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Dey A, Luk CC, Ishaque A, Ta D, Srivastava O, Krebs D, Seres P, Hanstock C, Beaulieu C, Korngut L, Frayne R, Zinman L, Graham S, Genge A, Briemberg H, Kalra S. Motor cortex functional connectivity is associated with underlying neurochemistry in ALS. J Neurol Neurosurg Psychiatry 2023; 94:193-200. [PMID: 36379713 PMCID: PMC9985743 DOI: 10.1136/jnnp-2022-329993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify structural and neurochemical properties that underlie functional connectivity impairments of the primary motor cortex (PMC) and how these relate to clinical findings in amyotrophic lateral sclerosis (ALS). METHODS 52 patients with ALS and 52 healthy controls, matched for age and sex, were enrolled from 5 centres across Canada for the Canadian ALS Neuroimaging Consortium study. Resting-state functional MRI, diffusion tensor imaging and magnetic resonance spectroscopy data were acquired. Functional connectivity maps, diffusion metrics and neurometabolite ratios were obtained from the analyses of the acquired multimodal data. A clinical assessment of foot tapping (frequency) was performed to examine upper motor neuron function in all participants. RESULTS Compared with healthy controls, the primary motor cortex in ALS showed reduced functional connectivity with sensory (T=5.21), frontal (T=3.70), temporal (T=3.80), putaminal (T=4.03) and adjacent motor (T=4.60) regions. In the primary motor cortex, N-acetyl aspartate (NAA, a neuronal marker) ratios and diffusion metrics (mean, axial and radial diffusivity, fractional anisotropy (FA)) were altered. Within the ALS cohort, foot tapping frequency correlated with NAA (r=0.347) and white matter FA (r=0.537). NAA levels showed associations with disturbed functional connectivity of the motor cortex. CONCLUSION In vivo neurochemistry may represent an effective imaging marker of impaired motor cortex functional connectivity in ALS.
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Affiliation(s)
- Avyarthana Dey
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Collin C Luk
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Abdullah Ishaque
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Ta
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ojas Srivastava
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dennell Krebs
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Seres
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Chris Hanstock
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Richard Frayne
- Seaman Family Magnetic Resonance Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada.,Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lorne Zinman
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Simon Graham
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Angela Genge
- The Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada
| | - Hannah Briemberg
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada .,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Bhattarai A, Chen Z, Chua P, Talman P, Mathers S, Chapman C, Howe J, Lee CMS, Lie Y, Poudel GR, Egan GF. Network diffusion model predicts neurodegeneration in limb-onset Amyotrophic Lateral Sclerosis. PLoS One 2022; 17:e0272736. [PMID: 35951510 PMCID: PMC9371353 DOI: 10.1371/journal.pone.0272736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Emerging evidences suggest that the trans-neural propagation of phosphorylated 43-kDa transactive response DNA-binding protein (pTDP-43) contributes to neurodegeneration in Amyotrophic Lateral Sclerosis (ALS). We investigated whether Network Diffusion Model (NDM), a biophysical model of spread of pathology via the brain connectome, could capture the severity and progression of neurodegeneration (atrophy) in ALS. Methods We measured degeneration in limb-onset ALS patients (n = 14 at baseline, 12 at 6-months, and 9 at 12 months) and controls (n = 12 at baseline) using FreeSurfer analysis on the structural T1-weighted Magnetic Resonance Imaging (MRI) data. The NDM was simulated on the canonical structural connectome from the IIT Human Brain Atlas. To determine whether NDM could predict the atrophy pattern in ALS, the accumulation of pathology modelled by NDM was correlated against atrophy measured using MRI. In order to investigate whether network spread on the brain connectome derived from healthy individuals were significant findings, we compared our findings against network spread simulated on random networks. Results The cross-sectional analyses revealed that the network diffusion seeded from the inferior frontal gyrus (pars triangularis and pars orbitalis) significantly predicts the atrophy pattern in ALS compared to controls. Whereas, atrophy over time with-in the ALS group was best predicted by seeding the network diffusion process from the inferior temporal gyrus at 6-month and caudal middle frontal gyrus at 12-month. Network spread simulated on the random networks showed that the findings using healthy brain connectomes are significantly different from null models. Interpretation Our findings suggest the involvement of extra-motor regions in seeding the spread of pathology in ALS. Importantly, NDM was able to recapitulate the dynamics of pathological progression in ALS. Understanding the spatial shifts in the seeds of degeneration over time can potentially inform further research in the design of disease modifying therapeutic interventions in ALS.
