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Simani L, Molaeipour L, Kian S, Leavitt VM. Correlation between cognitive changes and neuroradiological changes over time in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2024:10.1007/s00415-024-12517-8. [PMID: 38890188 DOI: 10.1007/s00415-024-12517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND While many studies have examined relationships of neuroimaging variables to cognitive measures in multiple sclerosis (MS), longitudinal studies are lacking. The relationship of cognitive changes to neuroradiological changes in MS is thus incompletely understood. The present study systematically reviews all studies reporting a relationship between MRI changes and cognitive changes after at least one year of follow-up. METHOD An extensive and methodical search of online databases was conducted to identify qualified studies until August 2023. Among various cognitive tests and magnetic resonance imaging (MRI) measures, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), verbal fluency, T2 lesion volume (T2LV), white matter lesion volume (WML), and grey matter volume (GMV) qualified for inclusion in a meta-analysis investigating the association of cognitive changes to neuroradiological changes. RESULTS We identified 35 studies that explored the link between MRI changes and changes in cognitive outcomes. Of these, twenty studies (57.14%) investigated the association between SDMT/PASAT and MRI metrics. Eleven studies (31.42%) focused on the relationship between MRI metrics and verbal learning and memory, while ten studies (28.57%) reported associations with visuospatial learning and memory. Furthermore, eight studies (22.85%) analyzed the correlation between verbal fluency and MRI measures. Only 5 were eligible for inclusion in the meta-analysis. The meta-analysis evaluated correlations between SDMT/PASAT and GMV (rs = 0.67, 95% CI 0.44-0.91), and verbal fluency and T2LV (rs = 0.35, 95% CI 0.09-0.60). CONCLUSION In this rigorously conducted systematic review, we found a significant association of cognitive changes, specifically SDMT/PASAT and verbal fluency, to changes in T2LV and atrophy in individuals with MS. Findings should be interpreted cautiously due to the limited amount of high-quality research, small sample sizes, and variability in study methodologies.
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Affiliation(s)
- Leila Simani
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leila Molaeipour
- Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Kian
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Victoria M Leavitt
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
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Durozard P, Maarouf A, Zaaraoui W, Stellmann JP, Boutière C, Rico A, Demortière S, Guye M, Le Troter A, Dary H, Ranjeva JP, Audoin B, Pelletier J. Cortical Lesions as an Early Hallmark of Multiple Sclerosis: Visualization by 7 T MRI. Invest Radiol 2024:00004424-990000000-00214. [PMID: 38889240 DOI: 10.1097/rli.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Compelling evidence indicates a significant involvement of cortical lesions in the progressive phase of multiple sclerosis (MS), significantly contributing to late-stage disability. Despite the promise of ultra-high-field magnetic resonance imaging (MRI) in detecting cortical lesions, current evidence falls short in providing insights into the existence of such lesions during the early stages of MS or their underlying cause. This study delineated, at the early stage of MS, (1) the prevalence and spatial distribution of cortical lesions identified by 7 T MRI, (2) their relationship with white matter lesions, and (3) their clinical implications. MATERIALS AND METHODS Twenty individuals with early-stage relapsing-remitting MS (disease duration <1 year) underwent a 7 T MRI session involving T1-weighted MP2RAGE, T2*-weighted multiGRE, and T2-weighted FLAIR sequences for cortical and white matter segmentation. Disability assessments included the Expanded Disability Status Scale, the Multiple Sclerosis Functional Composite, and an extensive evaluation of cognitive function. RESULTS Cortical lesions were detected in 15 of 20 patients (75%). MP2RAGE revealed a total of 190 intracortical lesions (median, 4 lesions/case [range, 0-44]) and 216 leukocortical lesions (median, 2 lesions/case [range, 0-75]). Although the number of white matter lesions correlated with the total number of leukocortical lesions (r = 0.91, P < 0.001), no correlation was observed between the number of white matter or leukocortical lesions and the number of intracortical lesions. Furthermore, the number of leukocortical lesions but not intracortical or white-matter lesions was significantly correlated with cognitive impairment (r = 0.63, P = 0.04, corrected for multiple comparisons). CONCLUSIONS This study highlights the notable prevalence of cortical lesions at the early stage of MS identified by 7 T MRI. There may be a potential divergence in the underlying pathophysiological mechanisms driving distinct lesion types, notably between intracortical lesions and white matter/leukocortical lesions. Moreover, during the early disease phase, leukocortical lesions more effectively accounted for cognitive deficits.
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Affiliation(s)
- Pierre Durozard
- From the Aix Marseille Univ, CNRS, CRMBM, Marseille, France (P.D., A.M., W.Z., J.-P.S., A.R., M.G., A.T., H.D., J.-P.R., B.A., J.P.); Aix Marseille Univ, APHM, Pôle de Neurosciences Cliniques, MICeME, Marseille, France (A.M., C.B., A.R., S.D., B.A., J.P.); Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle d'Imagerie Médicale, CEMEREM, Marseille, France (J.-P.S., M.G.); and CRC-SEP Corse, Centre Hospitalier d'Ajaccio, Ajaccio, France (P.D.)
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Weeda MM, van Nederpelt DR, Twisk JWR, Brouwer I, Kuijer JPA, van Dam M, Hulst HE, Killestein J, Barkhof F, Vrenken H, Pouwels PJW. Multimodal MRI study on the relation between WM integrity and connected GM atrophy and its effect on disability in early multiple sclerosis. J Neurol 2024; 271:355-373. [PMID: 37716917 PMCID: PMC10769935 DOI: 10.1007/s00415-023-11937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is characterized by pathology in white matter (WM) and atrophy of grey matter (GM), but it remains unclear how these processes are related, or how they influence clinical progression. OBJECTIVE To study the spatial and temporal relationship between GM atrophy and damage in connected WM in relapsing-remitting (RR) MS in relation to clinical progression. METHODS Healthy control (HC) and early RRMS subjects visited our center twice with a 1-year interval for MRI and clinical examinations, including the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) scores. RRMS subjects were categorized as MSFC decliners or non-decliners based on ΔMSFC over time. Ten deep (D)GM and 62 cortical (C) GM structures were segmented and probabilistic tractography was performed to identify the connected WM. WM integrity was determined per tract with, amongst others, fractional anisotropy (FA), mean diffusivity (MD), neurite density index (NDI), and myelin water fraction (MWF). Linear mixed models (LMMs) were used to investigate GM and WM differences between HC and RRMS, and between MSFC decliners and non-decliners. LMM was also used to test associations between baseline WM z-scores and changes in connected GM z-scores, and between baseline GM z-scores and changes in connected WM z-scores, in HC/RRMS subjects and in MSFC decliners/non-decliners. RESULTS We included 13 HCs and 31 RRMS subjects with an average disease duration of 3.5 years and a median EDSS of 3.0. Fifteen RRMS subjects showed declining MSFC scores over time, and they showed higher atrophy rates and greater WM integrity loss compared to non-decliners. Lower baseline WM integrity was associated with increased CGM atrophy over time in RRMS, but not in HC subjects. This effect was only seen in MSFC decliners, especially when an extended WM z-score was used, which included FA, MD, NDI and MWF. Baseline GM measures were not significantly related to WM integrity changes over time in any of the groups. DISCUSSION Lower baseline WM integrity was related to more cortical atrophy in RRMS subjects that showed clinical progression over a 1-year follow-up, while baseline GM did not affect WM integrity changes over time. WM damage, therefore, seems to drive atrophy more than conversely.
