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Vázquez-Marrufo M, Sarrias-Arrabal E, García-Torres M, Martín-Clemente R, Izquierdo G. A systematic review of the application of machine-learning algorithms in multiple sclerosis. Neurologia 2023; 38:577-590. [PMID: 35843587 DOI: 10.1016/j.nrleng.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/11/2020] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.
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Affiliation(s)
- M Vázquez-Marrufo
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain.
| | - E Sarrias-Arrabal
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain
| | - M García-Torres
- Escuela Politécnica Superior, Universidad Pablo de Olavide, Sevilla, Spain
| | - R Martín-Clemente
- Departamento de Teoría de la Señal y Comunicaciones, Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Sevilla, Spain
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital VITHAS, Sevilla, Spain
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Müller-Miny L, Sauer R, Schulte-Mecklenbeck A, Gross CC, Kovac S, Schilling M, Beuker C, Wiendl H, Meyer zu Hörste G. Contactin-associated protein 2 autoantibodies can be associated with multifocal motor-like neuropathy: a case report. Ther Adv Neurol Disord 2023; 16:17562864231189323. [PMID: 37599705 PMCID: PMC10434843 DOI: 10.1177/17562864231189323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Autoantibodies against contactin-associated protein 2 (CASPR2) are usually associated with autoimmune encephalitis and neuromyotonia. Their association with inflammatory neuropathies has been described in case reports albeit all with distal symmetric manifestation. Here, we report a patient who developed distal arm paresis, dominantly of the right arm, over the course of 1 year. Electroneurography showed a conduction block of motor nerve conduction, nerve ultrasonography a swelling of the right median and ulnar nerve and flow cytometry an increase in natural killer (NK cells) in the blood and natural killer T (NKT) cells in the cerebrospinal fluid (CSF), therefore indicating a multifocal motor neuropathy-like (MMN-like) phenotype. CASPR2 autoantibodies were detected in serum and CSF. Through immunotherapy with intravenous immunoglobulins the patient showed clinical and neurographic improvement. We therefore describe the first association of CASPR2 autoantibodies with a MMN-like clinical manifestation, extending the spectrum of CASPR2-associated diseases.
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Affiliation(s)
- Louisa Müller-Miny
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Raoul Sauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina C. Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Matthias Schilling
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Carolin Beuker
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of Translational Neurology, University of Münster, Albert-Schweitzer-Campus 1, Building A1, Münster 48149, Germany
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3
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Heming M, Müller-Miny L, Rolfes L, Schulte-Mecklenbeck A, Brix TJ, Varghese J, Pawlitzki M, Pavenstädt H, Kriegel MA, Gross CC, Wiendl H, Meyer zu Hörste G. Supporting the differential diagnosis of connective tissue diseases with neurological involvement by blood and cerebrospinal fluid flow cytometry. J Neuroinflammation 2023; 20:46. [PMID: 36823602 PMCID: PMC9951507 DOI: 10.1186/s12974-023-02733-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Neurological manifestations of autoimmune connective tissue diseases (CTD) are poorly understood and difficult to diagnose. We here aimed to address this shortcoming by studying immune cell compositions in CTD patients with and without neurological manifestation. METHODS Using flow cytometry, we retrospectively investigated paired cerebrospinal fluid (CSF) and blood samples of 28 CTD patients without neurological manifestation, 38 CTD patients with neurological manifestation (N-CTD), 38 non-inflammatory controls, and 38 multiple sclerosis (MS) patients, a paradigmatic primary neuroinflammatory disease. RESULTS We detected an expansion of plasma cells in the blood of both N-CTD and CTD compared to non-inflammatory controls and MS. Blood plasma cells alone distinguished the clinically similar entities N-CTD and MS with high discriminatory performance (AUC: 0.81). Classical blood monocytes indicated higher disease activity in systemic lupus erythematosus (SLE) patients. Surprisingly, immune cells in the CSF did not differ significantly between N-CTD and CTD, while CD4+ T cells and the CD4+/CD8+ ratio were elevated in the blood of N-CTD compared to CTD. Several B cell-associated parameters partially overlapped in the CSF in MS and N-CTD. We built a machine learning model that distinguished N-CTD from MS with high discriminatory power using either blood or CSF. CONCLUSION We here find that blood flow cytometry alone surprisingly suffices to distinguish CTD with neurological manifestations from clinically similar entities, suggesting that a rapid blood test could support clinicians in the differential diagnosis of N-CTD.