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Affiliation(s)
- Anjan Bhattarai
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phyllis Chua
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Paul Talman
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Susan Mathers
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Caron Chapman
- Neurosciences Department, University Hospital, Geelong, Victoria, Australia
| | - James Howe
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - C. M. Sarah Lee
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Yenni Lie
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Govinda R. Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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Kocar TD, Müller HP, Ludolph AC, Kassubek J. Feature selection from magnetic resonance imaging data in ALS: a systematic review. Ther Adv Chronic Dis 2021; 12:20406223211051002. [PMID: 34729157 PMCID: PMC8521429 DOI: 10.1177/20406223211051002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background: With the advances in neuroimaging in amyotrophic lateral sclerosis (ALS), it has been speculated that multiparametric magnetic resonance imaging (MRI) is capable to contribute to early diagnosis. Machine learning (ML) can be regarded as the missing piece that allows for the useful integration of multiparametric MRI data into a diagnostic classifier. The major challenges in developing ML classifiers for ALS are limited data quantity and a suboptimal sample to feature ratio which can be addressed by sound feature selection. Methods: We conducted a systematic review to collect MRI biomarkers that could be used as features by searching the online database PubMed for entries in the recent 4 years that contained cross-sectional neuroimaging data of subjects with ALS and an adequate control group. In addition to the qualitative synthesis, a semi-quantitative analysis was conducted for each MRI modality that indicated which brain regions were most commonly reported. Results: Our search resulted in 151 studies with a total of 221 datasets. In summary, our findings highly resembled generally accepted neuropathological patterns of ALS, with degeneration of the motor cortex and the corticospinal tract, but also in frontal, temporal, and subcortical structures, consistent with the neuropathological four-stage model of the propagation of pTDP-43 in ALS. Conclusions: These insights are discussed with respect to their potential for MRI feature selection for future ML-based neuroimaging classifiers in ALS. The integration of multiparametric MRI including DTI, volumetric, and texture data using ML may be the best approach to generate a diagnostic neuroimaging tool for ALS.
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Affiliation(s)
- Thomas D Kocar
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Ferrea S, Junker F, Korth M, Gruhn K, Grehl T, Schmidt-Wilcke T. Cortical Thinning of Motor and Non-Motor Brain Regions Enables Diagnosis of Amyotrophic Lateral Sclerosis and Supports Distinction between Upper- and Lower-Motoneuron Phenotypes. Biomedicines 2021; 9:biomedicines9091195. [PMID: 34572380 PMCID: PMC8468309 DOI: 10.3390/biomedicines9091195] [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: 08/01/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder clinically characterized by muscle atrophy and progressive paralysis. In addition to the classical ALS affecting both the upper and lower motoneurons (UMN and LMN), other subtypes with the predominant (or even exclusive) affection of the UMN or LMN have been identified. This work sought to detect specific patterns of cortical brain atrophy in the UMN and LMN phenotypes to distinguish these two forms from the healthy state. Methods: Using high-resolution structural MRI and cortical thickness analysis, 38 patients with a diagnosis of ALS and predominance of either the UMN (n = 20) or the LMN (n = 18) phenotype were investigated. Results: Significant cortical thinning in the temporal lobe was found in both the ALS groups. Additionally, UMN patients displayed a significant thinning of the cortical thickness in the pre- and postcentral gyrus, as well as the paracentral lobule. By applying multivariate analyses based on the cortical thicknesses of 34 brain regions, ALS patients with either a predominant UMN or LMN phenotype were distinguished from healthy controls with an accuracy of 94% and UMN from LMN patients with an accuracy of 75%. Conclusions: These findings support previous hypothesis that neural degeneration in ALS is not confined to the sole motor regions. In addition, the amount of cortical thinning in the temporal lobe helps to distinguish ALS patients from healthy controls, that is, to support or discourage the diagnosis of ALS, while the cortical thickness of the precentral gyrus specifically helps to distinguish the UMN from the LMN phenotype.
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Affiliation(s)
- Stefano Ferrea
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
- Correspondence:
| | - Frederick Junker
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
| | - Mira Korth
- Evangelisches Krankenhaus Hattingen, 45525 Hattingen, Germany;
| | - Kai Gruhn
- Neuro Center Mettmann, 40822 Mettmann, Germany;
| | - Torsten Grehl
- ALS Outpatient Clinic, Alfried Krupp Krankenhaus Rüttenscheid, 45131 Essen, Germany;
| | - Tobias Schmidt-Wilcke
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Dusseldorf, 40225 Dusseldorf, Germany; (F.J.); (T.S.-W.)
- Neurologisches Zentrum, Bezirksklinikum Mainkofen, 94469 Deggendorf, Germany
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