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Affiliation(s)
- Merlin M Weeda
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
| | - D R van Nederpelt
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - J W R Twisk
- Epidemiology and Data Science, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - I Brouwer
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - J P A Kuijer
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - M van Dam
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - H E Hulst
- Health-, Medical-, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - F Barkhof
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- UCL Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - H Vrenken
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - P J W Pouwels
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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Rojas JI, Patrucco L, Pappolla A, Sánchez F, Cristiano E. Brain volume loss and physical and cognitive impairment in naive multiple sclerosis patients treated with fingolimod: prospective cohort study in Buenos Aires, Argentina. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:699-705. [PMID: 36254442 PMCID: PMC9685825 DOI: 10.1055/s-0042-1755277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The percentage of brain volume loss (PBVL) has been classically considered as a biomarker in multiple sclerosis (MS). OBJECTIVE The objective of the present study was to analyze if the PBVL during the 1st year after the onset of the disease predicts physical and cognitive impairment (CI). METHODS Prospective study that included naïve patients without cognitive impairment who initiated MS treatment with fingolimod. Patients were followed for 3 years and relapses, expanded disability status scale (EDSS) progression (defined as worsening of 1 point on the EDSS), the annual PBVL (evaluated by structural image evaluation using normalization of atrophy [SIENA]), and the presence of CI were evaluated. Cognitive impairment was defined in patients who scored at least 2 standard deviations (SDs) below controls on at least 2 domains. The PBVL after 1 year of treatment with fingolimod was used as an independent variable, while CI and EDSS progression at the 3rd year of follow-up as dependent variables. RESULTS A total of 71 patients were included, with a mean age of 35.4 ± 3 years old. At the 3rd year, 14% of the patients were classified as CI and 6.2% had EDSS progression. In the CI group, the PBVL during the 1st year was - 0.52 (±0.07) versus -0.42 (±0.04) in the no CI group (p < 0.01; odds ratio [OR] = 2.24; 95% confidence interval [CI]: 1.72-2.44). In the group that showed EDSS progression, the PBVL during the 1st year was - 0.59 (±0.05) versus - 0.42 (±0.03) (p < 0.01; OR = 2.33; 95%CI: 1.60-2.55). CONCLUSIONS A higher PBVL during the 1st year in naïve MS patients was independently associated with a significant risk of CI and EDSS progression.
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Affiliation(s)
- Juan Ignacio Rojas
- Multiple Sclerosis Center of Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario CEMIC, Neurology Service, Buenos Aires, Argentina
| | - Liliana Patrucco
- Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina
| | - Agustín Pappolla
- Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina
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Collorone S, Kanber B, Hashem L, Cawley N, Prados F, Davagnanam I, Barkhof F, Ciccarelli O, Toosy A. Visual Function and Brief Cognitive Assessment for Multiple Sclerosis in Optic Neuritis Clinically Isolated Syndrome Patients. J Neuroophthalmol 2022; 42:e22-e31. [PMID: 34561401 PMCID: PMC8834161 DOI: 10.1097/wno.0000000000001280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we hypothesized that clinically isolated syndrome-optic neuritis patients may have disturbances in neuropsychological functions related to visual processes. METHODS Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision. RESULTS At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics. CONCLUSION Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Baris Kanber
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Leen Hashem
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Niamh Cawley
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ferran Prados
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Indran Davagnanam
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Frederik Barkhof
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Olga Ciccarelli
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ahmed Toosy
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
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Dziadkowiak E, Wieczorek M, Zagrajek M, Chojdak-Łukasiewicz J, Gruszka E, Budrewicz S, Pokryszko-Dragan A. Multimodal Evoked Potentials as Potential Biomarkers of Disease Activity in Patients With Clinically Isolated Syndrome. Front Neurol 2022; 12:678035. [PMID: 35211070 PMCID: PMC8860823 DOI: 10.3389/fneur.2021.678035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective There is an ongoing search for markers useful in monitoring and predicting disease activity at the early stage of multiple sclerosis (MS). The goals of this study were to prospectively evaluate the changes in parameters of multimodal evoked potentials (EP) and cognition within a 3-year follow-up period in patients with clinically isolated syndrome (CIS), and to assess the prognostic value of baseline findings with regard to the disease outcomes. Methods In 29 patients (20 women, nine men, mean age 31.1) multimodal (visual, brainstem auditory, somatosensory, event-related) EP and neuropsychological tests (NT) were performed at baseline (T0) and after 1 (T1) and 3 (T3) years. Their results were compared longitudinally between baseline, T1, and T3. Baseline results confirmed conversion of CIS into multiple sclerosis (MS) and disability level at T1 and T3 using multiple comparisons and a logistic regression model. Results Apart from mean N13/P16 SEP (somatosensory evoked potentials) amplitude (lower at T1 and T3 than at baseline (T0 1.02 ± 0.37 μV, T1 0.90 ± 0.26 μV, T3 0.74 ± 0.32 μV, p < 0.05 for both comparisons), no significant changes of EP or NT parameters were found in longitudinal assessment. Baseline P300 Pz latency was longer for the patients with MS than for those with CIS at T1 (352.69 vs. 325.56 ms). No predictive value was shown for any of the analyzed baseline variables with regard to conversion from CIS into MS. Significance Baseline ERP abnormalities were associated with their short-term conversion into MS. ERP are worth considering in multimodal EP evaluation at the early stage of MS.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
| | - Małgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wrocław, Wrocław, Poland
| | - Mieszko Zagrajek
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
| | | | - Ewa Gruszka
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
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Microstructural White Matter Alterations in Cognitively Impaired Patients at Early Stages of Multiple Sclerosis. Clin Neuroradiol 2021; 31:993-1003. [PMID: 33787958 PMCID: PMC8648694 DOI: 10.1007/s00062-021-01010-8] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/26/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE As conventional quantitative magnetic resonance imaging (MRI) parameters are weakly associated with cognitive impairment (CI) in early multiple sclerosis (MS), we explored microstructural white matter alterations in early MS or clinically isolated syndrome (CIS) comparing patients with or without CI. METHODS Based on a preceding tract-based spatial statistics analysis (3 Tesla MRI) which contrasted 106 patients with early MS or CIS and 49 healthy controls, diffusion metrics (fractional anisotropy, FA, mean diffusivity, MD) were extracted from significant clusters using an atlas-based approach. The FA and MD were compared between patients with (Ci_P n = 14) and without (Cp_P n = 81) cognitive impairment in a subset of patients who underwent CI screening. RESULTS The FA was reduced in Ci_P compared to Cp_P in the splenium of corpus callosum (p = 0.001), right parahippocampal cingulum (p = 0.002) and fornix cres./stria terminalis (0.042), left posterior corona radiata (p = 0.012), bilateral cerebral peduncles, medial lemniscus and in cerebellar tracts. Increased MD was detected in the splenium of corpus callosum (p = 0.01). The CI-related localizations overlapped only partially with MS lesions. CONCLUSION Microstructural white matter alterations at disease onset were detectable in Ci_P compared to Cp_P in known cognitively relevant fiber tracts, indicating the relevance of early treatment initiation in MS and CIS.
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Petracca M, Pontillo G, Moccia M, Carotenuto A, Cocozza S, Lanzillo R, Brunetti A, Brescia Morra V. Neuroimaging Correlates of Cognitive Dysfunction in Adults with Multiple Sclerosis. Brain Sci 2021; 11:346. [PMID: 33803287 PMCID: PMC8000635 DOI: 10.3390/brainsci11030346] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a frequent and meaningful symptom in multiple sclerosis (MS), caused by the accrual of brain structural damage only partially counteracted by effective functional reorganization. As both these aspects can be successfully investigated through the application of advanced neuroimaging, here, we offer an up-to-date overview of the latest findings on structural, functional and metabolic correlates of cognitive impairment in adults with MS, focusing on the mechanisms sustaining damage accrual and on the identification of useful imaging markers of cognitive decline.
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Affiliation(s)
- Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.P.); (S.C.); (A.B.)
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (M.M.); (A.C.); (V.B.M.)
