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Individual differences in visual evoked potential latency are associated with variance in brain tissue volume in people with multiple sclerosis: An analysis of brain function-structure correlates. Mult Scler Relat Disord 2022; 68:104116. [PMID: 36041331 DOI: 10.1016/j.msard.2022.104116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/16/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
Visual evoked potentials (VEP) index visual pathway functioning, and are often used for clinical assessment and as outcome measures in people with multiple sclerosis (PwMS). VEPs may also reflect broader neural disturbances that extend beyond the visual system, but this possibility requires further investigation. In the present study, we examined the hypothesis that delayed latency of the P100 component of the VEP would be associated with broader structural changes in the brain in PwMS. We obtained VEP latency for a standard pattern-reversal checkerboard stimulus paradigm, in addition to Magnetic Resonance Imaging (MRI) measures of whole brain volume (WBV), gray matter volume (GMV), white matter volume (WMV), and T2-weighted fluid attenuated inversion recovery (FLAIR) white matter lesion volume (FLV). Correlation analyses indicated that prolonged VEP latency was significantly associated with lower WBV, GMV, and WMV, and greater FLV. VEP latency remained significantly associated with WBV, GMV, and WMV even after controlling for the variance associated with inter-ocular latency, age, time between VEP and MRI assessments, and other MRI variables. VEP latency delays were most pronounced in PwMS that exhibited low volume in both white and gray matter simultaneously. Furthermore, PwMS that had delayed VEP latency based on a clinically relevant cutoff (VEP latency ≥ 113 ms) in both eyes had lower WBV, GMV, and WMV and greater FLV in comparison to PwMS that had normal VEP latency in one or both eyes. The findings suggest that PwMS that have delayed latency in both eyes may be particularly at risk for exhibiting greater brain atrophy and lesion volume. These analyses also indicate that VEP latency may index combined gray matter and white matter disturbances, and therefore broader network connectivity and efficiency. VEP latency may therefore provide a surrogate marker of broader structural disturbances in the brain in MS.
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Song Z, Krishnan A, Gaetano L, Tustison NJ, Clayton D, de Crespigny A, Bengtsson T, Jia X, Carano RAD. Deformation-based morphometry identifies deep brain structures protected by ocrelizumab. Neuroimage Clin 2022; 34:102959. [PMID: 35189455 PMCID: PMC8861820 DOI: 10.1016/j.nicl.2022.102959] [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: 11/01/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite advancements in treatments for multiple sclerosis, insidious disease progression remains an area of unmet medical need, for which atrophy-based biomarkers may help better characterize the progressive biology. METHODS We developed and applied a method of longitudinal deformation-based morphometry to provide voxel-level assessments of brain volume changes and identified brain regions that were significantly impacted by disease-modifying therapy. RESULTS Using brain MRI data from two identically designed pivotal trials of relapsing multiple sclerosis (total N = 1483), we identified multiple deep brain regions, including the thalamus and brainstem, where volume loss over time was reduced by ocrelizumab (p < 0.05), a humanized anti-CD20 + monoclonal antibody approved for the treatment of multiple sclerosis. Additionally, identified brainstem shrinkage, as well as brain ventricle expansion, was associated with a greater risk for confirmed disability progression (p < 0.05). CONCLUSIONS The identification of deep brain structures has a strong implication for developing new biomarkers of brain atrophy reduction to advance drug development for multiple sclerosis, which has an increasing focus on targeting the progressive biology.
