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Brier MR, Schindler SE, Salter A, Perantie D, Shelley N, Judge B, Keefe S, Kirmess KM, Verghese PB, Yarasheski KE, Venkatesh V, Raji CA, Gordon BA, Bateman RJ, Morris JC, Naismith RT, Holtzman DM, Benzinger TLS, Cross AH. Unexpected Low Rate of Amyloid-β Pathology in Multiple Sclerosis Patients. Ann Neurol 2024. [PMID: 38963256 DOI: 10.1002/ana.27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
The life expectancy of people with multiple sclerosis (MS) has increased, yet we have noted that development of a typical Alzheimer disease dementia syndrome is uncommon. We hypothesized that Alzheimer disease pathology is uncommon in MS patients. In 100 MS patients, the rate of amyloid-β plasma biomarker positivity was approximately half the rate in 300 non-MS controls matched on age, sex, apolipoprotein E proteotype, and cognitive status. Interestingly, most MS patients who did have amyloid-β pathology had features atypical for MS at diagnosis. These results support that MS is associated with reduced Alzheimer disease risk, and suggest new avenues of research. ANN NEUROL 2024.
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Affiliation(s)
- Matthew R Brier
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Suzanne E Schindler
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Amber Salter
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dana Perantie
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nicole Shelley
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Bradley Judge
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah Keefe
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | - Cyrus A Raji
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian A Gordon
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert T Naismith
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - David M Holtzman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne H Cross
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
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Preziosa P, Rocca MA, Filippi M. Radiologically isolated syndromes: to treat or not to treat? J Neurol 2024; 271:2370-2378. [PMID: 38502339 DOI: 10.1007/s00415-024-12294-4] [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: 02/08/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to increased detection of individuals exhibiting asymptomatic brain and spinal cord lesions suggestive of multiple sclerosis (MS), defined as "radiologically isolated syndrome" (RIS). Specific criteria have been proposed and updated over time to identify individuals with RIS. Moreover, a younger age, the presence of infratentorial, spinal cord or gadolinium-enhancing lesions, as well as of cerebrospinal fluid-specific oligoclonal bands have been recognized as relevant risk factors for the occurrence of a first clinical event. Recent randomized controlled trials conducted in individuals with RIS have shown that dimethyl fumarate and teriflunomide significantly reduce the occurrence of clinical events in this population. These findings support the notion that early treatment initiation may positively influence the prognosis of these patients. However, several aspects should be taken into account before treating individuals with RIS in the real-world clinical setting, including an accurate identification of individuals with RIS to avoid misdiagnosis, a precise stratification of their risk of experiencing a first clinical event and further data supporting favorable balance between benefits and risks, even in the long term. This commentary provides an overview of the latest updates in RIS diagnosis, prognosis, and emerging treatment evidence.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Snow NJ, Murphy HM, Chaves AR, Moore CS, Ploughman M. Transcranial magnetic stimulation enhances the specificity of multiple sclerosis diagnostic criteria: a critical narrative review. PeerJ 2024; 12:e17155. [PMID: 38563011 PMCID: PMC10984191 DOI: 10.7717/peerj.17155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that involves attacks of inflammatory demyelination and axonal damage, with variable but continuous disability accumulation. Transcranial magnetic stimulation (TMS) is a noninvasive method to characterize conduction loss and axonal damage in the corticospinal tract. TMS as a technique provides indices of corticospinal tract function that may serve as putative MS biomarkers. To date, no reviews have directly addressed the diagnostic performance of TMS in MS. The authors aimed to conduct a critical narrative review on the diagnostic performance of TMS in MS. Methods The authors searched the Embase, PubMed, Scopus, and Web of Science databases for studies that reported the sensitivity and/or specificity of any reported TMS technique compared to established clinical MS diagnostic criteria. Studies were summarized and critically appraised for their quality and validity. Results Seventeen of 1,073 records were included for data extraction and critical appraisal. Markers of demyelination and axonal damage-most notably, central motor conduction time (CMCT)-were specific, but not sensitive, for MS. Thirteen (76%), two (12%), and two (12%) studies exhibited high, unclear, and low risk of bias, respectively. No study demonstrated validity for TMS techniques as diagnostic biomarkers in MS. Conclusions CMCT has the potential to: (1) enhance the specificity of clinical MS diagnostic criteria by "ruling in" true-positives, or (2) revise a diagnosis from relapsing to progressive forms of MS. However, there is presently insufficient high-quality evidence to recommend any TMS technique in the diagnostic algorithm for MS.