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Motyl J, Friedova L, Vaneckova M, Krasensky J, Lorincz B, Blahova Dusankova J, Andelova M, Fuchs TA, Kubala Havrdova E, Benedict RHB, Horakova D, Uher T. Isolated Cognitive Decline in Neurologically Stable Patients with Multiple Sclerosis. Diagnostics (Basel) 2021; 11:diagnostics11030464. [PMID: 33800075 PMCID: PMC7999620 DOI: 10.3390/diagnostics11030464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Cognitive deterioration is an important marker of disease activity in multiple sclerosis (MS). It is vital to detect cognitive decline as soon as possible. Cognitive deterioration can take the form of isolated cognitive decline (ICD) with no other clinical signs of disease progression present. (2) Methods: We investigated 1091 MS patients from the longitudinal GQ (Grant Quantitative) study, assessing their radiological, neurological, and neuropsychological data. Additionally, the confirmatory analysis was conducted. Clinical disease activity was defined as the presence of new relapse or disability worsening. MRI activity was defined as the presence of new or enlarged T2 lesions on brain MRI. (3) Results: Overall, 6.4% of patients experienced cognitive decline and 4.0% experienced ICD without corresponding clinical activity. The vast majority of cognitively worsening patients showed concomitant progression in other neurological and radiologic measures. There were no differences in disease severity between completely stable patients and cognitively worsening patients but with normal cognition at baseline. (4) Conclusions: Only a small proportion of MS patients experience ICD over short-term follow-up. Patients with severe MS are more prone to cognitive decline; however, patients with normal cognitive performance and mild MS might benefit from the early detection of cognitive decline the most.
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Affiliation(s)
- Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (M.V.); (J.K.)
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (M.V.); (J.K.)
| | - Balazs Lorincz
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Tom A. Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (T.A.F.); (R.H.B.B.)
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Ralph H. B. Benedict
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (T.A.F.); (R.H.B.B.)
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
- Correspondence: ; Tel.: +420-224-966-515
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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12
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Neurochemical Changes in the Brain and Neuropsychiatric Symptoms in Clinically Isolated Syndrome. J Clin Med 2020; 9:jcm9123909. [PMID: 33276455 PMCID: PMC7761482 DOI: 10.3390/jcm9123909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/08/2020] [Accepted: 11/28/2020] [Indexed: 11/20/2022] Open
Abstract
To assess cognitive impairment and affective symptoms and their association with damage to normal-appearing white matter (NAWM) in patients with clinically isolated syndrome (CIS), we compared neuropsychological test scores between patients with CIS and healthy controls and examined correlations between these and proton magnetic resonance spectroscopy (1H-MRS) outcomes in patients with CIS. Forty patients with CIS and 40 healthy participants were tested with a set of neuropsychological tests, which included the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS). Single-voxel 1H-MRS was performed on frontal and parietal NAWM of patients with CIS to assess ratios of N-acetyl-aspartate (NAA) to creatine (Cr), myo-inositol (mI), and choline (Cho), as well as mI/Cr and Cho/Cr ratios. Patients with CIS had lower cognitive performance and higher scores for the BDI and anxiety subscale of HADS than healthy controls. There were significant correlations between the following neuropsychological tests and metabolic ratios in the frontal NAWM: Stroop Color-Word Test and Cho/Cr, Symbol Digit Modalities Test and mI/Cr, as well as NAA/mI, Go/no-go reaction time, and NAA/Cho, as well as NAA/mI, Californian Verbal Learning Test, and NAA/Cr. BDI scores were related to frontal NAA/mI and parietal NAA/Cr and Cho/Cr ratios, whereas HADS-depression scores were associated with frontal NAA/Cr and NAA/mI and parietal NAA/Cr and Cho/Cr ratios. HADS-anxiety correlated with parietal NAA/Cr ratio. This study suggests that neurochemical changes in the NAWM assessed with single-voxel 1H-MRS are associated with cognitive performance and affective symptoms in patients with CIS.
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The weak association between neurofilament levels at multiple sclerosis onset and cognitive performance after 9 years. Mult Scler Relat Disord 2020; 46:102534. [PMID: 33032055 DOI: 10.1016/j.msard.2020.102534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurofilament light chain level in serum (sNfL) and cerebrospinal fluid (CSF-NfL) is a promising biomarker of disease activity in multiple sclerosis (MS). However, predictive value of neurofilaments for development of cognitive decline over long-term follow-up has not been extensively studied. OBJECTIVE To investigate the relationship between early neurofilament levels and cognitive performance after 9-years. METHODS We included 58 MS patients from the SET study. sNfL levels were measured at screening, at 1 and 2 years. CSF-NfL were measured in 36 patients at screening. Cognitive performance was assessed by the Brief International Cognitive Assessment for Multiple Sclerosis and the Paced Auditory Serial Addition Test-3 s at baseline, at 1, 2 and 9 years. Association between neurofilament levels and cognition was analyzed using Spearman´s correlation, logistic regression and mixed models. RESULTS We did not observe associations among early sNfL levels and cross-sectional or longitudinal cognitive measures, except of a trend for association between higher sNfL levels at screening and lower California Verbal Learning Test-II (CVLT-II) scores at year 1 (rho=-0.31, unadjusted p = 0.028). Higher sNfL level was not associated with increased risk of cognitive decline, except of a trend for greater risk of CVLT-II decrease in patients with higher sNfL levels at 1 year (OR=15.8; 95% CI=1.7-147.0; unadjusted p = 0.015). Similar trends were observed for CSF-NfL. CONCLUSION We found only weak association between sNfL levels at disease onset and evolution of cognitive performance over long-term follow-up.
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Loring DW, Meador KJ, Goldstein FC. Valid or not: A critique of Graver and Green. APPLIED NEUROPSYCHOLOGY. ADULT 2020; 29:639-642. [PMID: 32735139 DOI: 10.1080/23279095.2020.1798961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Disagreements in science and medicine are not uncommon, and formal exchanges of disagreements serve a variety of valuable roles. As identified by a Nature Methods editorial entitled "The Power of Disagreement" (2016), disagreements bring attention to best practices so that differences in interpretation do not result from inferior data sets or confirmation bias, "prompting researchers to take a second look at evidence that is not in agreement with their hypothesis, rather than dismiss it as artifacts." Graver and Green published reasons why they disagree with a recent clinical case report and a decades old randomized control trial characterizing the effect of an acute 2 mg dosing of lorazepam on the Word Memory Test. In this article, we formally responded to their commentary to further clarify the reasons for our data interpretations. These two opposing views provide an excellent learning opportunity, particularly for students, demonstrating the importance of careful articulation of the rationale behind certain conclusions from different perspectives. We encourage careful review of the original articles being discussed so the neuropsychologists can read both positions and decide which interpretation of the findings they consider most sound.
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Affiliation(s)
- David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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15
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Graver C, Green P. Misleading conclusions about word memory test results in multiple sclerosis (MS) by Loring and Goldstein (2019). APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:315-323. [DOI: 10.1080/23279095.2020.1748035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Jakimovski D, Zivadinov R, Bergsland N, Ramasamy DP, Hagemeier J, Weinstock-Guttman B, Kolb C, Hojnacki D, Dwyer MG. Sex-Specific Differences in Life Span Brain Volumes in Multiple Sclerosis. J Neuroimaging 2020; 30:342-350. [PMID: 32392376 DOI: 10.1111/jon.12709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Numerous sex-specific differences in multiple sclerosis (MS) susceptibility, disease manifestation, disability progression, inflammation, and neurodegeneration have been previously reported. Previous magnetic resonance imaging (MRI) studies have shown structural differences between female and male MS brain volumes. To determine sex-specific global and tissue-specific brain volume throughout the MS life span in a real-world large MRI database. METHODS A total of 2,199 MS patients (female/male ratio of 1,651/548) underwent structural MRI imaging on either a 1.5-T or 3-T scanner. Global and tissue-specific volumes of whole brain (WBV), white matter, and gray matter (GMV) were determined by utilizing Structural Image Evaluation using Normalisation of Atrophy Cross-sectional (SIENAX). Lateral ventricular volume (LVV) was determined with the Neurological Software Tool for REliable Atrophy Measurement (NeuroSTREAM). General linear models investigated sex and age interactions, and post hoc comparative sex analyses were performed. RESULTS Despite being age-matched with female MS patents, a greater proportion of male MS patients were diagnosed with progressive MS and had lower normalized WBV (P < .001), GMV (P < .001), and greater LVV (P < .001). In addition to significant stand-alone main effects, an interaction between sex and age had an additional effect on the LVV (F-statistics = 4.53, P = .033) and GMV (F-statistics = 4.59, P = .032). The sex and age interaction was retained in both models of LVV (F-statistics = 3.31, P = .069) and GMV (F-statistics = 6.1, P = .003) when disease subtype and disease-modifying treatment (DMT) were also included. Although male MS patients presented with significantly greater LVV and lower GMV during the early and midlife period when compared to their female counterparts (P < .001 for LVV and P < .019 for GMV), these differences were nullified in 60+ years old patients. Similar findings were seen within a subanalysis of MS patients that were not on any DMT at the time of enrollment. CONCLUSION There are sex-specific differences in the LVV and GMV over the MS life span.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Translational Imaging Center at Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY
| | - Channa Kolb
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY
| | - David Hojnacki
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
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Katsari M, Kasselimis DS, Giogkaraki E, Breza M, Evangelopoulos ME, Anagnostouli M, Andreadou E, Kilidireas C, Hotary A, Zalonis I, Koutsis G, Potagas C. A longitudinal study of cognitive function in multiple sclerosis: is decline inevitable? J Neurol 2020; 267:1464-1475. [PMID: 32008073 DOI: 10.1007/s00415-020-09720-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Marina Katsari
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Dimitrios S Kasselimis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece.
