Motor performance was associated with WM (T25FW: RMSE = 0.524, R2 = 0.304; 9HPT dominant hand: RMSE = 0.662, R2 = 0.062; 9HPT non-dominant hand: RMSE = 0.649, R2 = 0.139), and SDMT with GM diffusion metrics (RMSE = 0.772, R2 = 0.186). Cingulum, longitudinal fasciculus, optic radiation, forceps minor and frontal aslant were the WM tracts most closely linked to motor dysfunction, and temporal and frontal cortex were relevant for cognition. Regional specificity related to clinical outcomes provide valuable information that can be used to develop more accurate predictive models that could improve therapeutic strategies.
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Affiliation(s)
- E Lopez-Soley
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - E Martinez-Heras
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
| | - E Solana
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
| | - A Solanes
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and CIBERSAM, Barcelona, Spain
| | - J Radua
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and CIBERSAM, Barcelona, Spain
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Early Psychosis Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - F Vivo
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - F Prados
- E-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - M Sepulveda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - J M Cabrera-Maqueda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - E Fonseca
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Y Blanco
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - S Alba-Arbalat
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - E H Martinez-Lapiscina
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - P Villoslada
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - A Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
| | - S Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain
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Correspondence among gray matter atrophy and atlas-based neurotransmitter maps is clinically relevant in multiple sclerosis. Mol Psychiatry 2023; 28:1770-1782. [PMID: 36658334 DOI: 10.1038/s41380-023-01943-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023]
Abstract
In multiple sclerosis (MS), gray matter (GM) atrophy progresses in a non-random manner, possibly in regions with a high distribution of specific neurotransmitters involved in several relevant central nervous system functions. We investigated the associations among regional GM atrophy, atlas-based neurotransmitter distributions and clinical manifestations in a large MS patients' group. Brain 3 T MRI scans, neurological examinations and neuropsychological evaluations were obtained from 286 MS patients and 172 healthy controls (HC). Spatial correlations among regional GM volume differences and atlas-based nuclear imaging-derived neurotransmitter maps, and their associations with MS clinical features were investigated using voxel-based morphometry and JuSpace toolbox. Compared to HC, MS patients showed widespread GM atrophy being spatially correlated with the majority of neurotransmitter maps (false discovery rate [FDR]-p ≤ 0.004). Patients with a disease duration ≥ 5 vs < 5 years had significant cortical, subcortical and cerebellar atrophy, being spatially correlated with a higher distribution of serotoninergic and dopaminergic receptors (FDR-p ≤ 0.03). Compared to mildly-disabled patients, those with Expanded Disability Status Scale ≥ 3.0 or ≥ 4.0 had significant cortical, subcortical and cerebellar atrophy being associated with serotonergic, dopaminergic, opioid and cholinergic maps (FDR-p ≤ 0.04). Cognitively impaired vs cognitively preserved patients had widespread GM atrophy being spatially associated with serotonergic, dopaminergic, noradrenergic, cholinergic and glutamatergic maps (FDR-p ≤ 0.04). Fatigued vs non-fatigued MS patients had significant cortical, subcortical and cerebellar atrophy, not associated with neurotransmitter maps. No significant association between GM atrophy and neurotransmitter maps was found for depression. Regional GM atrophy with specific neurotransmitter systems may explain part of MS clinical manifestations, including locomotor disability, cognitive impairment and fatigue.
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Reiszadeh-Jahromi S, Haddadi M, Mousavi P, Sanadgol N. Prophylactic effects of cucurbitacin B in the EAE Model of multiple sclerosis by adjustment of STAT3/IL-23/IL-17 axis and improvement of neuropsychological symptoms. Metab Brain Dis 2022; 37:2937-2953. [PMID: 36287356 DOI: 10.1007/s11011-022-01083-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/06/2022] [Indexed: 10/31/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. Although remarkable progress has been made in treating MS, current therapies are less effective in protecting against the progression of the disease. Since cucurbitacins have shown an extreme range of pharmacological properties, in this study, we aimed to investigate the prophylactic effect of cucurbitacin B (CuB) in the experimental MS model. Experimental autoimmune encephalomyelitis (EAE) induced by subcutaneous immunization of MOG35-55 in C57BL/6 mice. CuB interventions (0.5 and 1 mg/kg, i.p.) were performed every other day from the first day of EAE induction. Assessment of clinical scores and motor function, inflammatory responses, and microglial activation were assessed by qRT-PCR, western blotting, and immunohistochemical (IHC) analyses. CuB (1 mg/kg) significantly decreased the population of CD45+ (P < 0.01), CD11b+ (P < 0.01) and CD45+/CD11b+ (P < 0.05) cells in cortical lesions of EAE mice. In addition, activation of STAT3 (P < 0.001), expression of IL-17 A and IL-23 A (both mRNA and protein), and transcription of Iba-1 significantly decreased. On the contrary, CuB (1 mg/kg) significantly increased the transcription of MBP and Olig-2. Furthermore, a significant decrease in the severity of EAE (P < 0.05), and an improvement in motor function (P < 0.05) and coordination (P < 0.05) were observed after treatment with a high dose of CuB. Our results suggest that CuB may have a wide-ranging effect on autoimmune responses in MS via a reduction in STAT3 activation, microgliosis, and adaptation of the IL-23/IL-17 axis. Further studies are needed to investigate the exact effect of CuB in glial cells and its efficiency and bioavailability in other neuroinflammatory diseases.
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Affiliation(s)
| | - Mohammad Haddadi
- Department of Biology, Faculty of Basic Sciences, University of Zabol, Zabol, Iran
| | - Pegah Mousavi
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nima Sanadgol
- Department of Biology, Faculty of Basic Sciences, University of Zabol, Zabol, Iran.
- Institute of Neuroanatomy, RWTH University Hospital Aachen, Aachen, Germany.
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9
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Abuaf AF, Bunting SR, Klein S, Carroll T, Carpenter-Thompson J, Javed A, Cipriani V. Analysis of the extent of limbic system changes in multiple sclerosis using FreeSurfer and voxel-based morphometry approaches. PLoS One 2022; 17:e0274778. [PMID: 36137122 PMCID: PMC9499213 DOI: 10.1371/journal.pone.0274778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background and purpose The limbic brain is involved in diverse cognitive, emotional, and autonomic functions. Injury of the various parts of the limbic system have been correlated with clinical deficits in MS. The purpose of this study was to comprehensively examine different regions of the subcortical limbic system to assess the extent of damage within this entire system as it may be pertinent in correlating with specific aspects of cognitive and behavioral dysfunction in MS by using a fully automated, unbiased segmentation approach. Methods Sixty-seven subjects were included in this study, including 52 with multiple sclerosis (MS) and 15 healthy controls. Only patients with stable MS disease, without any relapses, MRI activity, or disability progression were included. Subcortical limbic system segmentation was performed using the FreeSurfer pipeline ScLimbic, which provides volumes for fornix, mammillary bodies, hypothalamus, septal nuclei, nucleus accumbens, and basal forebrain. Hippocampus and anterior thalamic nuclei were added as additional components of the limbic circuitry, also segmented through FreeSurfer. Whole limbic region mask was generated by combining these structures and used for Voxel-based morphometry (VBM) analysis. Results The mean [95% confidence interval] of the total limbic system volume was lower (0.22% [0.21–0.23]) in MS compared to healthy controls (0.27%, [0.25–0.29], p < .001). Pairwise comparisons of individual limbic regions between MS and controls was significant in the nucleus accumbens (0.046%, [0.043–0.050] vs. 0.059%, [0.051–0.066], p = .005), hypothalamus (0.062%, [0.059–0.065] vs. 0.074%, [0.068–0.081], p = .001), basal forebrain (0.038%, [0.036–0.040] vs. 0.047%, [0.042–0.051], p = .001), hippocampus (0.47%, [0.45–0.49] vs. 0.53%, [0.49–0.57], p = .004), and anterior thalamus (0.077%, [0.072–0.082] vs. 0.093%, [0.084–0.10], p = .001) after Bonferroni correction. Volume of several limbic regions was significantly correlated with T2 lesion burden and brain parenchymal fraction (BPF). Multiple regression model showed minimal influence of BPF on limbic brain volume and no influence of other demographic and disease state variables. VBM analysis showed cluster differences in the fornix and anterior thalamic nuclei at threshold p < 0.05 after adjusting for covariates but the results were insignificant after family-wise error corrections. Conclusions The results show evidence that brain volume loss is fairly extensive in the limbic brain. Given the significance of the limbic system in many disease states including MS, such volumetric analyses can be expanded to studying cognitive and emotional disturbances in larger clinical trials. FreeSurfer ScLimbic pipeline provided an efficient and reliable methodology for examining many of the subcortical structures related to the limbic brain.
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Affiliation(s)
- Amanda Frisosky Abuaf
- Department of Neurology, The University of Wisconsin, Madison, WI, United States of America
| | - Samuel R. Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States of America
| | - Sara Klein
- Department of Neurology, The University of Chicago, Chicago, IL, United States of America
| | - Timothy Carroll
- Department of Radiology, The University of Chicago, Chicago, IL, United States of America
| | | | - Adil Javed
- Department of Neurology, The University of Chicago, Chicago, IL, United States of America
- * E-mail:
| | - Veronica Cipriani
- Department of Neurology, The University of Chicago, Chicago, IL, United States of America
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10
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Siger M. Magnetic Resonance Imaging in Primary Progressive Multiple Sclerosis Patients : Review. Clin Neuroradiol 2022; 32:625-641. [PMID: 35258820 PMCID: PMC9424179 DOI: 10.1007/s00062-022-01144-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
The recently developed effective treatment of primary progressive multiple sclerosis (PPMS) requires the accurate diagnosis of patients with this type of disease. Currently, the diagnosis of PPMS is based on the 2017 McDonald criteria, although the contribution of magnetic resonance imaging (MRI) to this process is fundamental. PPMS, one of the clinical types of MS, represents 10%-15% of all MS patients. Compared to relapsing-remitting MS (RRMS), PPMS differs in terms of pathology, clinical presentation and MRI features. Regarding conventional MRI, focal lesions on T2-weighted images and acute inflammatory lesions with contrast enhancement are less common in PPMS than in RRMS. On the other hand, MRI features of chronic inflammation, such as slowly evolving/expanding lesions (SELs) and leptomeningeal enhancement (LME), and brain and spinal cord atrophy are more common MRI characteristics in PPMS than RRMS. Nonconventional MRI also shows differences in subtle white and grey matter damage between PPMS and other clinical types of disease. In this review, we present separate diagnostic criteria, conventional and nonconventional MRI specificity for PPMS, which may support and simplify the diagnosis of this type of MS in daily clinical practice.
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Affiliation(s)
- Malgorzata Siger
- Department of Neurology, Medical University of Łódź, 22 Kopcinskiego Str., 90-153, Łódź, Poland.