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Affiliation(s)
- Zhuang Song
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA.
| | - Anithapriya Krishnan
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Laura Gaetano
- Product Development Medical Affair, F. Hoffmann-La Roche Ltd, CH-4070 Basel, Switzerland
| | - Nicholas J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22904, USA
| | - David Clayton
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Alex de Crespigny
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Thomas Bengtsson
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Xiaoming Jia
- Biomarker Development, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Richard A D Carano
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
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Geraldes R, Juryńczyk M, dos Passos GR, Pichler A, Chung K, Hagens M, Ruggieri S, Auger C, Sastre-Garriga J, Enzinger C, Chard D, Barkhof F, Gasperini C, Rovira A, DeLuca G, Palace J. The role of pontine lesion location in differentiating multiple sclerosis from vascular risk factor-related small vessel disease. Mult Scler 2020; 27:968-972. [PMID: 32757905 PMCID: PMC8114427 DOI: 10.1177/1352458520943777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Differentiating multiple sclerosis (MS) from vascular risk factor (VRF)-small vessel disease (SVD) can be challenging. Objective and Methods: In order to determine whether or not pontine lesion location is a useful discriminator of MS and VRF-SVD, we classified pontine lesions on brain magnetic resonance imaging (MRI) as central or peripheral in 93 MS cases without VRF, 108 MS patients with VRF and 43 non-MS cases with VRF. Results: MS without VRF were more likely to have peripheral pons lesions (31.2%, 29/93) than non-MS with VRF (0%, 0/43) (Exp(B) = 29.8; 95% confidence interval (CI) = (1.98, 448.3); p = 0.014) but there were no significant differences regarding central pons lesions between MS without VRF (5.4%, 5/93) and non-MS with VRF patients (16.3%, 7/43) (Exp(B) = 0.89; 95% CI = (0.2, 3.94); p = 0.87). The presence of peripheral pons lesions discriminated between MS and VRF-SVD with 100% (95% CI = (91.8, 100)) specificity. The proportion of peripheral pons lesions in MS with VRF (30.5%, 33/108) was similar to that seen in MS without VRF (31.2%, 29/93, p = 0.99). Central lesions occurred in similar frequency in MS with VRF (8.3%, 9/108) and non-MS with VRF (16.3%, 7/43, p = 0.15). Conclusion: Peripheral pons lesion location is a good discriminator of MS from vascular lesions.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford, UK
| | | | | | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Vascular & Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, UK
| | - Marloes Hagens
- MS Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Serena Ruggieri
- Multiple Sclerosis Center, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Vascular & Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Frederik Barkhof
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands/NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Center, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Jacqueline Palace
- J Palace Nuffield Department of Clinical Neurosciences, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
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Valente P, Pinto I, Aguiar C, Castro E, Condé A, Larangeiro J. Acute vestibular syndrome and hearing loss mimicking labyrinthitis as initial presentation of multiple sclerosis. Int J Pediatr Otorhinolaryngol 2020; 134:110048. [PMID: 32353617 DOI: 10.1016/j.ijporl.2020.110048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022]
Abstract
Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.
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Affiliation(s)
- Pedro Valente
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal.
| | - Isabel Pinto
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal
| | - Cristina Aguiar
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal
| | - Eugénia Castro
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal
| | - Artur Condé
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal
| | - João Larangeiro
- Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/n, 4434-502, Vila Nova de Gaia, Porto, Portugal
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Habek M, Adamec I, Barun B, Crnošija L, Gabelić T, Krbot Skorić M. Clinical Neurophysiology of Multiple Sclerosis. MULTIPLE SCLEROSIS: BENCH TO BEDSIDE 2017; 958:129-139. [DOI: 10.1007/978-3-319-47861-6_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Vestibular evoked myogenic potentials and MRI in early multiple sclerosis: Validation of the VEMP score. J Neurol Sci 2016; 372:28-32. [PMID: 28017229 DOI: 10.1016/j.jns.2016.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND To validate the VEMP score as a measure of brainstem dysfunction in patients with the first symptom of multiple sclerosis (MS) (clinically isolated syndrome (CIS)) and to investigate the correlation between VEMP and brainstem MRI results. METHODS 121 consecutive CIS patients were enrolled and brainstem functional system score (BSFS) was determined. Ocular VEMP (oVEMP) and cervical VEMP (cVEMP) were analyzed for latencies, conduction block and amplitude asymmetry ratio and the VEMP score was calculated. MRI was analyzed for the presence of brainstem lesions as a whole and separately for the presence of pontine, midbrain and medulla oblongata lesions. RESULTS Patients with signs of brainstem involvement during the neurological examination (with BSFS ≥1) had a higher oVEMP score compared to patients with no signs of brainstem involvement. A binary logistic regression model showed that patients with brainstem lesion on the MRI are 6.780 times more likely to have BSFS ≥1 (p=0.001); and also, a higher VEMP score is associated with BSFS ≥1 (p=0.042). Furthermore, significant correlations were found between clinical brainstem involvement and brainstem and pontine MRI lesions, and prolonged latencies and/or absent VEMP responses. CONCLUSIONS The VEMP score is a valuable tool in evaluation of brainstem involvement in patients with early MS.