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece.
| | - Erasmia Giogkaraki
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Maria-Eleftheria Evangelopoulos
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Maria Anagnostouli
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Elisabeth Andreadou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Costas Kilidireas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Alia Hotary
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zalonis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vas. Sofias Av., 11528, Athens, Greece
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Abou Elmaaty AA, Flifel ME, Zarad CA. Correlation between brain magnetic resonance imaging, cognitive dysfunction and physical dysability in multiple sclerosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0100-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Johnen A, Schiffler P, Landmeyer NC, Tenberge JG, Riepl E, Wiendl H, Krämer J, Meuth SG. Resolving the cognitive clinico-radiological paradox - Microstructural degeneration of fronto-striatal-thalamic loops in early active multiple sclerosis. Cortex 2019; 121:239-252. [PMID: 31654896 DOI: 10.1016/j.cortex.2019.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/10/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Associations between cognitive impairment (CI) and both global and regional brain volumes can be weak in early multiple sclerosis (MS), a dilemma known as cognitive clinico-radiological paradox. We hypothesized that white-matter (WM) integrity within fronto-striatal-thalamic networks may be a sensitive marker for impaired performance in speed-dependent tasks, typical for early MS. METHODS Twenty-seven patients with early active relapsing-remitting MS (RRMS) received comprehensive neuropsychological assessment and underwent structural and diffusion-weighted brain magnetic resonance imaging (MRI). Global and regional brain volumes were obtained using FreeSurfer software. Fractional anisotropy (FA) was computed from diffusion tensor images to assess microstructural alterations within three anatomically predefined fronto-striatal-thalamic loops known to be relevant for speed-dependent attention and executive functions. RESULTS Overall cognitive performance (Spearman's ρ = .51) and performance in the domains processing speed (ρ = .44) and executive functions (ρ = .41) were correlated with patients' mean FA within the right dorsolateral-prefrontal loop. In addition, overall cognitive performance correlated with mean FA within the right lateral orbitofrontal loop (ρ = .39) - but only before controlling for WM lesion count. In contrast, regional volumes of grey-matter structures within these fronto-striatal-thalamic loops (including the thalamus) were not significantly related to CI. The total brain volume was associated with performance in the domain verbal memory (ρ = .43) only. CONCLUSIONS Microstructural degeneration within specific fronto-striatal-thalamic WM networks, previously characterized as crucial for task-monitoring, better accounts for speed-dependent CI in patients with early active RRMS than global or regional brain volumes. Our findings may advance our understanding of the neural substrates underlying CI characteristic for early RRMS.
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Affiliation(s)
- Andreas Johnen
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany.
| | - Patrick Schiffler
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nils C Landmeyer
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Jan-Gerd Tenberge
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Ester Riepl
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Julia Krämer
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
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Ghione E, Bergsland N, Dwyer MG, Hagemeier J, Jakimovski D, Paunkoski I, Ramasamy DP, Carl E, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. Aging and Brain Atrophy in Multiple Sclerosis. J Neuroimaging 2019; 29:527-535. [PMID: 31074192 DOI: 10.1111/jon.12625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain atrophy accelerates at the age of 60 in healthy individuals (HI) and at disease onset in multiple sclerosis (MS) patients. Whether there is an exacerbating effect of aging superimposed on MS-related brain atrophy is unknown. We estimated the aging effect on lateral ventricular volume (LVV) and whole brain volume (WBV) changes in MS patients. METHODS 1,982 MS patients (mean follow-up: 4.8 years) and 351 HI (mean follow-up: of 3.1 years), aged from 20 to 79 years old (yo), were collected retrospectively. Percent LVV change (PLVVC) and percent brain volume change (PBVC) on 1.5T and 3T MRI scanners (median of 3.9 scans per subject) were calculated. These were determined between all-time points and subjects were divided in six-decade age groups. MRI differences between age groups were calculated using analysis of covariance (ANCOVA). RESULTS Compared to HI, at first MRI, MS patients had significantly increased LVV in the age groups: 30-39 yo, 40-49 yo, 50-59 yo, 60-69 yo (all P < .0001), and 70-79 yo (P = .029), and decreased WBV in the age groups: 20-29 yo (P = .024), 30-39 yo (P = .031), 40-49 yo, and 50-59 yo (all P < .0001). Annualized PLVVC was significantly different between the age groups 20-59 and 60-79 yo in MS patients (P = .005) and HI (P < .0001), as was for PBVC in MS patients (P = .001), but not for HI (P = .521). There was a significant aging interaction effect in the annualized PLVVC (P = .001) between HI and MS patients, which was not observed for the annualized PBVC (P = .380). CONCLUSIONS Development of brain atrophy manifests progressively in MS patients, and occurs with a different pattern, as compared to aging HI. PLVVC increased across age in HI as compared to MS, while PBVC decreased across ages in both HI and MS.
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Affiliation(s)
- Emanuele Ghione
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Ivo Paunkoski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - David Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Channa Kolb
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Bianca Weinstock-Guttman
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
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21
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Brochet B, Ruet A. Cognitive Impairment in Multiple Sclerosis With Regards to Disease Duration and Clinical Phenotypes. Front Neurol 2019; 10:261. [PMID: 30949122 PMCID: PMC6435517 DOI: 10.3389/fneur.2019.00261] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/27/2019] [Indexed: 12/26/2022] Open
Abstract
The relationships between cognitive impairment that exist during the clinical course of multiple sclerosis (MS) remain poorly described. The effect of disease duration has been studied in a few longitudinal cohorts and some cross-sectional studies that suggest that cognitive deficits tend to extend with disease duration. However, the effect of disease duration seems to be confounded by the effect of age. At the pre-clinical stage, cognitive deficits have been observed in patients with radiologically isolated syndromes, and their profile is similar than in clinically isolated syndromes (CIS) and relapsing-remitting MS (RRMS). The frequency of cognitive impairment tends to be higher in RRMS than in CIS. In these phenotypes, slowness of information processing speed (IPS) and episodic verbal and visuo-spatial memory deficits are frequently observed, but executive functions, and in particular verbal fluency, could also be impaired. More frequent and severe deficits are reported in SPMS than in RRMS with more severe deficits for memory tests, working memory and IPS. Similarly to what is observed in SPMS, patients with primary progressive MS (PPMS) present with a wide range of cognitive deficits in IPS, attention, working memory, executive functions, and verbal episodic memory with more tests and domains impaired than RRMS patients. Altogether these data suggested that not only the duration of the disease and age play an important role in the cognitive profile of patients, but also the phenotype itself, probably because of its specific pathological mechanism.