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11
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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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12
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Kleerekooper I, Chua S, Foster PJ, Trip SA, Plant GT, Petzold A, Patel P. Associations of Alcohol Consumption and Smoking With Disease Risk and Neurodegeneration in Individuals With Multiple Sclerosis in the United Kingdom. JAMA Netw Open 2022; 5:e220902. [PMID: 35238934 PMCID: PMC8895260 DOI: 10.1001/jamanetworkopen.2022.0902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Understanding the effects of modifiable risk factors on risk for multiple sclerosis (MS) and associated neurodegeneration is important to guide clinical counseling. OBJECTIVE To investigate associations of alcohol use, smoking, and obesity with odds of MS diagnosis and macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the community-based UK Biobank study on health behaviors and retinal thickness (measured by optical coherence tomography in both eyes) in individuals aged 40 to 69 years examined from December 1, 2009, to December 31, 2010. Risk factors were identified with multivariable logistic regression analyses. To adjust for intereye correlations, multivariable generalized estimating equations were used to explore associations of alcohol use and smoking with mGCIPL thickness. Finally, interaction models explored whether the correlations of alcohol and smoking with mGCIPL thickness differed for individuals with MS. Data were analyzed from February 1 to July 1, 2021. EXPOSURES Smoking status (never, previous, or current), alcohol intake (never or special occasions only [low], once per month to ≤4 times per week [moderate], or daily/almost daily [high]), and body mass index. MAIN OUTCOMES AND MEASURES Multiple sclerosis case status and mGCIPL thickness. RESULTS A total of 71 981 individuals (38 685 women [53.7%] and 33 296 men [46.3%]; mean [SD] age, 56.7 [8.0] years) were included in the analysis (20 065 healthy control individuals, 51 737 control individuals with comorbidities, and 179 individuals with MS). Modifiable risk factors significantly associated with MS case status were current smoking (odds ratio [OR], 3.05 [95% CI, 1.95-4.64]), moderate alcohol intake (OR, 0.62 [95% CI, 0.43-0.91]), and obesity (OR, 1.72 [95% CI, 1.15-2.56]) compared with healthy control individuals. Compared with the control individuals with comorbidities, only smoking was associated with case status (OR, 2.30 [95% CI, 1.48-3.51]). High alcohol intake was associated with a thinner mGCIPL in individuals with MS (adjusted β = -3.09 [95% CI, -5.70 to -0.48] μm; P = .02). In the alcohol interaction model, high alcohol intake was associated with thinner mGCIPL in control individuals (β = -0.93 [95% CI, -1.07 to -0.79] μm; P < .001), but there was no statistically significant association in individuals with MS (β = -2.27 [95% CI, -4.76 to 0.22] μm; P = .07). Smoking was not associated with mGCIPL thickness in MS. However, smoking was associated with greater mGCIPL thickness in control individuals (β = 0.89 [95% CI, 0.74-1.05 μm]; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that high alcohol intake was associated with retinal features indicative of more severe neurodegeneration, whereas smoking was associated with higher odds of being diagnosed with MS.
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Affiliation(s)
- Iris Kleerekooper
- Queen Square MS Centre, Department of Neuroinflammation, UCL (University College London) Institute of Neurology, London, United Kingdom
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Sharon Chua
- NIHR (National Institute for Health Research) Biomedical Research Centre, Moorfields Eye Hospital, NHS (National Health Service) Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Paul J. Foster
- NIHR (National Institute for Health Research) Biomedical Research Centre, Moorfields Eye Hospital, NHS (National Health Service) Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - S. Anand Trip
- Queen Square MS Centre, Department of Neuroinflammation, UCL (University College London) Institute of Neurology, London, United Kingdom
| | - Gordon T. Plant
- Queen Square MS Centre, Department of Neuroinflammation, UCL (University College London) Institute of Neurology, London, United Kingdom
| | - Axel Petzold
- Queen Square MS Centre, Department of Neuroinflammation, UCL (University College London) Institute of Neurology, London, United Kingdom
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, London, United Kingdom
- Dutch Expertise Centre for Neuro-ophthalmology and MS (Multiple Sclerosis) Centre, Departments of Neurology and Ophthalmology, Amsterdam University Medical College, Amsterdam, the Netherlands
| | - Praveen Patel
- NIHR (National Institute for Health Research) Biomedical Research Centre, Moorfields Eye Hospital, NHS (National Health Service) Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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13
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Mirabelli E, Elkabes S. Neuropathic Pain in Multiple Sclerosis and Its Animal Models: Focus on Mechanisms, Knowledge Gaps and Future Directions. Front Neurol 2022; 12:793745. [PMID: 34975739 PMCID: PMC8716468 DOI: 10.3389/fneur.2021.793745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is a multifaceted, complex and chronic neurological disease that leads to motor, sensory and cognitive deficits. MS symptoms are unpredictable and exceedingly variable. Pain is a frequent symptom of MS and manifests as nociceptive or neuropathic pain, even at early disease stages. Neuropathic pain is one of the most debilitating symptoms that reduces quality of life and interferes with daily activities, particularly because conventional pharmacotherapies do not adequately alleviate neuropathic pain. Despite advances, the mechanisms underlying neuropathic pain in MS remain elusive. The majority of the studies investigating the pathophysiology of MS-associated neuropathic pain have been performed in animal models that replicate some of the clinical and neuropathological features of MS. Experimental autoimmune encephalomyelitis (EAE) is one of the best-characterized and most commonly used animal models of MS. As in the case of individuals with MS, rodents affected by EAE manifest increased sensitivity to pain which can be assessed by well-established assays. Investigations on EAE provided valuable insights into the pathophysiology of neuropathic pain. Nevertheless, additional investigations are warranted to better understand the events that lead to the onset and maintenance of neuropathic pain in order to identify targets that can facilitate the development of more effective therapeutic interventions. The goal of the present review is to provide an overview of several mechanisms implicated in neuropathic pain in EAE by summarizing published reports. We discuss current knowledge gaps and future research directions, especially based on information obtained by use of other animal models of neuropathic pain such as nerve injury.
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Affiliation(s)
- Ersilia Mirabelli
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States.,Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA, United States
| | - Stella Elkabes
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States
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14
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Argento O, Spanò B, Serra L, Incerti CC, Bozzali M, Caltagirone C, Francia A, Fratino M, Nocentini U, Piacentini C, Quartuccio ME, Pisani V. Relapsing-remitting and secondary-progressive multiple sclerosis patients differ in decoding others' emotions by their eyes. Eur J Neurol 2021; 29:505-514. [PMID: 34687120 DOI: 10.1111/ene.15155] [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: 03/25/2021] [Revised: 09/17/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Difficulties in emotion processing and social cognition identified in multiple sclerosis (MS) patients have a potential impact on their adaptation to the social environment. We aimed to explore the neural correlates of emotion recognition in MS and possible differences between relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) patients by the Reading the Mind in the Eyes test (RMEt). METHODS A total of 43 MS patients (27 RRMS, 16 SPMS) and 25 matched healthy controls (HC) underwent clinical assessments, RMEt, and a high-resolution T1-weighted 3-T magnetic resonance imaging (MRI) scan. The number of correct answers on the RMEt was compared between groups. T1-weighted volumes were processed according to an optimized voxel-based morphometry (VBM) protocol to obtain gray matter (GM) maps. Voxelwise analyses were run to assess potential associations between RMEt performance and regional GM volumes. RESULTS Taken altogether, MS patients reported significantly lower performance on the RMEt compared to HC. When dividing the patients into those with RRMS and those with SPMS, only the latter group was found to perform significantly worse than HC on the RMEt. VBM analysis revealed significant association between RMEt scores and GM volumes in several cortical (temporoparieto-occipital cortex) and subcortical (hippocampus, parahippocampus, and basal ganglia) brain regions, and in the cerebellum in SPMS patients only. CONCLUSIONS Results suggest that, in addition to other clinical differences between RRMS and SPMS, the ability to recognize others' emotional states may be affected in SPMS more significantly than RRMS patients. This is supported by both behavioral and MRI data.
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Affiliation(s)
- Ornella Argento
- Neurology and Neurorehabilitation Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Barbara Spanò
- Neuroimaging Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Laura Serra
- Neuroimaging Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Chiara Concetta Incerti
- Neurology and Neurorehabilitation Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Marco Bozzali
- Rita Levi Montalcini Department of Neuroscience,, University of Turin, Turin, Italy.,Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Carlo Caltagirone
- Scientific Direction, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Ada Francia
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariangela Fratino
- Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ugo Nocentini
- Neurology and Neurorehabilitation Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy.,Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Chiara Piacentini
- Neurology and Neurorehabilitation Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | | | - Valerio Pisani
- Neurology and Neurorehabilitation Unit, Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
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15
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Khan H, Sami MB, Litvak V. The utility of Magnetoencephalography in multiple sclerosis - A systematic review. NEUROIMAGE-CLINICAL 2021; 32:102814. [PMID: 34537682 PMCID: PMC8455859 DOI: 10.1016/j.nicl.2021.102814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
We conducted a Systematic Review of studies, looking at 30 studies from 13 centres. MS patients had reduced power in some induced responses (motor beta, visual gamma). Increased latency and reduced connectivity were seen for somatosensory evoked fields. There was an association between upper alpha connectivity and cognitive function. MEG shows promise, although work is too preliminary to recommend current clinical use.
Introduction Magnetoencephalography (MEG), allows for a high degree temporal and spatial accuracy in recording cortical oscillatory activity and evoked fields. To date, no review has been undertaken to synthesise all MEG studies in Multiple Sclerosis (MS). We undertook a Systematic Review of the utility of MEG in MS. Methods We identified MEG studies carried out in MS using EMBASE, Medline, Cochrane, TRIP and Psychinfo databases. We included original research articles with a cohort of minimum of five multiple sclerosis patients and quantifying of at least one MEG parameter. We used a modified version of the JBI (mJBI) for case-control studies to assess for risk of bias. Results We identified 30 studies from 13 centres involving at least 433 MS patients and 347 controls. We found evidence that MEG shows perturbed activity (most commonly reduced power modulations), reduced connectivity and association with altered clinical function in Multiple Sclerosis. Specific replicated findings were decreased motor induced responses in the beta band, diminished increase of gamma power after visual stimulation, increased latency and reduced connectivity for somatosensory evoked fields. There was an association between upper alpha connectivity and cognitive measures in people with MS. Overall studies were of moderate quality (mean mJBI score 6.7). Discussion We find evidence for the utility of MEG in Multiple Sclerosis. Event-related designs are of particular value and show replicability between centres. At this stage, it is not clear whether these changes are specific to Multiple Sclerosis or are also observable in other diseases. Further studies should look to explore cognitive control in more depth using in-task designs and undertake longitudinal studies to determine whether these changes have prognostic value.