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Affiliation(s)
- Michael Heming
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Louisa Müller-Miny
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Leoni Rolfes
- grid.14778.3d0000 0000 8922 7789Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Tobias J. Brix
- grid.5949.10000 0001 2172 9288Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Julian Varghese
- grid.5949.10000 0001 2172 9288Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Marc Pawlitzki
- grid.14778.3d0000 0000 8922 7789Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Hermann Pavenstädt
- grid.16149.3b0000 0004 0551 4246Division of General Internal Medicine, Nephrology and Rheumatology, Department of Medicine D, University Hospital of Münster, Münster, Germany
| | - Martin A. Kriegel
- grid.5949.10000 0001 2172 9288Department of Translational Rheumatology and Immunology, Institute of Musculoskeletal Medicine, University of Münster, Münster, Germany ,grid.16149.3b0000 0004 0551 4246Section of Rheumatology and Clinical Immunology, Department of Medicine, University Hospital Münster, Münster, Germany
| | - Catharina C. Gross
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Heinz Wiendl
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Gerd Meyer zu Hörste
- grid.16149.3b0000 0004 0551 4246Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
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Neurosarcoidosis: A call to arms. J Neuroimmunol 2022; 373:577990. [PMID: 36283148 DOI: 10.1016/j.jneuroim.2022.577990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/29/2022]
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Paley MA, Baker BJ, Dunham SR, Linskey N, Cantoni C, Lee K, Hassman LM, Laurent J, Roberson EDO, Clifford DB, Yokoyama WM. The CSF in neurosarcoidosis contains consistent clonal expansion of CD8 T cells, but not CD4 T cells. J Neuroimmunol 2022; 367:577860. [PMID: 35405431 PMCID: PMC9338453 DOI: 10.1016/j.jneuroim.2022.577860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 01/02/2023]
Abstract
The tissue-specific drivers of neurosarcoidosis remain poorly defined. To identify cerebrospinal fluid (CSF) specific, antigen-driven T and B cell responses, we performed single-cell RNA sequencing of CSF and blood cells from neurosarcoid participants coupled to T and B cell receptor sequencing. In contrast to pulmonary sarcoidosis, which is driven by CD4 T cells, we found CD8 T cell clonal expansion enriched in the neurosarcoid CSF. These CSF-enriched CD8 T cells were composed of two subsets with differential expression of EBI2, CXCR3, and CXCR4. Lastly, our data suggest that IFNγ signaling may distinguish neurosarcoidosis from other neurological disorders.
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Affiliation(s)
- Michael A Paley
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States of America.
| | - Brandi J Baker
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - S Richard Dunham
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Nicole Linskey
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Claudia Cantoni
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Kenneth Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Lynn M Hassman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Jennifer Laurent
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Elisha D O Roberson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States of America; Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Wayne M Yokoyama
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States of America.
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Otto F, Harrer C, Pilz G, Wipfler P, Harrer A. Role and Relevance of Cerebrospinal Fluid Cells in Diagnostics and Research: State-of-the-Art and Underutilized Opportunities. Diagnostics (Basel) 2021; 12:diagnostics12010079. [PMID: 35054246 PMCID: PMC8774636 DOI: 10.3390/diagnostics12010079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 01/15/2023] Open
Abstract
Cerebrospinal fluid (CSF) has recently experienced a revival in diagnostics and research. However, little progress has been made regarding CSF cell analysis. For almost a century, CSF cell count and cytomorphological examination have been central diagnostic parameters, with CSF pleocytosis as a hallmark finding of neuroinflammation and cytology offering valuable clues regarding infectious, autoimmune, and malignant aetiologies. A great deal of information, however, remains unattended as modern immune phenotyping technologies have not yet been broadly incorporated into routine CSF analysis. This is a serious deficit considering the central role of CSF cells as effectors in central nervous system (CNS) immune defence and autoimmune CNS processes, and the diagnostic challenges posed by clinically overlapping infectious and immune-mediated CNS diseases. Here, we summarize historical, specimen-intrinsic, methodological, and technical issues determining the state-of-the-art diagnostics of CSF cells and outline future perspectives for this underutilized window into meningeal and CNS immunity.