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Affiliation(s)
- Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Team Glia-Neuron Interactions, Neurocentre Magendie, INSERM U1215, Université de Bordeaux, Bordeaux, France
| | - Aurélie Ruet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France.,Team Glia-Neuron Interactions, Neurocentre Magendie, INSERM U1215, Université de Bordeaux, Bordeaux, France
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22
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Johnen A, Bürkner PC, Landmeyer NC, Ambrosius B, Calabrese P, Motte J, Hessler N, Antony G, König IR, Klotz L, Hoshi MM, Aly L, Groppa S, Luessi F, Paul F, Tackenberg B, Bergh FT, Kümpfel T, Tumani H, Stangel M, Weber F, Bayas A, Wildemann B, Heesen C, Zettl UK, Zipp F, Hemmer B, Meuth SG, Gold R, Wiendl H, Salmen A. Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS). J Neurol 2018; 266:386-397. [PMID: 30515631 PMCID: PMC6373354 DOI: 10.1007/s00415-018-9142-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis. METHODS Neuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes. RESULTS At baseline, 22% of patients had CI (impairment in ≥2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year. CONCLUSIONS Identification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction.
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Affiliation(s)
- Andreas Johnen
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany.
| | - Paul-Christian Bürkner
- Department of Statistics, Faculty of Psychology, Westfälische-Wilhelms-University, Münster, Germany
| | - Nils C Landmeyer
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Björn Ambrosius
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Pasquale Calabrese
- Department of Neuropsychology and Behavioral Neurology, University of Basel, Basel, Switzerland
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nicole Hessler
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gisela Antony
- Central Information Office (CIO), Philipps-University Marburg, Marburg, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Muna-Miriam Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sergiu Groppa
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, University Medicine Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Björn Tackenberg
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany
- Clinic of Neurology Dietenbronn, Schwendi, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Frank Weber
- Neurology, Max-Planck-Institute of Psychiatry, Munich, Germany
- Neurological Clinic, Sana Kliniken des Landkreises Cham, Cham, Germany
| | - Antonios Bayas
- Department of Neurology, Klinikum Augsburg, Augsburg, Germany
| | | | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Frauke Zipp
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland
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23
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Ghione E, Bergsland N, Dwyer MG, Hagemeier J, Jakimovski D, Paunkoski I, Ramasamy DP, Silva D, Carl E, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine. AJNR Am J Neuroradiol 2018; 39:2237-2242. [PMID: 30467212 DOI: 10.3174/ajnr.a5876] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years. MATERIALS AND METHODS A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR. RESULTS Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change (P < .001), percentage normalized brain volume change (P = .002), and percentage lateral ventricle volume change (P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change (P < .001) and normalized brain volume (P = .002) and a 33% increase in lateral ventricle volume (P = .004). CONCLUSIONS All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.
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Affiliation(s)
- E Ghione
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - M G Dwyer
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center.,Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York
| | - J Hagemeier
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Jakimovski
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - I Paunkoski
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D P Ramasamy
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Silva
- Novartis Pharmaceuticals AG (D.S.), Basel, Switzerland
| | - E Carl
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - C Kolb
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - B Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - R Zivadinov
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center .,Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York
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24
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Rasche L, Scheel M, Otte K, Althoff P, van Vuuren AB, Gieß RM, Kuchling J, Bellmann-Strobl J, Ruprecht K, Paul F, Brandt AU, Schmitz-Hübsch T. MRI Markers and Functional Performance in Patients With CIS and MS: A Cross-Sectional Study. Front Neurol 2018; 9:718. [PMID: 30210439 PMCID: PMC6123531 DOI: 10.3389/fneur.2018.00718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction: Brain atrophy is a widely accepted marker of disease severity with association to clinical disability in multiple sclerosis (MS). It is unclear to which extent this association reflects common age effects on both atrophy and function. Objective: To explore how functional performance in gait, upper extremities and cognition is associated with brain atrophy in patients with Clinically Isolated Syndrome (CIS) and relapsing-remitting MS (RRMS), controlling for effects of age and sex. Methods: In 27 patients with CIS, 59 with RRMS (EDSS ≤3) and 63 healthy controls (HC), 3T MRI were analyzed for T2 lesion count (T2C), volume (T2V) and brain volumes [normalized brain volume (NBV), gray matter volume (NGMV), white matter volume (NWMV), thalamic volume (NThalV)]. Functional performance was measured with short maximum walking speed (SMSW speed), 9-hole peg test (9HPT) and symbol digit modalities test (SDMT). Linear regression models were created for functional variables with stepwise inclusion of age, sex and MR imaging markers. Results: CIS differed from HC only in T2C and T2V. RRMS differed from HC in NBV, NGMV and NThalV, T2C and T2V, but not in NWMV. A strong association with age was seen in HC, CIS and RRMS groups for NBV (r = -0.5 to -0.6) and NGMV (r = -0.6 to -0.8). Associations with age were seen in HC and RRMS but not CIS for NThalV (r = -0.3; r = -0.5), T2C (rs = 0.3; rs = 0.2) and T2V (rs = 0.3; rs = 0.3). No effect of age was seen on NWMV. Correlations of functional performance with age in RRMS were seen for SMSW speed, 9HPTand SDMT (r = -0.27 to -0.46). Regression analyses yielded significant models only in the RRMS group for 9HPT, SMSW speed and EDSS. These included NBV, NGMV, NThalV, NWMV, logT2V, age and sex as predictors. NThalV was the only MRI variable predicting a functional measure (9HPTr) with a higher standardized beta than age and sex (R2 = 0.36, p < 1e-04). Conclusion: Thalamic atrophy was a stronger predictor of hand function (9HPT) in RRMS, than age and sex. This underlines the clinical relevance of thalamic atrophy and the relevance of hand function as a clinical marker even in mildly disabled patients.
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Affiliation(s)
- Ludwig Rasche
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karen Otte
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Motognosis GmbH, Berlin, Germany
| | - Patrik Althoff
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Annemieke B. van Vuuren
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- VU University Medical Center, Amsterdam, Netherlands
| | - Rene M. Gieß
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Tanja Schmitz-Hübsch
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany
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25
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Kitzler HH, Wahl H, Eisele JC, Kuhn M, Schmitz-Peiffer H, Kern S, Rutt BK, Deoni SCL, Ziemssen T, Linn J. Multi-component relaxation in clinically isolated syndrome: Lesion myelination may predict multiple sclerosis conversion. NEUROIMAGE-CLINICAL 2018; 20:61-70. [PMID: 30094157 PMCID: PMC6070690 DOI: 10.1016/j.nicl.2018.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/01/2018] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
We performed a longitudinal case-control study on patients with clinically isolated syndrome (CIS) with the aid of quantitative whole-brain myelin imaging. The aim was (1) to parse early myelin decay and to break down its distribution pattern, and (2) to identify an imaging biomarker of the conversion into clinically definite Multiple Sclerosis (MS) based on in vivo measurable changes of myelination. Imaging and clinical data were collected immediately after the onset of first neurological symptoms and follow-up explorations were performed after 3, 6, and, 12 months. The multi-component Driven Equilibrium Single Pulse Observation of T1/T2 (mcDESPOT) was applied to obtain the volume fraction of myelin water (MWF) in different white matter (WM) regions at every time-point. This measure was subjected to further voxel-based analysis with the aid of a comparison of the normal distribution of myelination measures with an age and sex matched healthy control group. Both global and focal relative myelination content measures were retrieved. We found that (1) CIS patients at the first clinical episode suggestive of MS can be discriminated from healthy control WM conditions (p < 0.001) and therewith reproduced our earlier findings in late CIS, (2) that deficient myelination in the CIS group increased in T2 lesion depending on the presence of gadolinium enhancement (p < 0.05), and (3) that independently the CIS T2 lesion relative myelin content provided a risk estimate of the conversion to clinically definite MS (Odds Ratio 2.52). We initially hypothesized that normal appearing WM myelin loss may determine the severity of early disease and the subsequent risk of clinically definite MS development. However, in contrast we found that WM lesion myelin loss was pivotal for MS conversion. Regional myelination measures may thus play an important role in future clinical risk stratification. The multicomponent relaxation method mcDESPOT allowed 3D resolved data acquisition appropriate for group comparison and voxel-wise analysis. Myelin imaging in early clinically isolated syndrome revealed initial imaging widespread myelin loss even in normal appearing brain tissue. In clinically isolated syndrome the myelin measures varied depending on the presence of Gadolinium enhancement. Short-term risk of clinically isolated syndrome to convert to multiple sclerosis was determined by myelin measures within white matter lesions.