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Affiliation(s)
- H Khan
- UCL Queen's Square Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; Queen's Medical Centre Nottingham, Clifton Boulevard, Derby Rd, Nottingham NG7 2UH, United Kingdom.
| | - M B Sami
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom
| | - V Litvak
- UCL Queen's Square Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
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16
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Trufanov A, Bisaga G, Skulyabin D, Temniy A, Poplyak M, Chakchir O, Efimtsev A, Dmitriy T, Odinak M, Litvinenko I. Thalamic nuclei degeneration in multiple sclerosis. J Clin Neurosci 2021; 89:375-380. [PMID: 34090763 DOI: 10.1016/j.jocn.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2020] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To define both the severity and extent of structural alteration in certain thalamic nuclei by means of MR morphometry and to compare these findings with clinical performance in different phenotypes of multiple sclerosis (MS). METHODS We comparatively measured the thalamus nuclei volumes of patients with remitting-relapsing (RRMS) and secondary-progressive (SPMS) phenotypes of multiple sclerosis and healthy control subjects (HC). The evaluation of neurological performance was based on the results of Expanded Disability Status Scale and Multiple Sclerosis Severity Scale. Cognitive and mental state was rated according to the results of Mini-Mental State Examination, Frontal Assessment Battery, Montreal Cognitive Assessment and Symbol Digit Modalities Test. Freesurfer 6.0 was used for thalamic nuclei volumes calculation. RESULTS The median volume decline in thalamic pulvinar nuclei in RRMS group on the left side (anterior nucleus - 186,6 mm3, posterior nucleus - 149,4 mm3, medial nucleus 852,4 mm3) compared to HC (anterior nucleus - 229,2 mm3, posterior nucleus - 187,5 mm3, medical nucleus - 1081,3 mm3). Same group, right side - anterior nucleus - 219,5 mm3, posterior nucleus 187,1 mm3, medial nucleus - 989,6 mm3; HC group - anterior nucleus 261,1 mm3, posterior nucleus 240,5 mm3, medial nucleus - 1196,7 mm3 (p < 0,05). The highest correlation of the written section of SDMT was observed with the left ventral anterior nucleus (r = 0,71). CONCLUSION These findings indicate the credible correlation between clinical progression of neurological and cognitive impairment in MS patients with asymmetry left-sided thalamic nuclei atrophy and may be considered a potential predicting tool of MS progression.
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Affiliation(s)
- Artem Trufanov
- Department of Nanobiotechnology, Autonomous Non-profit Higher Education Organization (University associated with the Interparliamentary Assembly of the Eurasian Economic Community), 14/1, letter B, Smolyachkova Street, 194044 Saint-Petersburg, Russia; Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia.
| | - Gennady Bisaga
- Department of Neurology, Almazov National Medical Research Centre, 2, Akkuratova Street, 197341 Saint-Petersburg, Russia
| | - Dmitry Skulyabin
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Alexandr Temniy
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Mariya Poplyak
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Oleg Chakchir
- Department of Nanobiotechnology, Autonomous Non-profit Higher Education Organization (University associated with the Interparliamentary Assembly of the Eurasian Economic Community), 14/1, letter B, Smolyachkova Street, 194044 Saint-Petersburg, Russia
| | - Aleksandr Efimtsev
- Department of Radiology, Almazov National Medical Research Centre, 2, Akkuratova Street, 197341 Saint-Petersburg, Russia
| | - Tarumov Dmitriy
- Department of Psychiatry, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Miroslav Odinak
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
| | - Igor Litvinenko
- Department of Neurology, Kirov Military Medical Academy, 6, Lebedeva Street, 194044 Saint-Petersburg, Russia
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Pérez-Miralles FC, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Maurino J, Carreres-Polo J, Casanova B. Brain region volumes and their relationship with disability progression and cognitive function in primary progressive multiple sclerosis. Brain Behav 2021; 11:e02044. [PMID: 33486890 PMCID: PMC8035443 DOI: 10.1002/brb3.2044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Evidence on regional changes resulting from neurodegenerative processes underlying primary progressive multiple sclerosis (PPMS) is still limited. We assessed brain region volumes and their relationship with disability progression and cognitive function in PPMS patients. METHODS This was an MRI analysis of 43 patients from the prospective Understanding Primary Progressive Multiple Sclerosis (UPPMS) cohort study. MRI scans were performed within 3 months before enrollment and at month 12. RESULTS Gray matter volume of declive and white matter volumes adjacent to left straight gyrus, right calcarine sulcus, and right inferior occipital gyrus significantly decreased from baseline to month 12. Baseline white matter volumes adjacent to right amygdala and left cuneus significantly differed between patients with and without disability progression, as well as baseline gray matter volumes of left cuneus, right parahippocampal gyrus, right insula, left superior frontal gyrus, declive, right inferior temporal gyrus, right superior temporal gyrus (pole), and right calcarine sulcus. Baseline gray matter volumes of right cuneus and right superior temporal gyrus positively correlated with 12-month Selective Reminding Test and Word List Generation performance, respectively. Gray matter changes in right superior semilunar lobe and white matter adjacent to left declive and right cerebellar tonsil also positively correlated with Word List Generation scores, while white matter change in left inferior semilunar lobe positively correlated with Symbol Digit Modalities Test performance after 12 months. CONCLUSIONS White and gray matter volumes of specific brain regions could predict disability progression and cognitive performance of PPMS patients after one year.
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Affiliation(s)
| | | | - Antonio García-Merino
- Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - José Ramón Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Guillermo Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari Josep Trueta and Hospital Santa Caterina, IDIBGI, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | | | - Óscar Fernández
- Department of Neurology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Sara Moreno-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Maurino
- Department of Medical, Roche Farma S.A, Madrid, Spain
| | - Joan Carreres-Polo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Stellmann JP, Wanke N, Maarouf A, Gellißen S, Heesen C, Audoin B, Gold SM, Zaaraoui W, Poettgen J. Cognitive performance shows domain specific associations with regional cortical thickness in multiple sclerosis. NEUROIMAGE-CLINICAL 2021; 30:102606. [PMID: 33744503 PMCID: PMC7985400 DOI: 10.1016/j.nicl.2021.102606] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
Cognitive impairment correlates with loss of cortical thickness in MS. Cognitive tests show distinctive regional associations with cortical thickness. Some regions, such as the left insula, correlate with multiple tests. Associations patterns seem reproducible in patients with very mild impairment. Better localization of cognitive functions may improve future MRI studies.
Multiple Sclerosis (MS) patients often suffer from significant cognitive impairment. Earlier research has shown relationships between regional cortical atrophy and cognitive deterioration. However, due to a large number of neuropsychological assessments and a heterogenous pattern of cognitive deficits in MS patients, reported associations patterns are also heterogenous. Using an extensive neuropsychological battery of 23 different tasks, we explored domain (attention/information processing, memory, spatial processing, executive functioning) and task-specific associations with regional cortical thickness in a representative sample of MS patients (N = 97). Cortical regions associated with multiple cognitive tasks in the left hemisphere were predominantly located in the inferior insula (attention p < 0.001, memory p = 0.047, spatial processing p = 0.004, executive functioning p = 0.037), the gyrus frontalis superior (attention p = 0.015, memory p = 0.037, spatial processing p = 0.033, executive functioning p = 0.017) and temporal medial (attention p < 0.001, memory two clusters p = 0.016 and p < 0.001, executive functioning p = 0.016). In the right hemisphere, we detected the strongest association in the sulcus interparietalis with five cluster (attention SDMT p = 0.003 and TAP_DA p < 0.001; memory Rey recall p = 0.013 and VLMT verbal learning p = 0.016; spatial processing Rey copy p < 0.001). We replicated parts of our results in an independent sample of 30 mildly disabled MS patients. Moreover, comparisons to 29 healthy controls showed that the regional associations seemed to represent rather pathophysiological dependency than a physiological one. We believe that our results may prove useful in diagnosis and rehabilitation of cognitive impairments and may serve as guidance in future magnetic resonance imaging (MRI) studies.
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Affiliation(s)
- Jan-Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; APHM, Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Univ, CNRS, CRMBM, Marseille, France.
| | - Nadine Wanke
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Cognitive Psychology, Institute of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Adil Maarouf
- APHM, Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Susanne Gellißen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Bertrand Audoin
- APHM, Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Charité Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité Universitätsmedizin Berlin, Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wafaa Zaaraoui
- APHM, Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Jana Poettgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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19
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Rovira A, Sastre-Garriga J, Kearney H, Ciccarelli O, Matthews L, Palace J, Gallo A, Bisecco A, Lukas C, Bellenberg B, Barkhof F, Vrenken H, Preziosa P, Filippi M. Association of Gray Matter Atrophy Patterns With Clinical Phenotype and Progression in Multiple Sclerosis. Neurology 2021; 96:e1561-e1573. [PMID: 33441452 DOI: 10.1212/wnl.0000000000011494] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Gay matter (GM) involvement is clinically relevant in multiple sclerosis (MS). Using source-based morphometry (SBM), we characterized GM atrophy and its 1-year evolution across different MS phenotypes. METHODS Clinical and MRI data were obtained at 8 European sites from 170 healthy controls (HCs) and 398 patients with MS (34 with clinically isolated syndrome [CIS], 226 with relapsing-remitting MS [RRMS], 95 with secondary progressive MS [SPMS], and 43 with primary progressive MS [PPMS]). Fifty-seven HCs and 144 with MS underwent 1-year follow-up. Baseline GM loss, atrophy progression, and correlations with disability and 1-year clinical worsening were assessed. RESULTS SBM identified 26 cerebellar, subcortical, sensory, motor, and cognitive GM components. GM atrophy was found in patients with MS vs HCs in almost all components (p range <0.001-0.04). Compared to HCs, patients with CIS showed circumscribed subcortical, cerebellar, temporal, and salience GM atrophy, while patients with RRMS exhibited widespread GM atrophy. Cerebellar, subcortical, sensorimotor, salience, and frontoparietal GM atrophy was found in patients with PPMS vs HCs and in patients with SPMS vs those with RRMS. At 1 year, 21 (15%) patients had clinically worsened. GM atrophy progressed in MS in subcortical, cerebellar, sensorimotor, and fronto-temporo-parietal components. Baseline higher disability was associated (R 2 = 0.65) with baseline lower normalized brain volume (β = -0.13, p = 0.001), greater sensorimotor GM atrophy (β = -0.12, p = 0.002), and longer disease duration (β = 0.09, p = 0.04). Baseline normalized GM volume (odds ratio 0.98, p = 0.008) and cerebellar GM atrophy (odds ratio 0.40, p = 0.01) independently predicted clinical worsening (area under the curve 0.83). CONCLUSION GM atrophy differed across disease phenotypes and progressed at 1 year in MS. In addition to global atrophy measures, sensorimotor and cerebellar GM atrophy explained baseline disability and clinical worsening.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK.