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Affiliation(s)
- Ferdinand Otto
- Department of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, 5020 Salzburg, Austria; (F.O.); (C.H.); (G.P.); (P.W.)
| | - Christine Harrer
- Department of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, 5020 Salzburg, Austria; (F.O.); (C.H.); (G.P.); (P.W.)
| | - Georg Pilz
- Department of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, 5020 Salzburg, Austria; (F.O.); (C.H.); (G.P.); (P.W.)
| | - Peter Wipfler
- Department of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, 5020 Salzburg, Austria; (F.O.); (C.H.); (G.P.); (P.W.)
| | - Andrea Harrer
- Department of Neurology, Paracelsus Medical University, Christian-Doppler-Klinik, 5020 Salzburg, Austria; (F.O.); (C.H.); (G.P.); (P.W.)
- Department of Dermatology and Allergology, Paracelsus Medical University, Landeskrankenhaus, 5020 Salzburg, Austria
- Correspondence:
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Hrastelj J, Andrews R, Loveless S, Morgan J, Bishop SM, Bray NJ, Williams NM, Robertson NP. CSF-resident CD4 + T-cells display a distinct gene expression profile with relevance to immune surveillance and multiple sclerosis. Brain Commun 2021; 3:fcab155. [PMID: 34761221 PMCID: PMC8574295 DOI: 10.1093/braincomms/fcab155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/12/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
The CNS has traditionally been considered an immune privileged site, but is now understood to have a system of immune surveillance, predominantly involving CD4+ T-cells. Identifying functional differences between CNS and blood CD4+ T-cells, therefore, have relevance to CNS immune surveillance as well as to neurological conditions, such as multiple sclerosis, in which CD4+ T-cells play a central role. Here, CD4+ T-cells were purified from CSF and blood from 21 patients with newly diagnosed treatment-naïve multiple sclerosis and 20 individuals with non-inflammatory disorders using fluorescence-activated cell sorting, and their transcriptomes were profiled by RNA sequencing. Paired comparisons between CD4+ T-cells from CSF and blood identified 5156 differentially expressed genes in controls and 4263 differentially expressed in multiple sclerosis patients at false discovery rate <5%. Differential expression analysis of CD4+ T-cells collected from the CSF highlighted genes involved in migration, activation, cholesterol biosynthesis and signalling, including those with known relevance to multiple sclerosis pathogenesis and treatment. Expression of markers of CD4+ T-cell subtypes suggested an increased proportion of Th1 and Th17 cells in CSF. Gene ontology terms significant only in multiple sclerosis were predominantly those involved in cellular proliferation. A two-way comparison of CSF versus blood CD4+ T-cells in multiple sclerosis compared with non-inflammatory disorder controls identified four significant genes at false discovery rate <5% (CYP51A1, LRRD1, YES1 and PASK), further implicating cholesterol biosynthesis and migration mechanisms. Analysis of CSF CD4+ T-cells in an extended cohort of multiple sclerosis cases (total N = 41) compared with non-inflammatory disorder controls (total N = 38) identified 140 differentially expressed genes at false discovery rate < 5%, many of which have known relevance to multiple sclerosis, including XBP1, BHLHE40, CD40LG, DPP4 and ITGB1. This study provides the largest transcriptomic analysis of purified cell subpopulations in CSF to date and has relevance for the understanding of CNS immune surveillance, as well as multiple sclerosis pathogenesis and treatment discovery.
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Affiliation(s)
- James Hrastelj
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
| | - Robert Andrews
- School of Medicine, Cardiff
University, Cardiff CF14 4XW, UK
| | - Samantha Loveless
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
| | - Joanne Morgan
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
| | - Stefan Mark Bishop
- European Cancer Stem Cell Research Institute,
Cardiff University, Cardiff CF24 4HQ, UK
| | - Nicholas J Bray
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
| | - Nigel M Williams
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
| | - Neil P Robertson
- Division of Psychological Medicine and Clinical
Neuroscience, Cardiff University, Cardiff CF14 4XW, UK
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Saad G, Jaber B, Al-hajri M, Househ M, Ahmed A, Abd-alrazaq A. Artificial Intelligence in Diagnosis and Prediction of the Multiple Sclerosis Progression: A Scoping Review (Preprint).. [DOI: 10.2196/preprints.29720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Multiple Sclerosis (MS) is an autoimmune disease that results from the demyelination of the nerves in the Central Nervous System. The diagnosis depends on clinical history, neurological examination, and radiological images. Artificial Intelligence proved to be an effective tool in enhancing the diagnostic tools of MS.
OBJECTIVE
To explore how AI assisted in diagnosis and predicting the progression of MS.