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Key Words
- Clinically isolated syndrome
- DAWM, diffusely abnormal white matter
- DVF, deficient volume fraction of myelin water
- EDSS, extended disability status scale
- FLASH, fast low-angle shot
- MCRI, multicomponent relaxation imaging
- MRI
- MSFC, multiple sclerosis functional composite
- MWF, myelin water fraction
- Multicomponent relaxation
- Multiple sclerosis
- Myelin imaging
- NAWM, normal appearing white matter
- mcDESPOT
- mcDESPOT, multi-component Driven Equilibrium Single Pulse Observation of T1/T2
- trueFISP, true fast imaging with steady state precession
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Affiliation(s)
- Hagen H Kitzler
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany.
| | - Hannes Wahl
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany
| | - Judith C Eisele
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kuhn
- Institute of Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | | | - Simone Kern
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Brian K Rutt
- Richard M. Lucas Center for Imaging, School of Medicine, Department of Radiology, Stanford University, Stanford, CA, USA
| | - Sean C L Deoni
- Memorial Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Tjalf Ziemssen
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Jennifer Linn
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany
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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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Moroso A, Ruet A, Lamargue-Hamel D, Munsch F, Deloire M, Ouallet JC, Cubizolle S, Charré-Morin J, Saubusse A, Tourdias T, Dousset V, Brochet B. Preliminary evidence of the cerebellar role on cognitive performances in clinically isolated syndrome. J Neurol Sci 2017; 385:1-6. [PMID: 29406885 DOI: 10.1016/j.jns.2017.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 11/02/2017] [Accepted: 11/29/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cerebellar and cognitive dysfunction can occur early in clinically isolated syndrome (CIS). Eye tracking is a reliable tool for the evaluation of both subtle cerebellar symptoms and cognitive impairment. OBJECTIVES To investigate the early cognitive profile using neuropsychological and ocular motor (OM) testing in CIS with and without cerebellar dysfunction with OM testing compared to healthy subjects (HS). METHODS Twenty-eight patients and 12 HC underwent OM and neuropsychological testing. Cerebellar impairment was defined by the registration of saccadic intrusions and/or at least 10% of dysmetria during ocular motor recording. Visually guided saccade (VGS), memory-guided saccade (MGS) and antisaccade (AS) paradigms were compared to neuropsychological assessments. RESULTS The group of patients with cerebellar dysfunction (n=16) performed worse on MGS latencies and error rates, and had worse working memory, executive function and information processing speed (IPS) z scores than patients without cerebellar dysfunction. IPS was correlated with the AS error rate in all patients and with the VGS error rate and the MGS final eye position ratio in cerebellar patients. CONCLUSION Eye tracking is a sensitive tool to assess cognitive and cerebellar dysfunctions in CIS. In CIS patients, cerebellar impairment is associated with working memory, executive functions and IPS slowness.
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Affiliation(s)
- Amandine Moroso
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Aurélie Ruet
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Delphine Lamargue-Hamel
- Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Fanny Munsch
- Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Mathilde Deloire
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | | | - Stéphanie Cubizolle
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Julie Charré-Morin
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Aurore Saubusse
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Thomas Tourdias
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Vincent Dousset
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Bruno Brochet
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France.
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28
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Wybrecht D, Reuter F, Pariollaud F, Zaaraoui W, Le Troter A, Rico A, Confort-Gouny S, Soulier E, Guye M, Maarouf A, Ranjeva JP, Pelletier J, Audoin B. New brain lesions with no impact on physical disability can impact cognition in early multiple sclerosis: A ten-year longitudinal study. PLoS One 2017; 12:e0184650. [PMID: 29149177 PMCID: PMC5693435 DOI: 10.1371/journal.pone.0184650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In early multiple sclerosis, although brain T2 lesions accrual are hallmark of the disease, only weak correlations were found between T2 lesions accrual and EDSS progression, the disability scale commonly used in multiple sclerosis studies. This may be related to the very poor sensitivity of EDSS to cognitive dysfunctions that may occur and progress from the first stage of the disease. In the present study, we aimed to demonstrate that cognitive deficits progress during the first ten years of MS and are significantly impacted by new T2 lesions. METHODS EDSS and extensive neuropsychological battery (22 measures) exploring memory, attention/speed of information processing and executive functions were assessed at baseline, Year 1 and Year 10 in 26 patients enrolled after their first clinical attack. To limit the bias of test-retest effect, only measures obtained at Year 1 and Year 10 were reported in the analysis. Raw scores of patients were transformed into z-scores using published normative data when available or scores of matched controls. Lesion probability mapping was used to assess the potential relationships between T2 lesions accumulation, cognitive decline and EDSS progression (P<0.05, FWE-corrected). RESULTS At Year 1, 27% of patients showed attention/speed of information processing deficits, 11.5% executive dysfunction and 11.5% memory impairment. During the follow-up, frequency and severity of executive dysfunction increased (from 11.5% of patients at Year 1 to 42% at Year 10, p<0.01) while no significant changes were evidenced for the other cognitive domains. Median EDSS increased from 0.5 [range: 0-3] at Year 1 to 2.5 [range: 0-6.5] at Year 10 (p<0.001). During the ten-year follow-up, lesions accumulation in the left cerebellum and semi-ovale centers was associated with EDSS progression. In contrast, most lesions accumulation in the frontal, parietal and temporal lobes were associated with cognitive decline but had no effect on EDSS progression. CONCLUSION The present study provides strong evidence that clinically silent T2 lesions impact cognition in early MS. In daily practice, early prevention of T2 lesions accrual may be useful to limit cognitive decline.
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Affiliation(s)
- D. Wybrecht
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- Hôpital d’Instruction des Armées Sainte Anne, Toulon, France
- * E-mail:
| | - F. Reuter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - F. Pariollaud
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - W. Zaaraoui
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Le Troter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Rico
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - S. Confort-Gouny
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - E. Soulier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - M. Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle d’Imagerie Médicale, CEMEREM, Marseille, France
| | - A. Maarouf
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - J-P. Ranjeva
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - J. Pelletier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - B. Audoin
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
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Mishra VR, Zhuang X, Sreenivasan KR, Banks SJ, Yang Z, Bernick C, Cordes D. Multimodal MR Imaging Signatures of Cognitive Impairment in Active Professional Fighters. Radiology 2017; 285:555-567. [PMID: 28741982 DOI: 10.1148/radiol.2017162403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose To investigate whether combining multiple magnetic resonance (MR) imaging modalities such as T1-weighted and diffusion-weighted MR imaging could reveal imaging biomarkers associated with cognition in active professional fighters. Materials and Methods Active professional fighters (n = 297; 24 women and 273 men) were recruited at one center. Sixty-two fighters (six women and 56 men) returned for a follow-up examination. Only men were included in the main analysis of the study. On the basis of computerized testing, fighters were separated into the cognitively impaired and nonimpaired groups on the basis of computerized testing. T1-weighted and diffusion-weighted imaging were performed, and volume and cortical thickness, along with diffusion-derived metrics of 20 major white matter tracts were extracted for every subject. A classifier was designed to identify imaging biomarkers related to cognitive impairment and was tested in the follow-up dataset. Results The classifier allowed identification of seven imaging biomarkers related to cognitive impairment in the cohort of active professional fighters. Areas under the curve of 0.76 and 0.69 were obtained at baseline and at follow-up, respectively, with the optimized classifier. The number of years of fighting had a significant (P = 8.8 × 10-7) negative association with fractional anisotropy of the forceps major (effect size [d] = 0.34) and the inferior longitudinal fasciculus (P = .03; d = 0.17). A significant difference was observed between the impaired and nonimpaired groups in the association of fractional anisotropy in the forceps major with number of fights (P = .03, d = 0.38) and years of fighting (P = 6 × 10-8, d = 0.63). Fractional anisotropy of the inferior longitudinal fasciculus was positively associated with psychomotor speed (P = .04, d = 0.16) in nonimpaired fighters but no association was observed in impaired fighters. Conclusion Without enforcement of any a priori assumptions on the MR imaging-derived measurements and with a multivariate approach, the study revealed a set of seven imaging biomarkers that were associated with cognition in active male professional fighters. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Virendra R Mishra