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Auditory evoked potentials and vestibular evoked myogenic potentials in evaluation of brainstem lesions in multiple sclerosis. J Neurol Sci 2013; 328:24-7. [DOI: 10.1016/j.jns.2013.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 11/23/2022]
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8
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Habek M. Evaluation of brainstem involvement in multiple sclerosis. Expert Rev Neurother 2013; 13:299-311. [DOI: 10.1586/ern.13.18] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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9
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Patti F, Ventimiglia B, Failla G, Genazzani AA, Reggio A. Micturition disorders in multiple sclerosis patients: neurological, neurourodynamic and magnetic resonance findings. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1997.tb00345.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Increasing the Diagnostic Value of Evoked Potentials in Multiple Sclerosis by Quantitative Topographic Analysis of Multichannel Recordings. J Clin Neurophysiol 2009; 26:316-25. [DOI: 10.1097/wnp.0b013e3181baac00] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Abstract
After the advent of immunomodulatory treatment in Multiple Sclerosis and after several options for early treatment have become available, the early identification of patients non responder has become a very important issue. Therefore, methods are needed for the detection of disease activity and, particularly in more advanced phases of the disease, of disease progression. Neurophysiological methods, mainly evoked potentials (EPs), are widely used in the functional assessment of sensory and motor pathways. Their usefulness in the assessment of disease activity is limited by the fact that, although they can also reveal clinically silent lesions, EPs abnormalities are present only if their corresponding pathway is involved. With this respect, EPs have been extensively replaced by magnetic resonance imaging (MRI), with the exception of optic nerve in which the sensitivity of EPs and MRI is similar. Nevertheless, EPs can be useful for the assessment of disease progression, since their abnormalities have been demonstrated to be more strictly related to disability than MRI lesion burden. With this perspective, EPs can still be useful in the identification of non responder by providing the clinician with objective functional assessment of eloquent pathways in patients with ambiguous new symptoms, for the confirmation of a dubious relapse, and by providing a method for detecting worsening of nervous conduction for the confirmation of disease progression.
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Affiliation(s)
- Letizia Leocani
- Institute of Experimental Neurology Dept. of Neurology, Clinical Neurophysiology, Neurorehabilitation, Univ. Vita-Salute and Scientific Institute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Saari A, Tolonen U, Pääkkö E, Suominen K, Pyhtinen J, Sotaniemi K, Myllylä V. Cardiovascular autonomic dysfunction correlates with brain MRI lesion load in MS. Clin Neurophysiol 2004; 115:1473-8. [PMID: 15134718 DOI: 10.1016/j.clinph.2004.01.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the cardiovascular autonomic control in clinically definite multiple sclerosis (MS) patients with a standardised battery of cardiovascular tests and to correlate these findings with the brain magnetic resonance imaging (MRI) lesion load. METHODS Fifty-one patients with MS and 50 healthy controls were studied. Brain MRI was performed in all patients showing typical MS lesions. The cardiovascular tests were carried out using a standardised battery. RESULTS Heart rate (HR) responses to deep breathing (P < 0.05) and tilt table testing (P < 0.001) were significantly decreased in MS patients when compared to those of the controls. Blood pressure (BP) responses in the tilt table test were also impaired in MS patients (diastolic P < 0.001, systolic P < 0.05). Of the different brain areas investigated the total volume of the midbrain MRI lesions (P < 0.05) was the one most clearly associated with the impaired BP responses. CONCLUSIONS MS results in both reduced HR variation and decreased BP reactions indicating disturbed cardiovascular regulation. In particular, the midbrain lesions found in MS are associated with cardiovascular dysfunction.