| | - Paola Valsasina
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alessandro Meani
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Claudio Gobbi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Chiara Zecca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alex Rovira
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Jaume Sastre-Garriga
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Hugh Kearney
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Olga Ciccarelli
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Lucy Matthews
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Jacqueline Palace
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Antonio Gallo
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alvino Bisecco
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Carsten Lukas
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Barbara Bellenberg
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Frederik Barkhof
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Hugo Vrenken
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
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20
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Leavitt VM, Rocca M. Siponimod for Cognition in Secondary Progressive Multiple Sclerosis: Thinking Through the Evidence. Neurology 2020; 96:91-92. [PMID: 33328322 DOI: 10.1212/wnl.0000000000011279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Victoria M Leavitt
- From the Translational Cognitive Neuroscience Laboratory (V.M.L.) and Multiple Sclerosis Center (V.M.L.), Department of Neurology, Columbia University Irving Medical Center, New York, New York; Neuroimaging Research Unit (M.R.), Division of Neuroscience and Neurology Unit (M.R.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.R.), Milan, Italy.
| | - Maria Rocca
- From the Translational Cognitive Neuroscience Laboratory (V.M.L.) and Multiple Sclerosis Center (V.M.L.), Department of Neurology, Columbia University Irving Medical Center, New York, New York; Neuroimaging Research Unit (M.R.), Division of Neuroscience and Neurology Unit (M.R.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.R.), Milan, Italy
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21
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Margoni M, Poggiali D, Zywicki S, Rubin M, Lazzarotto A, Franciotta S, Anglani MG, Causin F, Rinaldi F, Perini P, Filippi M, Gallo P. Early red nucleus atrophy in relapse-onset multiple sclerosis. Hum Brain Mapp 2020; 42:154-160. [PMID: 33047810 PMCID: PMC7721227 DOI: 10.1002/hbm.25213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022] Open
Abstract
No study has investigated red nucleus (RN) atrophy in multiple sclerosis (MS) despite cerebellum and its connections are elective sites of MS‐related pathology. In this study, we explore RN atrophy in early MS phases and its association with cerebellar damage (focal lesions and atrophy) and physical disability. Thirty‐seven relapse‐onset MS (RMS) patients having mean age of 35.6 ± 8.5 (18–56) years and mean disease duration of 1.1 ± 1.5 (0–5) years, and 36 age‐ and sex‐matched healthy controls (HC) were studied. Cerebellar and RN lesions and volumes were analyzed on 3 T‐MRI images. RMS did not differ from HC in cerebellar lobe volumes but significantly differed in both right (107.84 ± 13.95 mm3 vs. 99.37 ± 11.53 mm3, p = .019) and left (109.71 ± 14.94 mm3 vs. 100.47 ± 15.78 mm3, p = .020) RN volumes. Cerebellar white matter lesion volume (WMLV) inversely correlated with both right and left RN volumes (r = −.333, p = .004 and r = −.298, p = .010, respectively), while no correlation was detected between RN volumes and mean cortical thickness, cerebellar gray matter lesion volume, and supratentorial WMLV (right RN: r = −.147, p = .216; left RN: r = −.153, p = .196). Right, but not left, RN volume inversely correlated with midbrain WMLV (r = −.310, p = .008), while no correlation was observed between whole brainstem WMLV and either RN volumes (right RN: r = −.164, p = .164; left RN: r = −.64, p = .588). Finally, left RN volume correlated with vermis VIIb (r = .297, p = .011) and right interposed nucleus (r = .249, p = .034) volumes. We observed RN atrophy in early RMS, likely resulting from anterograde axonal degeneration starting in cerebellar and midbrain WML. RN atrophy seems a promising marker of neurodegeneration and/or cerebellar damage in RMS.
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Affiliation(s)
- Monica Margoni
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy.,Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy
| | - Davide Poggiali
- Padova Neuroscience Centre (PNC), University of Padua, Padua, Italy.,Department of Mathematics, University of Padua, Padua, Italy
| | - Sofia Zywicki
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | - Martina Rubin
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | - Andrea Lazzarotto
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | - Silvia Franciotta
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | | | | | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, 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
| | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy.,Department of Neurosciences, Medical School, University of Padua, Padua, Italy
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22
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Lorefice L, Carta E, Frau J, Contu F, Casaglia E, Coghe G, Barracciu MA, Cocco E, Fenu G. The impact of deep grey matter volume on cognition in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102351. [PMID: 32731200 DOI: 10.1016/j.msard.2020.102351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive dysfunctions are very frequent in people living with multiple sclerosis (MS). Several studies have previously indicated grey matter (GM) atrophy as useful predictor of patients' cognitive impairment. However, considerable uncertainty exists about the possible impact of deep grey matter volumes on cognition. This study aimed to evaluate the relationship of the subcortical (sc) GM volumes with the presence and severity of global and selective cognitive impairment in MS. METHODS A group of MS patients with relapsing remitting course were enrolled. Patients underwent a neuropsychological evaluation by using the Brief Repeatable Battery of Neuropsychological Tests (BRBN) and the Delis-Kaplan Executive Function System Sorting Test (D-KEFST); z scores were estimated and items with z score below 2 standard deviation were considered failed. Thus, brain MRIs images were acquired and measurements of whole brain (WB), white matter (WM), and cortical grey matter (GM) were obtained by SIENAX. After FIRST tool segmentation, volumes of subcortical GM structures were also estimated. RESULTS The sample included 50 MS patients, of which 16/50 (32%) subjects were cognitively impaired. Multiple regression analyses found a significant association of severity of cognitive impairment, defined as number of failed neuropsychological tests, with lower volumes of cortex (p=0.003), thalamus (p=0.009), caudate (p=0.011), putamen (p=0.020), pallidus (p=0.012) and hippocampus (p=0.045), independently from other MS features. In addition, an association between accumbens volume and D-KEFS ST FSC and D-KEFS ST FSD z scores was observed (p<0.03). CONCLUSIONS Our results indicated that volumes of several scGM structures, and in particular of thalamus, contribute to determine cognitive dysfunctions in MS, mainly influencing the executive functioning. Further investigations in larger MS cohorts with cognitive impairment are necessary to better understand the structural brain damage underlying this "invisible disability".
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Affiliation(s)
- L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy.
| | - E Carta
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - F Contu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - E Casaglia
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy; Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Fenu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
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23
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Engl C, Tiemann L, Grahl S, Bussas M, Schmidt P, Pongratz V, Berthele A, Beer A, Gaser C, Kirschke JS, Zimmer C, Hemmer B, Mühlau M. Cognitive impairment in early MS: contribution of white matter lesions, deep grey matter atrophy, and cortical atrophy. J Neurol 2020; 267:2307-2318. [PMID: 32328718 PMCID: PMC7359155 DOI: 10.1007/s00415-020-09841-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 12/02/2022]
Abstract
Background Cognitive impairment (CI) is a frequent and debilitating symptom in MS. To better understand the neural bases of CI in MS, this magnetic resonance imaging (MRI) study aimed to identify and quantify related structural brain changes and to investigate their relation to each other. Methods We studied 51 patients with CI and 391 patients with cognitive preservation (CP). We analyzed three-dimensional T1-weighted and FLAIR scans at 3 Tesla. We determined mean cortical thickness as well as volumes of cortical grey matter (GM), deep GM including thalamus, cerebellar cortex, white matter, corpus callosum, and white matter lesions (WML). We also analyzed GM across the whole brain by voxel-wise and surface-based techniques. Results Mean disease duration was 5 years. Comparing MS patients with CI and CP, we found higher volumes of WML, lower volumes of deep and cortical GM structures, and lower volumes of the corpus callosum (all corrected p values < 0.05). Effect sizes were largest for WML and thalamic volume (standardized ß values 0.25 and − 0.25). By logistic regression analysis including both WML and thalamic volume, we found a significant effect only for WML volume. Inclusion of the interaction term of WML and thalamic volume increased the model fit and revealed a highly significant interaction of WML and thalamic volume. Moreover, voxel-wise and surface-based comparisons of MS patients with CI and CP showed regional atrophy of both deep and cortical GM independent of WML volume and overall disability, but effect sizes were lower. Conclusion Although several mechanisms contribute to CI already in the early stage of MS, WML seem to be the main driver with thalamic atrophy primarily intensifying this effect.
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Affiliation(s)
- Christina Engl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Laura Tiemann
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Sophia Grahl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Paul Schmidt
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Annkathrin Beer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Christian Gaser
- Department of Psychiatry and Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany. .,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.
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24
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False memories in relapsing remitting multiple sclerosis patients: A preliminary investigation with the DRM paradigm. Mult Scler Relat Disord 2020; 37:101418. [PMID: 32172993 DOI: 10.1016/j.msard.2019.101418] [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: 02/25/2019] [Revised: 07/16/2019] [Accepted: 09/25/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Memory impairment is one of the most frequently and early detected impairment in multiple sclerosis (MS) patients. Several authors have argued that when a failure occurs in the retrieval of lexical information, this might be due to a reduction of the lexical pool, related to semantic memory. Here we further investigated memory alteration in MS patients, by focusing on memory distortions (i.e., false memories) for semantically-related material. METHODS A group of 40 consecutive relapsing remitting MS (RRMS) patients and a matched control group of 40 healthy controls performed the Deese-Roediger-McDermott (DRM), a false memory task for lists of associated words. RESULTS At recall, RRMS patients reported a reduced number of false recalls for semantically-related but non-presented items (i.e., critical false recalls) compared to HCs; at recognition, RRMS patients showed a reduced level of confidence for false recognitions of critical items. CONCLUSION We found a reduced susceptibility to false memories in RRMS patients compared to HCs. The potential mechanisms underlying this effect are discussed in light of the alterations in the structure of semantic memory.
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Cassiano MT, Lanzillo R, Alfano B, Costabile T, Comerci M, Prinster A, Moccia M, Megna R, Morra VB, Quarantelli M, Brunetti A. Voxel-based analysis of gray matter relaxation rates shows different correlation patterns for cognitive impairment and physical disability in relapsing-remitting multiple sclerosis. NEUROIMAGE-CLINICAL 2020; 26:102201. [PMID: 32062567 PMCID: PMC7025083 DOI: 10.1016/j.nicl.2020.102201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regional analyses of markers of microstructural gray matter (GM) changes, including relaxation rates, have shown inconsistent correlations with physical and cognitive impairment in MS. OBJECTIVE To assess voxelwise the correlation of the R1 and R2 relaxation rates with the physical and cognitive impairment in MS. METHODS GM R1 and R2 relaxation rate maps were obtained in 241 relapsing-remitting MS patients by relaxometric segmentation of MRI studies. Correlations with the Expanded Disability Status Scale (EDSS) and the percentage of impaired cognitive test (Brief Repeatable Battery and Stroop Test, available in 186 patients) were assessed voxelwise, including voxel GM content as nuisance covariate to remove the effect of atrophy on the correlations. RESULTS Extensive clusters of inverse correlation between EDSS and R2 were detected throughout the brain, while inverse correlations with R1 were mostly limited to perirolandic and supramarginal cortices. Cognitive impairment correlated negatively with R1, and to a lesser extent with R2, in the middle frontal, mesial temporal, midcingulate and medial parieto-occipital cortices. CONCLUSION In relapsing-remitting MS patients, GM microstructural changes correlate diffusely with physical disability, independent of atrophy, with a preferential role of the sensorimotor cortices. Neuronal damage in the limbic system and dorsolateral prefrontal cortices correlates with cognitive dysfunction.