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Affiliation(s)
- Nicholas J. Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Hannah M. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Arthur R. Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Neuromodulation Research Clinic, The Royal’s Institute of Mental Health Research, Ottawa, ON, Canada
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Craig S. Moore
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
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Siger M, Wydra J, Wildner P, Podyma M, Puzio T, Matera K, Stasiołek M, Świderek-Matysiak M. Differences in Brain Atrophy Pattern between People with Multiple Sclerosis and Systemic Diseases with Central Nervous System Involvement Based on Two-Dimensional Linear Measures. J Clin Med 2024; 13:333. [PMID: 38256467 PMCID: PMC10816254 DOI: 10.3390/jcm13020333] [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: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Conventional brain magnetic resonance imaging (MRI) in systemic diseases with central nervous system involvement (SDCNS) may imitate MRI findings of multiple sclerosis (MS). In order to better describe the MRI characteristics of these conditions, in our study we assessed brain volume parameters in MS (n = 58) and SDCNS (n = 41) patients using two-dimensional linear measurements (2DLMs): bicaudate ratio (BCR), corpus callosum index (CCI) and width of third ventricle (W3V). In SDCNS patients, all 2DLMs were affected by age (CCI p = 0.005, BCR p < 0.001, W3V p < 0.001, respectively), whereas in MS patients only BCR and W3V were (p = 0.001 and p = 0.015, respectively). Contrary to SDCNS, in the MS cohort BCR and W3V were associated with T1 lesion volume (T1LV) (p = 0.020, p = 0.009, respectively) and T2 lesion volume (T2LV) (p = 0.015, p = 0.009, respectively). CCI was associated with T1LV in the MS cohort only (p = 0.015). Moreover, BCR was significantly higher in the SDCNS group (p = 0.01) and CCI was significantly lower in MS patients (p = 0.01). The best predictive model to distinguish MS and SDCNS encompassed gender, BCR and T2LV as the explanatory variables (sensitivity 0.91; specificity 0.68; AUC 0.86). Implementation of 2DLMs in the brain MRI analysis of MS and SDCNS patients allowed for the identification of diverse patterns of local brain atrophy in these clinical conditions.
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Affiliation(s)
- Małgorzata Siger
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Jacek Wydra
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Paula Wildner
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Marek Podyma
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Tomasz Puzio
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Katarzyna Matera
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Mariusz Stasiołek
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Mariola Świderek-Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
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Usta NC, Gunay BO. Is the ganglion cell layer thickness to macular thickness ratio a new biomarker for multiple sclerosis? Int Ophthalmol 2023; 43:3841-3852. [PMID: 37578548 DOI: 10.1007/s10792-023-02839-3] [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: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Ganglion cell layer thickness (GCLT)-to-total macular thickness (MT) is a new parameter that has not been studied in multiple sclerosis (MS) before. The current study aims to reveal the status of the GCLT-to-MT ratio in MS and its role in supporting the diagnosis of MS. METHODS In this retrospective and cross sectional study, the medical records of the MS patients between January 2016 and December 2021 were reviewed. Age-sex matched healthy control group was generated. Demographic and clinical data recorded. All participants were examined using a spectral-domain optic coherence tomography (OCT) device. Retinal layers, choroidal thickness (CT) was recorded. GCLT-to-MT ratio was calculated. RESULTS A total of 74 eyes of 37 MS (9 male,28 female) patients and 82 eyes of 41 control (13 male, 28 female) were included in the study. The mean age was 37 ± 9.0 (years) in MS group. The MS patients and the control group were compared in terms of OCT parameters, CT was thicker at all regions in MS patients (p < 0.001). Macular thickness, GCLT, and inner plexiform layer thickness (IPLT) were thinner than the control group (p < 0.05). For distinguishing MS patients from healthy subjects, AUROC values for central GCLT/MT, temporal GCLT/MT, superior GCLT/MT, nasal GCLT/MT, and inferior GCLT/MT were 0.717, 0.689, 0.694, 0.733, and 0.740, respectively. CONCLUSIONS In conclusion MT, GCLT, and IPLT thickness were thinner in MS patients, regardless of optic neuritis. The AUROC values of GCLT/MT were high and GCLT/MT ratio may be a helpful modality in demonstrating retinal neurodegeneration in MS patients.