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Affiliation(s)
- A Saari
- Department of Neurology, Oulu University Hospital, P.O. Box 25, 90029 OYS, Oulu, Finland.
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Wedekind C, Hesselmann V, Klug N. Comparison of MRI and electrophysiological studies for detecting brainstem lesions in traumatic brain injury. Muscle Nerve 2002; 26:270-3. [PMID: 12210392 DOI: 10.1002/mus.10187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The yield of magnetic resonance imaging (MRI) and electrophysiological studies in detecting brainstem lesions was assessed in 35 patients suffering from traumatic brain injury (Glasgow Coma Scale, 3-10). As an inclusion criterion, all patients had brainstem trauma as revealed by early MRI or electrophysiological studies. Of the 35 cases, 7 (20%) had brainstem lesions detected by MRI only, whereas in 10 patients (29%), electrophysiological examination disclosed impairment of brainstem function with normal MRI. In 18 (51%) subjects, both diagnostic techniques revealed brainstem lesions. The midbrain was the most common location of lesions. Masseter reflex recording had the highest yield (93%) of abnormal findings. No mismatch with respect to site and side of abnormality occurred between MRI and electrophysiological studies. Outcome analysis indicated an unfavorable course for the vast majority (83%) of patients, regardless of the diagnostic means disclosing traumatic brainstem injury. Therefore, both techniques are effective in disclosing traumatic brainstem injury, with diagnostic overlap in about 50% of cases. In contrast to MRI, electrophysiological investigation is easily performed and repeated at low cost in the setting of an intensive care unit, where such patients are typically hospitalized after trauma. In addition to electrophysiological assessment of brainstem function, MRI is recommended in each case having normal electrophysiological findings when brainstem injury is suspected.
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Affiliation(s)
- Christoph Wedekind
- Department of Neurosurgery, University of Cologne, 50924 Cologne, Germany.
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Catalaa I, Grossman RI, Kolson DL, Udupa JK, Nyul LG, Wei L, Zhang X, Polansky M, Mannon LJ, McGowan JC. Multiple sclerosis: magnetization transfer histogram analysis of segmented normal-appearing white matter. Radiology 2000; 216:351-5. [PMID: 10924552 DOI: 10.1148/radiology.216.2.r00au16351] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate and characterize the global distribution of magnetization transfer (MT) ratio values of normal-appearing white matter (NAWM) in patients with relapsing-remitting multiple sclerosis (MS) and test the hypothesis that the MT histogram for NAWM reflects disease progression. MATERIALS AND METHODS Conventional and MT magnetic resonance (MR) images were obtained in 23 patients and 25 healthy volunteers. Clinical tests for comparison with the MT histogram parameters included the Extended Disability Status Scale and the ambulation index. Lesion load calculated with T2-weighted MR images and whole-brain and white matter volumes were measured. RESULTS The location of the MT histogram peak and the mean MT ratio for NAWM were significantly lower in patients with MS than in control subjects. In longitudinal studies, the histogram peak location and mean MT ratio shifted in the direction of normal values as the duration of disease increased. A mean of 26.5% of the volume of new lesions identified on the later studies were demonstrated to have originated in NAWM corresponding to "lost" pixels on the histogram. CONCLUSION MT histogram analysis of NAWM, including longitudinal analysis, may provide new prognostic information regarding lesion formation and increase understanding of the course of the disease.