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Xiaowei Zhuang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Karthik R Sreenivasan
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Sarah J Banks
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Zhengshi Yang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Charles Bernick
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Dietmar Cordes
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
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Dwyer MG, Silva D, Bergsland N, Horakova D, Ramasamy D, Durfee J, Vaneckova M, Havrdova E, Zivadinov R. Neurological software tool for reliable atrophy measurement (NeuroSTREAM) of the lateral ventricles on clinical-quality T2-FLAIR MRI scans in multiple sclerosis. NEUROIMAGE-CLINICAL 2017; 15:769-779. [PMID: 28706852 PMCID: PMC5496213 DOI: 10.1016/j.nicl.2017.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/19/2017] [Accepted: 06/16/2017] [Indexed: 11/18/2022]
Abstract
Background There is a need for a brain volume measure applicable to the clinical routine scans. Nearly every multiple sclerosis (MS) protocol includes low-resolution 2D T2-FLAIR imaging. Objectives To develop and validate cross-sectional and longitudinal brain atrophy measures on clinical-quality T2-FLAIR images in MS patients. Methods A real-world dataset from 109 MS patients from 62 MRI scanners was used to develop a lateral ventricular volume (LVV) algorithm with a longitudinal Jacobian-based extension, called NeuroSTREAM. Gold-standard LVV was calculated on high-resolution T1 1 mm, while NeuroSTREAM LVV was obtained on low-resolution T2-FLAIR 3 mm thick images. Scan-rescan reliability was assessed in 5 subjects. The variability of LVV measurement at different field strengths was tested in 76 healthy controls and 125 MS patients who obtained both 1.5T and 3T scans in 72 hours. Clinical validation of algorithm was performed in 176 MS patients who obtained serial yearly MRI 1.5T scans for 10 years. Results Correlation between gold-standard high-resolution T1 LVV and low-resolution T2-FLAIR LVV was r = 0.99, p < 0.001 and the scan-rescan coefficient of variation was 0.84%. Correlation between low-resolution T2-FLAIR LVV on 1.5T and 3T was r = 0.99, p < 0.001 and the scan-rescan coefficient of variation was 2.69% cross-sectionally and 2.08% via Jacobian integration. NeuroSTREAM showed comparable effect size (d = 0.39–0.71) in separating MS patients with and without confirmed disability progression, compared to SIENA and VIENA. Conclusions Brain atrophy measurement on clinical quality T2-FLAIR scans is feasible, accurate, reliable, and relates to clinical outcomes. A robust algorithm for measuring lateral ventricular volume on clinical FLAIR scans is proposed. The algorithm combines multi-atlas joint fusion labeling with level-set smoothness-constraining refinement. Results show a similar relationship to disability progression as with established metrics on high-resolution scans.
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Affiliation(s)
- Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | | | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Deepa Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jaqueline Durfee
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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31
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Affiliation(s)
- Tomas Kalincik
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia/Department of Medicine, University of Melbourne, Melbourne, Australia
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32
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Cognitive impairment and structural brain changes in patients with clinically isolated syndrome at high risk for multiple sclerosis. J Neurol 2016; 264:482-493. [DOI: 10.1007/s00415-016-8368-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/10/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Paul F. Pathology and MRI: exploring cognitive impairment in MS. Acta Neurol Scand 2016; 134 Suppl 200:24-33. [PMID: 27580903 DOI: 10.1111/ane.12649] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/24/2023]
Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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Uher T, Havrdova E, Sobisek L, Krasensky J, Vaneckova M, Seidl Z, Tyblova M, Ramasamy D, Zivadinov R, Horakova D. Is no evidence of disease activity an achievable goal in MS patients on intramuscular interferon beta-1a treatment over long-term follow-up? Mult Scler 2016; 23:242-252. [PMID: 27230790 DOI: 10.1177/1352458516650525] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND No evidence of disease activity (NEDA) has been proposed as a new treatment goal in multiple sclerosis (MS). NEDA-3 status is defined as the absence of magnetic resonance imaging (MRI; new/enlarging/enhancing lesions and increased whole brain volume loss in NEDA-4) and clinical disease activity. OBJECTIVES To investigate the persistence of NEDA status over long-term follow-up in MS patients treated with weekly intramuscular interferon beta-1a. METHODS We included 192 patients after the first demyelinating event suggestive of MS, that is, clinically isolated syndrome (CIS) and 162 relapsing-remitting MS (RRMS) patients. RESULTS NEDA-3 status was observed in 40.1% of CIS and 20.4% of RRMS patients after 1 year. After 4 years, 10.1% of CIS patients had NEDA-3 status. After 10 years, none of the RRMS patients had NEDA-3 status. Only 4.6% of CIS and 1.0% of RRMS patients maintained NEDA-4 status after 4 years. Loss of NEDA-3 status after the first year was associated with a higher risk of disability progression (hazard ratio (HR) = 2.3-4.0; p = 0.005-0.03) over 6 years. CONCLUSIONS Despite intramuscular interferon beta-1a treatment, loss of NEDA status occurred in the vast majority of individuals. Loss of NEDA status during the first year was associated with disability progression over long-term follow-up; however, specificity for individual patient was low.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Michaela Tyblova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Deepa Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
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Zivadinov R, Jakimovski D, Gandhi S, Ahmed R, Dwyer MG, Horakova D, Weinstock-Guttman B, Benedict RRH, Vaneckova M, Barnett M, Bergsland N. Clinical relevance of brain atrophy assessment in multiple sclerosis. Implications for its use in a clinical routine. Expert Rev Neurother 2016; 16:777-93. [PMID: 27105209 DOI: 10.1080/14737175.2016.1181543] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Brain atrophy measurement in multiple sclerosis (MS) has become an important outcome for determining patients at risk for developing physical and cognitive disability. AREAS COVERED In this article, we discuss the methodological issues related to using this MRI metric routinely, in a clinical setting. Understanding trajectories of annualized whole brain, gray and white matter, thalamic volume loss, and enlargement of ventricular space in specific MS phenotypes is becoming increasingly important. Evidence is mounting that disease-modifying treatments exert a positive effect on slowing brain atrophy progression in MS. Expert Commentary: While there is a need to translate measurement of brain atrophy to clinical routine at the individual patient level, there are still a number of challenges to be met before this can actually happen, including how to account for biological confounding factors and pseudoatrophy, standardize acquisition and analyses parameters, which can influence the accuracy of the assessments.
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Affiliation(s)
- Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Sirin Gandhi
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Rahil Ahmed
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Michael G Dwyer
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Dana Horakova
- c Department of Neurology and Center of Clinical Neuroscience , Charles University in Prague, First Faculty of Medicine and General University Hospital , Prague , Czech Republic
| | - Bianca Weinstock-Guttman
- d Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Ralph R H Benedict
- d Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Manuela Vaneckova
- e Department of Radiology, First Faculty of Medicine and General University Hospital , Charles University , Prague , Czech Republic
| | - Michael Barnett
- f Sydney Neuroimaging Analysis Centre; Brain & Mind Centre , University of Sydney , Sydney , Australia
| | - Niels Bergsland
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,g IRCCS 'S.Maria Nascente' , Don Gnocchi Foundation , Milan , Italy
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D'Amico E, Leone C, Hayrettin T, Patti F. Can we define a rehabilitation strategy for cognitive impairment in progressive multiple sclerosis? A critical appraisal. Mult Scler 2016; 22:581-9. [PMID: 26920381 DOI: 10.1177/1352458516632066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
Cognitive impairment (CI) has been shown to be severe in patients with progressive forms of multiple sclerosis (MS), and the most frequently impaired domains are sustained attention, information processing speed, memory, and executive functions. In contrast to relapsing forms of MS, where studies have shown favorable results from cognitive rehabilitation, there is a lack of data on cognitive rehabilitation in progressive forms of MS. A specific approach in assessing CI and in designing and administering rehabilitation training for patients with progressive forms of MS is needed.