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Affiliation(s)
- Maria Teresa Cassiano
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Bruno Alfano
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy
| | - Teresa Costabile
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Marco Comerci
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Rosario Megna
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy.
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
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Aharoni R, Schottlender N, Bar-Lev DD, Eilam R, Sela M, Tsoory M, Arnon R. Cognitive impairment in an animal model of multiple sclerosis and its amelioration by glatiramer acetate. Sci Rep 2019; 9:4140. [PMID: 30858445 PMCID: PMC6412002 DOI: 10.1038/s41598-019-40713-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/21/2019] [Indexed: 01/28/2023] Open
Abstract
The severe motor impairment in the MS animal model experimental autoimmune encephalomyelitis (EAE) obstructs the assessment of cognitive functions. We developed an experimental system that evaluates memory faculties in EAE-affected mice, irrespective of their motor performance, enabling the assessment of cognitive impairments along the disease duration, the associated brain damage, and the consequences of glatiramer acetate (GA) treatment on these manifestations. The delayed-non-matching to sample (DNMS) T-maze task, testing working and long term memory was adapted and utilized. Following the appearance of clinical manifestations task performances of the EAE-untreated mice drastically declined. Cognitive impairments were associated with disease severity, as indicated by a significant correlation between the T-maze performance and the clinical symptoms in EAE-untreated mice. GA-treatment conserved cognitive functions, so that despite their exhibited mild motor impairments, the treated mice performed similarly to naïve controls. The cognitive deficit of EAE-mice coincided with inflammatory and neurodegenerative damage to the frontal cortex and the hippocampus; these damages were alleviated by GA-treatment. These combined findings indicate that in addition to motor impairment, EAE leads to substantial impairment of cognitive functions, starting at the early stages and increasing with disease aggravation. GA-treatment, conserves cognitive capacities and prevents its disease related deterioration.
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Affiliation(s)
- Rina Aharoni
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel.
| | - Nofar Schottlender
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Dekel D Bar-Lev
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Raya Eilam
- Department of Veterinary Resources, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Michael Sela
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Michael Tsoory
- Department of Veterinary Resources, The Weizmann Institute of Science, Rehovot, 761001, Israel
| | - Ruth Arnon
- Department of Immunology, The Weizmann Institute of Science, Rehovot, 761001, Israel.
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Abstract
PURPOSE OF REVIEW Clinical MRI is of paramount importance for multiple sclerosis diagnosis but lacks the specificity to investigate the pathogenic mechanisms underlying disease onset and progression. The application of advanced MR sequences allows the characterization of diverse and complex pathological mechanisms, granting insights into multiple sclerosis natural history and response to treatment. RECENT FINDINGS This review provides an update on the most recent international guidelines for optimal standard imaging of multiple sclerosis and discusses advantages and limitations of advanced imaging approaches for investigating inflammation, demyelination and neurodegeneration. An overview is provided for methods devoted to imaging leptomeningeal enhancement, microglial activation, demyelination, neuronal metabolic damage and neuronal loss. SUMMARY The application of magnetic resonance (MR) guidelines to standard-of-care MR protocols, although still limited, would substantially contribute to the optimization of multiple sclerosis management. From an academic perspective, different mechanism-specific imaging techniques are available and offer a powerful tool to elucidate multiple sclerosis pathogenesis, monitor disease progression and guide therapeutic choices.
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Kletenik I, Alvarez E, Honce JM, Valdez B, Vollmer TL, Medina LD. Subjective cognitive concern in multiple sclerosis is associated with reduced thalamic and cortical gray matter volumes. Mult Scler J Exp Transl Clin 2019; 5:2055217319827618. [PMID: 30800417 PMCID: PMC6378429 DOI: 10.1177/2055217319827618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Brain atrophy has been correlated with objective cognitive dysfunction in multiple sclerosis but few studies have explored self-reported subjective cognitive concerns and their relationship to brain volume changes. This study explores the relationship between subjective cognitive concerns in multiple sclerosis and reduced brain volume in regions of interest implicated in cognitive dysfunction. Methods A total of 158 patients with multiple sclerosis completed the Quality of Life in Neurologic Disorders Measures (Neuro-QoL) short forms to assess subjective cognitive concerns and underwent brain magnetic resonance imaging. Regional brain volumes from regions of interest implicated in cognitive dysfunction were measured using NeuroQuant automated volumetric quantitation. Linear regression was used to analyze the relationship between subjective cognitive concerns and brain volume. Results Controlling for age, disease duration, gender, depression and fatigue, increased subjective cognitive concerns were associated with reduced thalamic volume (standardized β = 0.223, t150 =2.406, P = 0.017) and reduced cortical gray matter volume (standardized β = 0.240, t150 = 2.777, P = 0.006). Increased subjective cognitive concerns were not associated with any other regions of interest that were analyzed. Conclusions Subjective cognitive concern in MS is associated with reduced thalamic and cortical gray matter volumes, areas of the brain that have been implicated in objective cognitive impairment. These findings may lend neuroanatomical significance to subjective cognitive concerns and patient-reported outcomes as measured by Neuro-QoL.
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Affiliation(s)
- Isaiah Kletenik
- Department of Neurology, University of Colorado School of Medicine, USA
| | - Enrique Alvarez
- Department of Neurology, University of Colorado School of Medicine, USA.,Rocky Mountain MS Center, University of Colorado School of Medicine, USA
| | - Justin M Honce
- Department of Radiology, University of Colorado School of Medicine, USA
| | - Brooke Valdez
- Rocky Mountain MS Center, University of Colorado School of Medicine, USA
| | - Timothy L Vollmer
- Department of Neurology, University of Colorado School of Medicine, USA.,Rocky Mountain MS Center, University of Colorado School of Medicine, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, USA.,IK and EA are co-first authors and contributed equally to the work
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29
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Gadolinium effect on thalamus and whole brain tissue segmentation. Neuroradiology 2018; 60:1167-1173. [DOI: 10.1007/s00234-018-2082-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
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Amiri H, de Sitter A, Bendfeldt K, Battaglini M, Gandini Wheeler-Kingshott CAM, Calabrese M, Geurts JJG, Rocca MA, Sastre-Garriga J, Enzinger C, de Stefano N, Filippi M, Rovira Á, Barkhof F, Vrenken H. Urgent challenges in quantification and interpretation of brain grey matter atrophy in individual MS patients using MRI. Neuroimage Clin 2018; 19:466-475. [PMID: 29984155 PMCID: PMC6030805 DOI: 10.1016/j.nicl.2018.04.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/28/2018] [Accepted: 04/22/2018] [Indexed: 01/18/2023]
Abstract
Atrophy of the brain grey matter (GM) is an accepted and important feature of multiple sclerosis (MS). However, its accurate measurement is hampered by various technical, pathological and physiological factors. As a consequence, it is challenging to investigate the role of GM atrophy in the disease process as well as the effect of treatments that aim to reduce neurodegeneration. In this paper we discuss the most important challenges currently hampering the measurement and interpretation of GM atrophy in MS. The focus is on measurements that are obtained in individual patients rather than on group analysis methods, because of their importance in clinical trials and ultimately in clinical care. We discuss the sources and possible solutions of the current challenges, and provide recommendations to achieve reliable measurement and interpretation of brain GM atrophy in MS.