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Affiliation(s)
- I Catalaa
- Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104, USA
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Abstract
The advent of magnetic resonance imaging techniques has greatly reduced the diagnostic value of neurophysiological tests, particularly evoked potentials, in multiple sclerosis patients, because of the higher sensitivity in revealing subclinical involvement of the central nervous system. Technical progress and new methods of investigating afferent and efferent nervous pathways would seem to increase the sensitivity in detecting neural dysfunction, but the 'clinical gain' is modest at best. More promising is the utilization of neurophysiological tests to quantify the severity of white matter involvement. Transversal and longitudinal studies have demonstrated good correlations between neurophysiological parameters and disability measures, indicating that a battery of neurophysiological tests could be useful in monitoring the disease evolution in single patients and as surrogate endpoints in clinical trials. Further studies are needed for a better definition of the applications of evoked potentials and other neurophysiological techniques. Finally, event-related potentials and advanced electroencephalogram techniques, such as coherence analysis, could provide useful information on the pathophysiology of cognitive dysfunction, so common in multiple sclerosis patients, and with a strong impact on the quality of life.
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Affiliation(s)
- L Leocani
- Neurophysiology Department, Scientific Institute Hosptial San Raffaele, Milan, Italy.
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Patti F, L'Episcopo MR, Cataldi ML, Reggio A. Natural interferon-beta treatment of relapsing-remitting and secondary-progressive multiple sclerosis patients. A two-year study. Acta Neurol Scand 1999; 100:283-9. [PMID: 10536913 DOI: 10.1111/j.1600-0404.1999.tb00397.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate clinical and MRI effects of natural interferon beta treatment in both relapsing-remitting (RR) and secondary-progressive (SP) multiple sclerosis patients. MATERIAL AND METHODS A double-blind, randomized trial of natural interferon beta (nIFN-beta) in 58 ambulatory patients with RR and 40 with SP multiple sclerosis. Forty-nine patients (29 RR and 20 SP) were treated with intramuscular nIFN-beta6 MIU three times a week for 24 months and 49 control patients were treated with placebo. RESULTS Primary clinical endpoints were differences in exacerbation rates and proportion of patients remaining exacerbation-free. There were no significant baseline differences between the treated and placebo groups. In the treated RR group a significant reduction in exacerbation rate, an increase in the probability of remaining exacerbation-free, and an improvement in mean EDSS were found at 24 months. MRI activity and total lesion burden were significantly reduced in treated RR patients. In the SP group, nIFN-beta produced a significant reduction in EDSS score, a significant reduction in active lesion number, a marginally significant favourable difference in total lesion burden but no significant effect on the number of gadolinium-enhancing lesions. Side effects were transient and mild in treated patients. CONCLUSIONS These observations confirm that nIFN-beta is a promising and well-tolerated treatment for either RR or SP MS patients.
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Affiliation(s)
- F Patti
- Department of Neurological Sciences, MS Center, University of Catania, Italy
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17
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Comi G, Leocani L, Medaglini S, Locatelli T, Martinelli V, Santuccio G, Rossi P. Measuring evoked responses in multiple sclerosis. Mult Scler 1999; 5:263-7. [PMID: 10467386 DOI: 10.1177/135245859900500412] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evoked potentials (EPs) have been widely utilised in Multiple Sclerosis (MS) patients to demonstrate the involvement of sensory and motor pathways. Their diagnostic value is based on the ability to reveal clinically silent lesions and to objectivate the central nervous system damage in patients who complain frequently of vague and indefinite disturbances which frequently occurs in the early phases of the disease. The advent of magnetic resonance imaging (MRI) techniques has greatly reduced the clinical utilisation of EPs, which is not fully justifiable, as the information provided by EPs are quite different from those provided by MRI. The abnormalities of evoked responses reflect the global damage of the evoked nervous pathway and are significantly correlated with the clinical findings, while the vast majority of MRI lesions are not associated to symptoms and signs. Transversal and longitudinal studies have demonstrated that EP changes in MS are more strictly related to disability than MRI lesion burden. On the contrary, MRI is more sensitive than EPs in revealing the disease activity. Evoked responses modifications observed in MS are not disease-specific; moreover longitudinal studies showed latency and morphology changes of evoked responses not always related to clinical changes. Such a dissociation can be explained both by technical factors and by subclinical disease activity. To reduce the negative impact of technical aspects, only reproducible parameters of the evoked responses should be used to monitor disease evolution and therapeutic interventions.