METHODS
We used three bibliographic databases in our search: PubMed IEEE Xplore and Cochrane in our search. The study selection process included: removal of duplicated articles, screening titles and abstracts, and reading the full text. This process was performed by two reviewers. The data extracted from the included studies have been filled in an Excel sheet. This step had been done by each reviewer accordingly to the assigned articles. The extracted data sheet was checked by two reviewers to have accuracy ensured. The narrative approach is applied in data synthesis.
RESULTS
The search conducted resulted in 320 articles Removing duplicates and excluding the ineligible articles due to irrelevancy to the population, intervention, and outcomes resulted in excluding 299 articles. Thus, our review will include 21 articles for data extraction and data synthesis.
CONCLUSIONS
Artificial Intelligence is becoming a trend in the medical field. Its contribution in enhancing the diagnostic tools of many diseases, as in MS, is prominent and can be built on in further development plans. However, the implementation of Artificial Intelligence in Multiple Sclerosis is not widespread to confirm the benefits gained, and the datasets involved in the current practice are relatively small. It is recommended to have more studies that focus on the relationship between the employment of AI in diagnosis and monitoring progression and the accuracy gained by this employment.
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Tur C. Machine and deep learning in MS research are just powerful statistics - Yes. Mult Scler 2021; 27:661-662. [PMID: 33625280 DOI: 10.1177/1352458520981309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Carmen Tur
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Barcelona, Spain; Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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10
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Vázquez-Marrufo M, Sarrias-Arrabal E, García-Torres M, Martín-Clemente R, Izquierdo G. A systematic review of the application of machine-learning algorithms in multiple sclerosis. Neurologia 2021; 38:S0213-4853(20)30431-X. [PMID: 33549371 DOI: 10.1016/j.nrl.2020.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.
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Affiliation(s)
- M Vázquez-Marrufo
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, España.
| | - E Sarrias-Arrabal
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, España
| | - M García-Torres
- Escuela Politécnica Superior, Universidad Pablo de Olavide, Sevilla, España
| | - R Martín-Clemente
- Departamento de Teoría de la Señal y Comunicaciones, Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Sevilla, España
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital VITHAS, Sevilla, España
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11
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Helmstaedter C, Hansen N, Leelaarporn P, Schwing K, Oender D, Widman G, Racz A, Surges R, Becker A, Witt JA. Specific B- and T-cell populations are associated with cognition in patients with epilepsy and antibody positive and negative suspected limbic encephalitis. J Neurol 2021; 268:455-466. [PMID: 32816110 PMCID: PMC7880943 DOI: 10.1007/s00415-020-10158-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Neuropsychological impairments are major symptoms of autoimmune limbic encephalitis (LE) epilepsy patients. In LE epilepsy patients with an autoimmune response against intracellular antigens as well as in antibody-negative patients, the antibody findings and magnetic resonance imaging pathology correspond poorly to the clinical features. Here, we evaluated whether T- and B-cells are linked to cognitive impairment in these groups. METHODS In this cross-sectional, observational, case-controlled study, we evaluated 106 patients with adult-onset epilepsies with a suspected autoimmune etiology. We assessed verbal and visual memory, executive function, and mood in relation to the presence or absence of known auto-antibodies, and regarding T- and B-cell activity as indicated by flow cytometry (fluorescence-activated cell sorting = FACS, peripheral blood = PB and cerebrospinal fluid = CSF). RESULTS 56% of the patients were antibody-negative. In the other patients, auto-antibodies were directed against intracellular antigens (GAD65, paraneoplastic: 38%), or cellular surface antigens (LGI1/CASPR2/NMDA-R: 6%). Excluding LGI1/CASPR2/NMDA-R, the groups with and without antibodies did not differ in disease features, cognition, or mood. CD4+ T-cells and CD8+ T-cells in blood and CD4+ T-cells in CSF were prominent in the auto-antibody positive group. Regression analyses indicated the role education, drug load, amygdala and/or hippocampal pathology, and CD4+ T-cells play in verbal memory and executive function. Depressed mood revealed no relation to flow cytometry results. CONCLUSION Our results indicate a link between T- and B-cell activity and cognition in epilepsy patients with suspected limbic encephalitis, thus suggesting that flow cytometry results can provide an understanding of cognitive impairment in LE patients with autoantibodies against intracellular antigens.