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Key Words
- BET, brain extraction tool
- Brain atrophy
- CNS, central nervous system
- CTh, cortical thickness
- DGM, deep grey matter
- DTI, diffusion tensor imaging
- FA, fractional anisotropy
- GM, grey matter
- Grey matter
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- Magnetic resonance imaging
- Multiple sclerosis
- TE, echo time
- TI, inversion time
- TR, repetition time
- VBM, voxel-based morphometry
- WM, white matter
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Affiliation(s)
- Houshang Amiri
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandra de Sitter
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Massimiliano Calabrese
- Multiple Sclerosis Centre, Neurology Section, Department of Neurosciences, Biomedicine and Movements, University of Verona, Italy
| | - Jeroen J G Geurts
- Anatomy & Neurosciences, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Enzinger
- Department of Neurology & Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Álex Rovira
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Keser Z, Hasan KM, Mwangi B, Younes K, Khayat-Khoei M, Kamali A, Lincoln JA, Nelson FM. Quantitative Limbic System Mapping of Main Cognitive Domains in Multiple Sclerosis. Front Neurol 2018; 9:132. [PMID: 29593633 PMCID: PMC5857595 DOI: 10.3389/fneur.2018.00132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/22/2018] [Indexed: 12/03/2022] Open
Abstract
Background and objective Cognitive impairment (CI) is common in multiple sclerosis (MS), but underlying mechanisms and their imaging correlates are not completely understood. The gray and white matter structures of the limbic system (LS) play crucial roles in different aspects of cognition. To investigate their role in MS related CI, and since a detailed evaluations are lacking in the literature, we used a comprehensive neuroimaging approach to evaluate CI’s correlations with the main components of the LS. Methods Ten non-cognitively impaired MS patients and 30 MS patients with diagnosed CI, who underwent a comprehensive neuropsychological evaluation were included in the analysis. Microstructural integrity, volumetry of main limbic gray and white matter structures and cortical thickness were assessed for associations with CI. Results Fornix and cingulum/cingulate cortices were found to be the strongest correlates of CI in MS. As expected, LS’ gray and white matter structures were involved in various cognitive functions. Uncinate fasciculi showed significant correlation with verbal and visuospatial learning and memory, phonemic and semantic fluency; hippocampi with visuospatial skills, phonemic and semantic fluency, executive functions, and processing speed; thalami with verbal learning, visuospatial skills, semantic fluency; and amygdala with verbal recognition discrimination. Conclusion This comprehensive neuroimaging approach elucidated the role of the main limbic structures in cognitive functions associated with MS-related CI.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Khader M Hasan
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Benson Mwangi
- Department of Psychiatry, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kyan Younes
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mahsa Khayat-Khoei
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arash Kamali
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - John A Lincoln
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Flavia M Nelson
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
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Eshaghi A, Prados F, Brownlee WJ, Altmann DR, Tur C, Cardoso MJ, De Angelis F, van de Pavert SH, Cawley N, De Stefano N, Stromillo ML, Battaglini M, Ruggieri S, Gasperini C, Filippi M, Rocca MA, Rovira A, Sastre‐Garriga J, Vrenken H, Leurs CE, Killestein J, Pirpamer L, Enzinger C, Ourselin S, Wheeler‐Kingshott CAG, Chard D, Thompson AJ, Alexander DC, Barkhof F, Ciccarelli O. Deep gray matter volume loss drives disability worsening in multiple sclerosis. Ann Neurol 2018; 83:210-222. [PMID: 29331092 PMCID: PMC5838522 DOI: 10.1002/ana.25145] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Gray matter (GM) atrophy occurs in all multiple sclerosis (MS) phenotypes. We investigated whether there is a spatiotemporal pattern of GM atrophy that is associated with faster disability accumulation in MS. METHODS We analyzed 3,604 brain high-resolution T1-weighted magnetic resonance imaging scans from 1,417 participants: 1,214 MS patients (253 clinically isolated syndrome [CIS], 708 relapsing-remitting [RRMS], 128 secondary-progressive [SPMS], and 125 primary-progressive [PPMS]), over an average follow-up of 2.41 years (standard deviation [SD] = 1.97), and 203 healthy controls (HCs; average follow-up = 1.83 year; SD = 1.77), attending seven European centers. Disability was assessed with the Expanded Disability Status Scale (EDSS). We obtained volumes of the deep GM (DGM), temporal, frontal, parietal, occipital and cerebellar GM, brainstem, and cerebral white matter. Hierarchical mixed models assessed annual percentage rate of regional tissue loss and identified regional volumes associated with time-to-EDSS progression. RESULTS SPMS showed the lowest baseline volumes of cortical GM and DGM. Of all baseline regional volumes, only that of the DGM predicted time-to-EDSS progression (hazard ratio = 0.73; 95% confidence interval, 0.65, 0.82; p < 0.001): for every standard deviation decrease in baseline DGM volume, the risk of presenting a shorter time to EDSS worsening during follow-up increased by 27%. Of all longitudinal measures, DGM showed the fastest annual rate of atrophy, which was faster in SPMS (-1.45%), PPMS (-1.66%), and RRMS (-1.34%) than CIS (-0.88%) and HCs (-0.94%; p < 0.01). The rate of temporal GM atrophy in SPMS (-1.21%) was significantly faster than RRMS (-0.76%), CIS (-0.75%), and HCs (-0.51%). Similarly, the rate of parietal GM atrophy in SPMS (-1.24-%) was faster than CIS (-0.63%) and HCs (-0.23%; all p values <0.05). Only the atrophy rate in DGM in patients was significantly associated with disability accumulation (beta = 0.04; p < 0.001). INTERPRETATION This large, multicenter and longitudinal study shows that DGM volume loss drives disability accumulation in MS, and that temporal cortical GM shows accelerated atrophy in SPMS than RRMS. The difference in regional GM atrophy development between phenotypes needs to be taken into account when evaluating treatment effect of therapeutic interventions. Ann Neurol 2018;83:210-222.
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Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Wallace J. Brownlee
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel R. Altmann
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Medical Statistics DepartmentLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Carmen Tur
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - M. Jorge Cardoso
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
| | - Floriana De Angelis
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Steven H. van de Pavert
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Niamh Cawley
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Nicola De Stefano
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - M. Laura Stromillo
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Marco Battaglini
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Serena Ruggieri
- Department of NeurosciencesS Camillo Forlanini HospitalRomeItaly
- Department of Neurology and PsychiatryUniversity of Rome SapienzaRomeItaly
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Maria A. Rocca
- Neuroimaging Research Unit, Institute of Experimental NeurologyDivision of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityMilanItaly
| | - Alex Rovira
- MR Unit and Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Jaume Sastre‐Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Hugo Vrenken
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Cyra E. Leurs
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center AmsterdamVU University Medical CenterAmsterdamThe Netherlands
| | - Lukas Pirpamer
- Department of NeurologyMedical University of GrazGrazAustria
| | - Christian Enzinger
- Department of NeurologyMedical University of GrazGrazAustria
- Division of Neuroradiology, Vascular & Interventional Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Sebastien Ourselin
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Claudia A.M. Gandini Wheeler‐Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Brain MRI 3T Mondino Research CenterC. Mondino National Neurological InstitutePaviaItaly
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
| | - Alan J. Thompson
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
| | - Daniel C. Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- Centre for Medical Image Computing (CMIC), Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and BioengineeringUniversity College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
- Department of Radiology and Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of NeurologyFaculty of Brain SciencesUniversity College London
- National Institute for Health Research (NIHR)University College London Hospitals (UCLH) Biomedical Research Centre (BRC)LondonUnited Kingdom
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Favaretto A, Lazzarotto A, Margoni M, Poggiali D, Gallo P. Effects of disease modifying therapies on brain and grey matter atrophy in relapsing remitting multiple sclerosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40893-017-0033-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Uher T, Krasensky J, Sobisek L, Blahova Dusankova J, Seidl Z, Kubala Havrdova E, Sormani MP, Horakova D, Kalincik T, Vaneckova M. Cognitive clinico-radiological paradox in early stages of multiple sclerosis. Ann Clin Transl Neurol 2017; 5:81-91. [PMID: 29376094 PMCID: PMC5771324 DOI: 10.1002/acn3.512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate whether the strength of the association between magnetic resonance imaging (MRI) metrics and cognitive outcomes differs between various multiple sclerosis subpopulations. Methods A total of 1052 patients were included in this large cross‐sectional study. Brain MRI (T1 and T2 lesion volume and brain parenchymal fraction) and neuropsychological assessment (Brief International Cognitive Assessment for Multiple Sclerosis and Paced Auditory Serial Addition Test) were performed. Results Weak correlations between cognitive domains and MRI measures were observed in younger patients (age≤30 years; absolute Spearman's rho = 0.05–0.21), with short disease duration (<2 years; rho = 0.01–0.21), low Expanded Disability Status Scale [EDSS] (≤1.5; rho = 0.08–0.18), low T2 lesion volume (lowest quartile; <0.59 mL; rho = 0.01–0.20), and high brain parenchymal fraction (highest quartile; >86.66; rho = 0.01–0.16). Stronger correlations between cognitive domains and MRI measures were observed in older patients (age>50 years; rho = 0.24–0.50), with longer disease duration (>15 years; rho = 0.26–0.53), higher EDSS (≥5.0; rho = 0.23–0.39), greater T2 lesion volume (highest quartile; >5.33 mL; rho = 0.16–0.32), and lower brain parenchymal fraction (lowest quartile; <83.71; rho = 0.13–0.46). The majority of these observed results were confirmed by significant interactions (P ≤ 0.01) using continuous variables. Interpretation The association between structural brain damage and functional cognitive impairment is substantially weaker in multiple sclerosis patients with a low disease burden. Therefore, disease stage should be taken into consideration when interpreting associations between structural and cognitive measures in clinical trials, research studies, and clinical practice.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Jan Krasensky
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability University of Economics in Prague Prague Czech Republic
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Zdenek Seidl
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Tomas Kalincik
- CORe Department of Medicine University of Melbourne Melbourne Australia.,Department of Neurology Royal Melbourne Hospital Melbourne Australia
| | - Manuela Vaneckova
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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35
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Distinct cognitive impairments in different disease courses of multiple sclerosis—A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 83:568-578. [DOI: 10.1016/j.neubiorev.2017.09.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
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Abstract
The neuropsychological aspects of multiple sclerosis (MS) have evolved over the past three decades. What was once thought to be a rare occurrence, cognitive dysfunction is now viewed as one of the most disabling symptoms of the disease, with devastating effects on patients' quality of life. This selective review will highlight major innovations and scientific discoveries in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to our understanding of the neuropsychological aspects of MS. Specifically, we focus on the recent discovery that MS produces pathogical lesions of gray matter (GM) that have consequences for cognitive functions. Methods for imaging these GM lesions in MS are discussed along with multimodal imaging studies that integrate structural and functional imaging methods to provide a better understanding of the relationship between cognitive test performance and functional reserve. Innovations in the screening and comprehensive assessment of cognitive disorders are presented along with recent research that examines cognitive dysfunction in pediatric MS. Results of innovative outcome studies in cognitive rehabilitation are discussed. Finally, we highlight trends for potential future innovations over the next decade. (JINS, 2017, 23, 832-842).
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37
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Cognitive Impairment in Multiple Sclerosis: A Review of Neuropsychological Assessments. Cogn Behav Neurol 2017; 29:55-67. [PMID: 27336803 DOI: 10.1097/wnn.0000000000000097] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Of the more than two million people worldwide with multiple sclerosis, 40% to 65% experience cognitive impairment, many of them early in the course of the disease. Cognitive impairment has been found in patients with all subtypes of multiple sclerosis. Because both pharmacologic and nonpharmacologic interventions may improve patients' brain function, cognitive assessment should be a routine part of the clinical evaluation. Traditional paper-and-pencil neuropsychological tests and batteries can help detect and monitor patients' cognitive problems. Computerized cognitive batteries also show promise. Controversy continues over which test is most reliable at assessing cognitive impairment in both everyday clinical practice and research. Each battery has possible disadvantages, such as practice effects, poor sensitivity and specificity, and questionable applicability to multiple sclerosis. Based on our review of the literature, we describe the tests that are currently being used or that might be used in assessing cognitive deficits in patients with multiple sclerosis, and we summarize the strengths and limitations of each.