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Affiliation(s)
| | | | - Tumani Hayrettin
- Klinik und PoliklinikfürNeurologie der Universität Ulm, Ulm, Germany
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Zivadinov R, Uher T, Hagemeier J, Vaneckova M, Ramasamy DP, Tyblova M, Bergsland N, Seidl Z, Dwyer MG, Krasensky J, Havrdova E, Horakova D. A serial 10-year follow-up study of brain atrophy and disability progression in RRMS patients. Mult Scler 2016; 22:1709-1718. [PMID: 26883943 DOI: 10.1177/1352458516629769] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/07/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND We explored the evolution of brain atrophy in relation to development of confirmed disability progression (CDP) on serial 1.5T magnetic resonance imaging (MRI) scans over a 10-year period in 181 patients with early relapsing-remitting multiple sclerosis (RRMS). METHODS At 10-year follow-up, they were divided into those with (100) or without (76) CDP (confirmed after 48 weeks). Changes in whole brain (WB), cortical, gray matter (GM), white matter, and ventricular cerebrospinal fluid (vCSF) volumes were calculated on three-dimensional T1-weighted (3D-T1) scans between all available time points. RESULTS In multiple sclerosis (MS) patients with CDP compared to those without, the greatest effect size percentage volume change from baseline to follow-up was detected for WB (d = 0.55, -7.5% vs -5.2%, p < 0.001), followed by vCSF (d = 0.51, +41.1% vs +25.7%, p < 0.001), cortical (d = 0.49, -7.7% vs -6.2%, p = 0.001), and GM (d = 0.40, -7.1% vs -5.8%, p = 0.006) volumes. Mixed-effects model analysis, adjusted for age, sex, and treatment change, showed significant interactions between CDP status and percentage changes for WB and vCSF (p < 0.001), cortical (p = 0.02), and GM (p = 0.04) volumes. CONCLUSIONS WB and cortical atrophy, and enlargement of vCSF spaces are associated with development of CDP on serial yearly MRI assessments over a period of 10 years.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Tomas Uher
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Michaela Tyblova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/IRCCS "S. Maria Nascente," Don Carlo Gnocchi Foundation, Milan, Italy
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
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38
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Longitudinal associations between MRI and cognitive changes in very early MS. Mult Scler Relat Disord 2016; 5:47-52. [DOI: 10.1016/j.msard.2015.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/17/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
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Tauhid S, Chu R, Sasane R, Glanz BI, Neema M, Miller JR, Kim G, Signorovitch JE, Healy BC, Chitnis T, Weiner HL, Bakshi R. Brain MRI lesions and atrophy are associated with employment status in patients with multiple sclerosis. J Neurol 2015. [PMID: 26205635 PMCID: PMC4639581 DOI: 10.1007/s00415-015-7853-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) commonly
affects occupational function. We investigated the link between brain MRI and employment status. Patients with MS (n = 100) completed a Work Productivity and Activity Impairment (WPAI) (general health version) survey measuring employment status, absenteeism, presenteeism, and overall work and daily activity impairment. Patients “working for pay” were considered employed; “temporarily not working but looking for work,” “not working or looking for work due to age,” and “not working or looking for work due to disability” were considered not employed. Brain MRI T1 hypointense (T1LV) and T2 hyperintense (T2LV) lesion volumes were quantified. To assess lesional destructive capability, we calculated each subject’s ratio of T1LV to T2LV (T1/T2). Normalized brain parenchymal volume (BPV) assessed brain atrophy. The mean (SD) age was 45.5 (9.7) years; disease duration was 12.1 (8.1) years; 75 % were women, 76 % were relapsing-remitting, and 76 % were employed. T1LV, T1/T2, Expanded Disability Status Scale (EDSS) scores, and activity impairment were lower and BPV was higher in the employed vs. not employed group (Wilcoxon tests, p < 0.05). Age, disease duration, MS clinical subtype, and T2LV did not differ between groups (p > 0.05). In multivariable logistic regression modeling, adjusting for age, sex, and disease duration, higher T1LV predicted a lower chance of employment (p < 0.05). Pearson correlations showed that EDSS was associated with activity impairment (p < 0.05). Disease duration, age, and MRI measures were not correlated with activity impairment or other WPAI outcomes (p > 0.05). We report a link between brain atrophy and lesions, particularly lesions with destructive potential, to MS employment status.
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Affiliation(s)
- Shahamat Tauhid
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Bonnie I Glanz
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohit Neema
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Miller
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Gloria Kim
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian C Healy
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, Department of Radiology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, One Brookline Place, Brookline, MA, 02445, USA.
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40
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Varosanec M, Uher T, Horakova D, Hagemeier J, Bergsland N, Tyblova M, Seidl Z, Vaneckova M, Krasensky J, Dwyer MG, Havrdova E, Zivadinov R. Longitudinal Mixed-Effect Model Analysis of the Association between Global and Tissue-Specific Brain Atrophy and Lesion Accumulation in Patients with Clinically Isolated Syndrome. AJNR Am J Neuroradiol 2015; 36:1457-64. [PMID: 26113068 DOI: 10.3174/ajnr.a4330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/26/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between lesion formation and brain atrophy development in the early phase of multiple sclerosis is unclear. We investigated the association between new lesion accumulation and brain atrophy progression in patients with clinically isolated syndrome over 48 months. MATERIALS AND METHODS Patients with clinically isolated syndrome (n = 210) were evaluated with 1.5T MR imaging at baseline and at 6, 12, 24, 36, and 48 months as part of a multicenter observational study of early administration of intramuscular interferon β-1a. Mixed-effect model analyses, adjusted for age, sex, and treatment status, investigated the association between accumulation of contrast-enhancing and T2 lesions and brain-volume percent changes in a 48-month period. RESULTS In patients with clinically isolated syndrome, the average whole-brain volume decreased 2.5%, the mean lateral ventricle volume increased 16.9%, and a mean of 7.7 new/enlarging T2 lesions accumulated over the follow-up period. Patients with clinically isolated syndrome who showed greater percentages of change in whole-brain, white and gray matter, cortical, and lateral ventricle volumes over the follow-up period had more severe lesion outcomes at baseline (all P < .007). There were significant associations between decreased individual brain-volume measures at baseline and greater percentages of change during follow-up (P < .05). We found a significant association between the total cumulative number of new/enlarging T2 lesions and the evolution of whole-brain (P < .001), lateral ventricle (P = .007), gray matter and thalamic (P = .013), subcortical deep gray matter (P = .015), and cortical (P = .036) volumes over the follow-up period. CONCLUSIONS Lesion accumulation and brain-volume changes occur simultaneously in the early phase of clinically isolated syndrome. More severe lesion and brain-volume outcomes at baseline were associated with greater development of brain atrophy over the follow-up period in patients with clinically isolated syndrome.
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Affiliation(s)
- M Varosanec
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York
| | - T Uher
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York Department of Neurology and Center of Clinical Neuroscience (T.U., D.H., M.T., E.H.)
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience (T.U., D.H., M.T., E.H.)
| | - J Hagemeier
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York
| | - N Bergsland
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York IRCCS "Santa Maria Nascente" (N.B.), Don Gnocchi Foundation, Milan, Italy
| | - M Tyblova
- Department of Neurology and Center of Clinical Neuroscience (T.U., D.H., M.T., E.H.)
| | - Z Seidl
- Department of Radiology (Z.S., M.V., J.K.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - M Vaneckova
- Department of Radiology (Z.S., M.V., J.K.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - J Krasensky
- Department of Radiology (Z.S., M.V., J.K.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - M G Dwyer
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York
| | - E Havrdova
- Department of Neurology and Center of Clinical Neuroscience (T.U., D.H., M.T., E.H.)
| | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center (M.V., T.U., J.H., N.B., M.G.D., R.Z.), Department of Neurology, University at Buffalo SUNY, Buffalo, New York
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Uher T, Benedict RH, Horakova D, Bergsland N, Dusankova JB, Tyblova M, Ramasamy DP, Seidl Z, Vaneckova M, Krasensky J, Havrdova E, Zivadinov R. Relationship between gray matter volume and cognitive learning in CIS patients on disease-modifying treatment. J Neurol Sci 2014; 347:229-34. [DOI: 10.1016/j.jns.2014.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 12/26/2022]
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