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Affiliation(s)
- Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Niels Hansen
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Pitshaporn Leelaarporn
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Kerstin Schwing
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Demet Oender
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Guido Widman
- SEIN Epilepsy Center, Hemsteede, The Netherlands
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital, Bonn, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
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12
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Cerebrospinal fluid flow cytometry distinguishes psychosis spectrum disorders from differential diagnoses. Mol Psychiatry 2021; 26:7661-7670. [PMID: 34363013 PMCID: PMC8873003 DOI: 10.1038/s41380-021-01244-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/11/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023]
Abstract
Psychotic disorders are common and disabling mental conditions. The relative importance of immune-related mechanisms in psychotic disorders remains subject of debate. Here, we present a large-scale retrospective study of blood and cerebrospinal fluid (CSF) immune cell profiles of psychosis spectrum patients. We performed basic CSF analysis and multi-dimensional flow cytometry of CSF and blood cells from 59 patients with primary psychotic disorders (F20, F22, F23, and F25) in comparison to inflammatory (49 RRMS and 16 NMDARE patients) and non-inflammatory controls (52 IIH patients). We replicated the known expansion of monocytes in the blood of psychosis spectrum patients, that we identified to preferentially affect classical monocytes. In the CSF, we found a relative shift from lymphocytes to monocytes, increased protein levels, and evidence of blood-brain barrier disruption in psychosis. In fact, these CSF features confidently distinguished autoimmune encephalitis from psychosis despite similar (initial) clinical features. We then constructed machine learning models incorporating blood and CSF parameters and demonstrated their superior ability to differentiate psychosis from non-inflammatory controls compared to individual parameters. Multi-dimensional and multi-compartment immune cell signatures can thus support the diagnosis of psychosis spectrum disorders with the potential to accelerate diagnosis and initiation of therapy.
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Kister I, Lotan I, Wallach A, Bacon T, Cutter G, Arbini A. CSF plasmablasts differentiate MS from other neurologic disorders. Mult Scler Relat Disord 2020; 48:102719. [PMID: 33383365 DOI: 10.1016/j.msard.2020.102719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Multiparametric flow cytometry (FC) of CSF allows one to easily estimate the percentage of lymphocyte subpopulations in CSF. We hypothesized that an increased ratio of B-lineage cells in CSF of MS patients, as assessed with FC, could be useful for diagnostics. We analyzed CSF of 137 patients (70 MS, 24 infectious/autoimmune neurologic disorders (INDs), and 43 non-infectious/autoimmune neurologic disorders (NINDs)), and showed that CSF plasmablasts of >0.1% had a sensitivity of 40% for MS and specificity of 92% when comparing MS and IND, while plasmablasts of >0.25% had sensitivity of 36%, and 100% specificity.
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Affiliation(s)
- I Kister
- NYU MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY.
| | - I Lotan
- NYU MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY; Department of Neurology and Neuroimmunology Unit, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Wallach
- Alfiero and Lucia Palestroni MS Comprehensive Care Center, Holy Name Medical Center, Teaneck, NJ
| | - T Bacon
- NYU MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY
| | - G Cutter
- UAB School of Public Health at Birmingham, Birmingham, AL
| | - A Arbini
- Department of Pathology, NYU Langone Medical Center, New York, NY
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Mende KC, Pantel TF, Flitsch J. Revived Attention for Adult Craniopharyngioma. Exp Clin Endocrinol Diabetes 2020; 129:172-177. [PMID: 32750720 DOI: 10.1055/a-1217-7282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Craniopharyngioma as a rare tumor originating from cells of rathke's pouch and representing 2-5% of all intracranial tumors is a rare and generally benign neoplasm of the central nervous system with two incidence peaks one in childhood and one after 40 years of age. Data on adult patients is scarce compared to childhood onset tumors, however the burden of disease caused by the tumors and related treatment options is significant. Clinical symptoms range from headaches, visual disability, cranial nerve affection or hypothalamic symptoms (e. g. morbid obesity) to endocrine disorders. Most symptoms are related to tumor mass effect. The current standard of diagnostics is the determination of serum hormone levels and contrast enhanced magnetic resonance imaging often resulting in surgical treatment which holds a key role in all treatment concepts and should follow a hypothalamus sparing path. Radiation therapy may prove beneficial as adjuvant therapeutic option or in recurrent tumor, especially papillary tumors may be targeted using BRAF-600 inhibitors, targeted therapies for adamantinomatous craniopharyngioma have not yet reached a stage of clinical testing. Although prognosis regarding overall survival is favorable, life expectancy may be reduced due to the tumor itself as well as due to treatment effects. An important aspect especially in the adult population is the reduction in quality of life which is comparable to primary malignant brain tumors and metastases, calling for individual patient specific treatment approaches.
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Affiliation(s)
- Klaus Christian Mende
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Fabian Pantel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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