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Dobryakova E, Rocca MA, Valsasina P, DeLuca J, Filippi M. Altered neural mechanisms of cognitive control in patients with primary progressive multiple sclerosis: An effective connectivity study. Hum Brain Mapp 2017; 38:2580-2588. [PMID: 28205364 DOI: 10.1002/hbm.23542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/16/2017] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
Abstract
Primary progressive multiple sclerosis (PPMS) leads to physical and cognitive disability. Specifically, cognitive deficits in PPMS have been explained by both grey matter atrophy and white matter lesions. However, existing research still lacks in the understanding of how the brain of a patient with PPMS functions under cognitive control demands. Thus, the aim of the current study was to examine information integration in patients with PPMS using a search-based effective connectivity method. Fourteen patients with PPMS and 22 age- and gender-matched healthy controls (HC) performed the Stroop task, a cognitively demanding interference task that taxes neural resources required for cognitive control and response inhibition. Results showed that compared to HC, PPMS patients exhibited poor behavioral performance and alterations in information flow, manifested in the form of the loss of top-down connections, reversal of connections, and hyperconnectivity. Significant correlations were observed between connection strengths and behavioral measures. The connection between the posterior parietal cortex (PCC) and left posterior parietal lobule, which was present in both groups, showed a negative correlation with performance accuracy on incongruent trials. The connection between the left dorsolateral prefrontal cortex and PCC showed a positive correlation with performance accuracy on incongruent trials. However, the adaptive nature of this connection was not significant on a behavioral level as the PPMS group performed significantly worse compared to the HC group during the Stroop task. Thus, the current study provides important evidence about effective connectivity patterns that can be characterized as maladaptive cerebral re-organization in the PPMS brain. Hum Brain Mapp 38:2580-2588, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ekaterina Dobryakova
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Milan, Italy.,Traumatic Brain Injury Research, Kessler Foundation, West Orange, New Jersey
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - John DeLuca
- Traumatic Brain Injury Research, Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Massimo Filippi
- Neuroimaging Research Unit, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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39
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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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40
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Cerina M, Narayanan V, Göbel K, Bittner S, Ruck T, Meuth P, Herrmann AM, Stangel M, Gudi V, Skripuletz T, Daldrup T, Wiendl H, Seidenbecher T, Ehling P, Kleinschnitz C, Pape HC, Budde T, Meuth SG. The quality of cortical network function recovery depends on localization and degree of axonal demyelination. Brain Behav Immun 2017; 59:103-117. [PMID: 27569659 DOI: 10.1016/j.bbi.2016.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022] Open
Abstract
Myelin loss is a severe pathological hallmark common to a number of neurodegenerative diseases, including multiple sclerosis (MS). Demyelination in the central nervous system appears in the form of lesions affecting both white and gray matter structures. The functional consequences of demyelination on neuronal network and brain function are not well understood. Current therapeutic strategies for ameliorating the course of such diseases usually focus on promoting remyelination, but the effectiveness of these approaches strongly depends on the timing in relation to the disease state. In this study, we sought to characterize the time course of sensory and behavioral alterations induced by de- and remyelination to establish a rational for the use of remyelination strategies. By taking advantage of animal models of general and focal demyelination, we tested the consequences of myelin loss on the functionality of the auditory thalamocortical system: a well-studied neuronal network consisting of both white and gray matter regions. We found that general demyelination was associated with a permanent loss of the tonotopic cortical organization in vivo, and the inability to induce tone-frequency-dependent conditioned behaviors, a status persisting after remyelination. Targeted, focal lysolecithin-induced lesions in the white matter fiber tract, but not in the gray matter regions of cortex, were fully reversible at the morphological, functional and behavioral level. These findings indicate that remyelination of white and gray matter lesions have a different functional regeneration potential, with the white matter being able to regain full functionality while cortical gray matter lesions suffer from permanently altered network function. Therefore therapeutic interventions aiming for remyelination have to consider both region- and time-dependent strategies.
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Affiliation(s)
- Manuela Cerina
- Department of Neurology, University of Münster, Münster, Germany.
| | - Venu Narayanan
- Department of Neurology, University of Münster, Münster, Germany
| | - Kerstin Göbel
- Department of Neurology, University of Münster, Münster, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology, University of Münster, Münster, Germany
| | - Patrick Meuth
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School and Centre for Systems Neuroscience, Hannover, Germany
| | - Viktoria Gudi
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Thiemo Daldrup
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Petra Ehling
- Department of Neurology, University of Münster, Münster, Germany
| | | | | | - Thomas Budde
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Münster, Germany.
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41
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Rocca MA, Battaglini M, Benedict RHB, De Stefano N, Geurts JJG, Henry RG, Horsfield MA, Jenkinson M, Pagani E, Filippi M. Brain MRI atrophy quantification in MS: From methods to clinical application. Neurology 2016; 88:403-413. [PMID: 27986875 DOI: 10.1212/wnl.0000000000003542] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/18/2016] [Indexed: 01/06/2023] Open
Abstract
Patients with the main clinical phenotypes of multiple sclerosis (MS) manifest varying degrees of brain atrophy beyond that of normal aging. Assessment of atrophy helps to distinguish clinically and cognitively deteriorating patients and predicts those who will have a less-favorable clinical outcome over the long term. Atrophy can be measured from brain MRI scans, and many technological improvements have been made over the last few years. Several software tools, with differing requirements on technical ability and levels of operator intervention, are currently available and have already been applied in research or clinical trial settings. Despite this, the measurement of atrophy in routine clinical practice remains an unmet need. After a short summary of the pathologic substrates of brain atrophy in MS, this review attempts to guide the clinician towards a better understanding of the methods currently used for quantifying brain atrophy in this condition. Important physiologic factors that affect brain volume measures are also considered. Finally, the most recent research on brain atrophy in MS is summarized, including whole brain and various compartments thereof (i.e., white matter, gray matter, selected CNS structures). Current methods provide sufficient precision for cohort studies, but are not adequate for confidently assessing changes in individual patients over the scale of months or a few years.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Marco Battaglini
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Ralph H B Benedict
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Nicola De Stefano
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Jeroen J G Geurts
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Roland G Henry
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Mark A Horsfield
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Mark Jenkinson
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., E.P., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Medicine, Surgery and Neuroscience (M.B., N.D.S.), University of Siena, Italy; Department of Neurology (R.H.B.B.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York; Department of Anatomy and Neuroscience (J.J.G.G.), Section of Clinical Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, the Netherlands; Department of Neurology (R.G.H.), University of California, San Francisco; Xinapse Systems Ltd. (M.A.H.), Colchester, Essex, UK; and FMRIB Centre (M.J.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
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Louapre C, Govindarajan ST, Giannì C, Madigan N, Nielsen AS, Sloane JA, Kinkel RP, Mainero C. The association between intra- and juxta-cortical pathology and cognitive impairment in multiple sclerosis by quantitative T 2* mapping at 7 T MRI. NEUROIMAGE-CLINICAL 2016; 12:879-886. [PMID: 27872810 PMCID: PMC5107649 DOI: 10.1016/j.nicl.2016.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/09/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
Using quantitative T2* at 7 Tesla (T) magnetic resonance imaging, we investigated whether impairment in selective cognitive functions in multiple sclerosis (MS) can be explained by pathology in specific areas and/or layers of the cortex. Thirty-one MS patients underwent neuropsychological evaluation, acquisition of 7 T multi-echo T2* gradient-echo sequences, and 3 T anatomical images for cortical surfaces reconstruction. Seventeen age-matched healthy subjects served as controls. Cortical T2* maps were sampled at various depths throughout the cortex and juxtacortex. Relation between T2*, neuropsychological scores and a cognitive index (CI), calculated from a principal component analysis on the whole battery, was tested by a general linear model. Cognitive impairment correlated with T2* increase, independently from white matter lesions and cortical thickness, in cortical areas highly relevant for cognition belonging to the default-mode network (p < 0.05 corrected). Dysfunction in different cognitive functions correlated with longer T2* in selective cortical regions, most of which showed longer T2* relative to controls. For most tests, this association was strongest in deeper cortical layers. Executive dysfunction, however, was mainly related with pathology in juxtameningeal cortex. T2* explained up to 20% of the variance of the CI, independently of conventional imaging metrics (adjusted-R2: 52–67%, p < 5.10− 4). Location of pathology across the cortical width and mantle showed selective correlation with impairment in differing cognitive domains. These findings may guide studies at lower field strength designed to develop surrogate markers of cognitive impairment in MS. Cognitive deficit in multiple sclerosis is associated with cortical T2* increase. Location of clusters of correlation varies upon affected cognitive domains. Global cognitive deficit was associated with T2* increase in deepest cortical layers. Executive dysfunction was associated with T2* increase in outer cortical layers. Regional T2* explained up to 20% of the variance of cognitive performance in MS.
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Key Words
- 7 Tesla MRI
- BVMT - DR, brief visuo-spatial memory test delayed recall
- BVMT, brief visual memory test
- CI, cognitive index
- CVLT, California verbal learning test
- Cognitive impairment
- DB, digit span backward
- DF, digit span forward
- DR, delayed recall
- EDSS, expanded disability status score
- JLOT, judgment of line orientation test
- LDCR, long delayed cued recall
- LDFR, long delayed free recall
- Laminar cortical pathology
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- Multiple sclerosis
- NP, neuropsychological
- PCA, principal component analysis
- SDMT, symbol digit modalities test
- T2*
- TMT, trail making test
- TOT, total recall
- WCST, Wisconsin card sorting test
- WM, white matter
- WMLV, white matter lesion volume
- q-T2*, quantitative T2*
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Affiliation(s)
- Céline Louapre
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sindhuja T Govindarajan
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Costanza Giannì
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nancy Madigan
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jacob A Sloane
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Revere P Kinkel
- University of California San Diego, Department of Neuroscience, San Diego, CA, USA
| | - Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
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43
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Ruano L, Portaccio E, Goretti B, Niccolai C, Severo M, Patti F, Cilia S, Gallo P, Grossi P, Ghezzi A, Roscio M, Mattioli F, Stampatori C, Trojano M, Viterbo RG, Amato MP. Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Mult Scler 2016; 23:1258-1267. [PMID: 27738090 DOI: 10.1177/1352458516674367] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is limited and inconsistent information on the clinical determinants of cognitive impairment (CI) in multiple sclerosis (MS). OBJECTIVE The aim of this study was to compare the prevalence and profile of CI across MS disease subtypes and assess its clinical determinants. METHODS Cognitive performance was assessed through the Brief Repeatable Battery and the Stroop test in consecutive patients with MS referred to six Italian centers. CI was defined as impairment in ⩾ 2 cognitive domains. RESULTS A total of 1040 patients were included, 167 with clinically isolated syndrome (CIS), 759 with relapsing remitting (RR), 74 with secondary progressive (SP), and 40 with primary progressive (PP) disease course. The overall prevalence of CI was 46.3%; 34.5% in CIS, 44.5% in RR, 79.4% in SP, and 91.3% in PP. The severity of impairment and the number of involved domains were significantly higher in SP and primary progressive multiple sclerosis (PPMS) than in CIS and RR. In multivariable logistic regression analysis, the presence of CI was significantly associated with higher Expanded Disability Status Scale (EDSS) and older age. CONCLUSION CI is present in all MS subtypes since the clinical onset and its frequency is increased in the progressive forms, but these differences seem to be more associated with patient age and physical disability than to disease subtype per se.