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Affiliation(s)
- G Comi
- Department of Clinical Neurophysiology, MS Centre, University of Milan, Scientific Institute H San Raffaele, Milan, Italy
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18
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Nakashima I, Fujihara K, Okita N, Takase S, Itoyama Y. Clinical and MRI study of brain stem and cerebellar involvement in Japanese patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 1999; 67:153-7. [PMID: 10406980 PMCID: PMC1736498 DOI: 10.1136/jnnp.67.2.153] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the clinical and MRI features of brain stem and cerebellar lesions in Japanese patients with multiple sclerosis. METHODS A retrospective study of 66 consecutive Japanese patients with multiple sclerosis (42 women and 24 men) was done by reviewing the medical records and MRI films. Forty nine patients were diagnosed as having clinically definite multiple sclerosis and 17 patients as having clinically probable multiple sclerosis according to Poser's criteria. Prevalence rates of each brain stem and cerebellar manifestation and frequency and distribution of MRI lesions in these patients were studied. RESULTS Forty three patients (65%) had one or more infratentorial manifestations. Cranial nerves were clinically involved in 28 patients (42%), and most of the lesions were identified by MRI. Among them, manifestations of facial, trigeminal, and abducens nerves were relatively common. Cerebellar ataxia was found in 20 patients (30%). The MRI study showed that the lesions responsible for ataxia in these patients were mainly found in the cerebellar peduncles, but cerebellar hemispheric lesions were detected in only four patients (6.4%). CONCLUSION The low frequency (6.4%) of the cerebellar MRI lesions in these patients is in sharp contrast with the figures reported for white patients with multiple sclerosis (50%-90%). Racial and genetic differences may have an influence on the susceptibility of each part of the CNS to demyelination in multiple sclerosis.
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Affiliation(s)
- I Nakashima
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Japan.
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Comi G, Martinelli V, Locatelli T, Leocani L, Medaglini S. Neurophysiological and cognitive markers of disease evolution in multiple sclerosis. Mult Scler 1998; 4:260-5. [PMID: 9762686 DOI: 10.1177/135245859800400333] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Both evoked potentials and cognitive tests may provide useful information which cannot be derived from the clinical observation. For this reason, there have been some attempts to use EPs in monitoring the natural history of the disease and in assessing the efficacy of therapeutic trials. However, no conclusion can be derived from the few available data. Although MRI is more sensitive than EPs in revealing new lesions in brain, cerebellum and brainstem, EPs are more sensitive in revealing optic nerve and spinal cord lesions. Moreover, the poor relationship between brain MRI abnormalities and disability has raised the possibility that cognitive evaluation may be an additional sensitive marker of brain involvement over time. Since the gold standard for the assessment of disease activity is uncertain, it is therefore advisable that frequent MRI, EPs and cognitive assessment may integrate clinical outcomes measured by conventional scales, both in the study of the natural disease course and in monitoring clinical trials.
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Affiliation(s)
- G Comi
- Department of Neurology, University of Milano, San Raffaele Scientific Institute, Italy
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Accornero N, Rinalduzzi S, Capozza M, Millefiorini E, Filligoi GC, Capitanio L. Computerized color perimetry in multiple sclerosis. Mult Scler 1998; 4:79-84. [PMID: 9599338 DOI: 10.1177/135245859800400207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Color visual field analysis has proven highly sensitive for early visual impairments diagnosis in MS, yet it has never attained widespread popularity usually because the procedure is difficult to standardize, the devices are costly, and the test is fatiguing. We propose a computerized procedure running on standard PC, cost effective, clonable, and easy handled. Two hundred and sixty-four colored patches subtending 1 degree angle vision, with selected hues and low saturation levels are sequentially and randomly displayed on gray equiluminous background of the PC screen subtending 24 degrees x 40 degrees angle of vision. The subject is requested to press a switch at the perception of the stimulus. The output provides colored maps with quantitative information. Comparison between normals and a selected population of MS patients with no actual luminance visual field defects, showed high statistical difference.
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Affiliation(s)
- N Accornero
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
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