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Affiliation(s)
- Luis Ruano
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal/Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal/Entre Douro e Vouga Hospital Centre, Santa Maria da Feira, Portugal
| | | | | | | | - Milton Severo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal/Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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44
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Damjanovic D, Valsasina P, Rocca MA, Stromillo ML, Gallo A, Enzinger C, Hulst HE, Rovira A, Muhlert N, De Stefano N, Bisecco A, Fazekas F, Arévalo MJ, Yousry TA, Filippi M. Hippocampal and Deep Gray Matter Nuclei Atrophy Is Relevant for Explaining Cognitive Impairment in MS: A Multicenter Study. AJNR Am J Neuroradiol 2016; 38:18-24. [PMID: 27686487 DOI: 10.3174/ajnr.a4952] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/11/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE The structural MR imaging correlates of cognitive impairment in multiple sclerosis are still debated. This study assessed lesional and atrophy measures of white matter and gray matter involvement in patients with MS acquired in 7 European sites to identify the MR imaging variables most closely associated with cognitive dysfunction. MATERIALS AND METHODS Brain dual-echo, 3D T1-weighted, and double inversion recovery scans were acquired at 3T from 62 patients with relapsing-remitting MS and 65 controls. Patients with at least 2 neuropsychological tests with abnormal findings were considered cognitively impaired. Focal WM and cortical lesions were identified, and volumetric measures from WM, cortical GM, the hippocampus, and deep GM nuclei were obtained. Age- and site-adjusted models were used to compare lesion and volumetric MR imaging variables between patients with MS who were cognitively impaired and cognitively preserved. A multivariate analysis identified MR imaging variables associated with cognitive scores and disability. RESULTS Twenty-three patients (38%) were cognitively impaired. Compared with those with who were cognitively preserved, patients with MS with cognitive impairment had higher T2 and T1 lesion volumes and a trend toward a higher number of cortical lesions. Significant brain, cortical GM, hippocampal, deep GM nuclei, and WM atrophy was found in patients with MS with cognitive impairment versus those who were cognitively preserved. Hippocampal and deep GM nuclei atrophy were the best predictors of cognitive impairment, while WM atrophy was the best predictor of disability. CONCLUSIONS Hippocampal and deep GM nuclei atrophy are key factors associated with cognitive impairment in MS. These MR imaging measures could be applied in a multicenter context, with cognition as clinical outcome.
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Affiliation(s)
- D Damjanovic
- From the Neuroimaging Research Unit (D.D., P.V., M.A.R., M.F.).,Center for Radiology and MRI of Clinical Center of Serbia (D.D.), Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - P Valsasina
- From the Neuroimaging Research Unit (D.D., P.V., M.A.R., M.F.)
| | - M A Rocca
- From the Neuroimaging Research Unit (D.D., P.V., M.A.R., M.F.).,Department of Neurology (M.A.R., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M L Stromillo
- Department of Neurological and Behavioural Sciences (M.L.S., N.D.S.), University of Siena, Siena, Italy
| | - A Gallo
- MRI Center "SUN-FISM" (A.G., A.B.), Second University of Naples and Institute of Diagnosis and Care "Hermitage-Capodimonte," Naples, Italy.,I Division of Neurology (A.G., A.B.), Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - C Enzinger
- Department of Neurology (C.E., F.F.).,Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - H E Hulst
- Department of Radiology and Nuclear Medicine (H.E.H.), MS Centre Amsterdam, VU University Medical Centre, Amsterdam, Netherlands
| | - A Rovira
- Magnetic Resonance Unit (A.R., M.J.A.), Department of Radiology and MS Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - N Muhlert
- NMR Research Unit (N.M., T.A.Y.), Queen Square MS Centre, University College London Institute of Neurology, London, UK
| | - N De Stefano
- Department of Neurological and Behavioural Sciences (M.L.S., N.D.S.), University of Siena, Siena, Italy
| | - A Bisecco
- MRI Center "SUN-FISM" (A.G., A.B.), Second University of Naples and Institute of Diagnosis and Care "Hermitage-Capodimonte," Naples, Italy.,I Division of Neurology (A.G., A.B.), Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - F Fazekas
- Department of Neurology (C.E., F.F.)
| | - M J Arévalo
- Magnetic Resonance Unit (A.R., M.J.A.), Department of Radiology and MS Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - T A Yousry
- NMR Research Unit (N.M., T.A.Y.), Queen Square MS Centre, University College London Institute of Neurology, London, UK
| | - M Filippi
- From the Neuroimaging Research Unit (D.D., P.V., M.A.R., M.F.) .,Department of Neurology (M.A.R., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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45
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Rocca MA, Preziosa P, Mesaros S, Pagani E, Dackovic J, Stosic-Opincal T, Drulovic J, Filippi M. Clinically Isolated Syndrome Suggestive of Multiple Sclerosis: Dynamic Patterns of Gray and White Matter Changes—A 2-year MR Imaging Study. Radiology 2016; 278:841-53. [DOI: 10.1148/radiol.2015150532] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Roy S, Carass A, Pacheco J, Bilgel M, Resnick SM, Prince JL, Pham DL. Temporal filtering of longitudinal brain magnetic resonance images for consistent segmentation. Neuroimage Clin 2016; 11:264-275. [PMID: 26958465 PMCID: PMC4773508 DOI: 10.1016/j.nicl.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/13/2016] [Accepted: 02/12/2016] [Indexed: 01/13/2023]
Abstract
Longitudinal analysis of magnetic resonance images of the human brain provides knowledge of brain changes during both normal aging as well as the progression of many diseases. Previous longitudinal segmentation methods have either ignored temporal information or have incorporated temporal consistency constraints within the algorithm. In this work, we assume that some anatomical brain changes can be explained by temporal transitions in image intensities. Once the images are aligned in the same space, the intensities of each scan at the same voxel constitute a temporal (or 4D) intensity trend at that voxel. Temporal intensity variations due to noise or other artifacts are corrected by a 4D intensity-based filter that smooths the intensity values where appropriate, while preserving real anatomical changes such as atrophy. Here smoothing refers to removal of sudden changes or discontinuities in intensities. Images processed with the 4D filter can be used as a pre-processing step to any segmentation method. We show that such a longitudinal pre-processing step produces robust and consistent longitudinal segmentation results, even when applying 3D segmentation algorithms. We compare with state-of-the-art 4D segmentation algorithms. Specifically, we experimented on three longitudinal datasets containing 4-12 time-points, and showed that the 4D temporal filter is more robust and has more power in distinguishing between healthy subjects and those with dementia, mild cognitive impairment, as well as different phenotypes of multiple sclerosis.
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Affiliation(s)
- Snehashis Roy
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, United States,Corresponding author.
| | - Aaron Carass
- Image Analysis and Communications Laboratory, Department of Electrical and Computer Engineering, Johns Hopkins University, United States,Department of Computer Science, Johns Hopkins University, United States
| | - Jennifer Pacheco
- Laboratory of Behavioral Neuroscience, National Institute on Aging, United States
| | - Murat Bilgel
- Image Analysis and Communications Laboratory, Department of Electrical and Computer Engineering, Johns Hopkins University, United States,Laboratory of Behavioral Neuroscience, National Institute on Aging, United States
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, United States
| | - Jerry L. Prince
- Image Analysis and Communications Laboratory, Department of Electrical and Computer Engineering, Johns Hopkins University, United States
| | - Dzung L. Pham
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, United States
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47
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Preziosa P, Rocca MA, Pagani E, Stromillo ML, Enzinger C, Gallo A, Hulst HE, Atzori M, Pareto D, Riccitelli GC, Copetti M, De Stefano N, Fazekas F, Bisecco A, Barkhof F, Yousry TA, Arévalo MJ, Filippi M. Structural MRI correlates of cognitive impairment in patients with multiple sclerosis: A Multicenter Study. Hum Brain Mapp 2016; 37:1627-44. [PMID: 26833969 DOI: 10.1002/hbm.23125] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/07/2022] Open
Abstract
In a multicenter setting, we applied voxel-based methods to different structural MR imaging modalities to define the relative contributions of focal lesions, normal-appearing white matter (NAWM), and gray matter (GM) damage and their regional distribution to cognitive deficits as well as impairment of specific cognitive domains in multiple sclerosis (MS) patients. Approval of the institutional review boards was obtained, together with written informed consent from all participants. Standardized neuropsychological assessment and conventional, diffusion tensor and volumetric brain MRI sequences were collected from 61 relapsing-remitting MS patients and 61 healthy controls (HC) from seven centers. Patients with ≥2 abnormal tests were considered cognitively impaired (CI). The distribution of focal lesions, GM and WM atrophy, and microstructural WM damage were assessed using voxel-wise approaches. A random forest analysis identified the best imaging predictors of global cognitive impairment and deficits of specific cognitive domains. Twenty-three (38%) MS patients were CI. Compared with cognitively preserved (CP), CI MS patients had GM atrophy of the left thalamus, right hippocampus and parietal regions. They also showed atrophy of several WM tracts, mainly located in posterior brain regions and widespread WM diffusivity abnormalities. WM diffusivity abnormalities in cognitive-relevant WM tracts followed by atrophy of cognitive-relevant GM regions explained global cognitive impairment. Variable patterns of NAWM and GM damage were associated with deficits in selected cognitive domains. Structural, multiparametric, voxel-wise MRI approaches are feasible in a multicenter setting. The combination of different imaging modalities is needed to assess and monitor cognitive impairment in MS.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - 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, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Laura Stromillo
- Department of Neurological and Behavioral Sciences, University of Siena, Siena, Italy
| | | | - Antonio Gallo
- MRI Center "SUN-FISM," Second University of Naples and Institute of Diagnosis and Care "Hermitage-Capodimonte,", Naples, Italy
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, I Division of Neurology, Second University of Naples, Naples, Italy
| | - Hanneke E Hulst
- Department of Radiology and Nuclear Medicine, MS Centre Amsterdam, VU Medical Centre, Amsterdam, Netherlands
| | - Matteo Atzori
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, United Kingdom
| | - Deborah Pareto
- Unitat De Neuroimmunologia Clinica, CEM-Cat, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimiliano Copetti
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola De Stefano
- Department of Neurological and Behavioral Sciences, University of Siena, Siena, Italy
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Alvino Bisecco
- MRI Center "SUN-FISM," Second University of Naples and Institute of Diagnosis and Care "Hermitage-Capodimonte,", Naples, Italy
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, I Division of Neurology, Second University of Naples, Naples, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Centre Amsterdam, VU Medical Centre, Amsterdam, Netherlands
| | - Tarek A Yousry
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, United Kingdom
| | - Maria J Arévalo
- Unitat De Neuroimmunologia Clinica, CEM-Cat, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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48
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Roman CAF, Arnett PA. Structural brain indices and executive functioning in multiple sclerosis: A review. J Clin Exp Neuropsychol 2016; 38:261-74. [DOI: 10.1080/13803395.2015.1105199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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50
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McGee J, Minagar A. Thalamus and MS: Role of thalamic atrophy in daily living and employment activities of MS patients. J Neurol Sci 2015; 358:1-2. [PMID: 26362337 DOI: 10.1016/j.jns.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jeanie McGee
- Department of Neurology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Alireza Minagar
- Department of Neurology, LSU Health Sciences Center, Shreveport, LA, USA.
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