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Affiliation(s)
- Nuray Can Usta
- Department of Neurology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Inonu Mah., Maras Cad., Ortahisar, Trabzon, Turkey.
| | - Betul Onal Gunay
- Department of Ophthalmology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Ortahisar, Trabzon, Turkey
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Capasso N, Virgilio E, Covelli A, Giovannini B, Foschi M, Montini F, Nasello M, Nilo A, Prestipino E, Schirò G, Sperandei S, Clerico M, Lanzillo R. Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review. Front Neurol 2023; 14:1207617. [PMID: 37332984 PMCID: PMC10272733 DOI: 10.3389/fneur.2023.1207617] [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: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.
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Affiliation(s)
- Nicola Capasso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Eleonora Virgilio
- Neurology Unit, Department of Translational Medicine, AOU Maggiore della Carità Novara, University of Eastern Piedmont, Novara, Italy
| | - Antonio Covelli
- Department of Neurology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Beatrice Giovannini
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Foschi
- Department of Neuroscience, MS Center, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Federico Montini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Nasello
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Head, Neck and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Elio Prestipino
- UOSC Neuro-Stroke Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Giuseppe Schirò
- Section of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Silvia Sperandei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
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Involvement of the Intestinal Microbiota in the Appearance of Multiple Sclerosis: Aloe vera and Citrus bergamia as Potential Candidates for Intestinal Health. Nutrients 2022; 14:nu14132711. [PMID: 35807891 PMCID: PMC9269320 DOI: 10.3390/nu14132711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a neurological and inflammatory autoimmune disease of the Central Nervous System in which selective activation of T and B lymphocytes prompts a reaction against myelin, inducing demyelination and axonal loss. Although MS is recognized to be an autoimmune pathology, the specific causes are many; thus, to date, it has been considered a disorder resulting from environmental factors in genetically susceptible individuals. Among the environmental factors hypothetically involved in MS, nutrition seems to be well related, although the role of nutritional factors is still unclear. The gut of mammals is home to a bacterial community of about 2000 species known as the “microbiota”, whose composition changes throughout the life of each individual. There are five bacterial phylas that make up the microbiota in healthy adults: Firmicutes (79.4%), Bacteroidetes (16.9%), Actinobacteria (2.5%), Proteobacteria (1%) and Verrucomicrobia (0.1%). The diversity and abundance of microbial populations justifies a condition known as eubiosis. On the contrary, the state of dysbiosis refers to altered diversity and abundance of the microbiota. Many studies carried out in the last few years have demonstrated that there is a relationship between the intestinal microflora and the progression of multiple sclerosis. This correlation was also demonstrated by the discovery that patients with MS, treated with specific prebiotics and probiotics, have greatly increased bacterial diversity in the intestinal microbiota, which might be otherwise reduced or absent. In particular, natural extracts of Aloe vera and bergamot fruits, rich in polyphenols and with a high percentage of polysaccharides (mostly found in indigestible and fermentable fibers), appear to be potential candidates to re-equilibrate the gut microbiota in MS patients. The present review article aims to assess the pathophysiological mechanisms that reveal the role of the microbiota in the development of MS. In addition, the potential for supplementing patients undergoing early stages of MS with Aloe vera as well as bergamot fibers, on top of conventional drug treatments, is discussed.
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Rath J, Foesleitner O, Haider L, Bickel H, Leutmezer F, Polanec S, Arnoldner MA, Sunder-Plassmann G, Prayer D, Berger T, Rommer P, Kasprian G. Neuroradiological differentiation of white matter lesions in patients with multiple sclerosis and Fabry disease. Orphanet J Rare Dis 2022; 17:37. [PMID: 35123534 PMCID: PMC8817613 DOI: 10.1186/s13023-022-02187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objective White matter lesions (WML) in multiple sclerosis (MS) differ from vascular WML caused by Fabry disease (FD). However, in atypical cases the discrimination can be difficult and may vary between individual raters. The aim of this study was to evaluate interrater reliability of WML differentiation between MS and FD patients. Materials and methods Brain MRI scans of 21 patients with genetically confirmed FD were compared to 21 matched patients with MS. Pseudonymized axial FLAIR sequences were assessed by 6 blinded raters and attributed to either the MS or the FD group to investigate interrater reliability. Additionally, localization of WML was compared between the two groups. Results The median age of patients was 46 years (IQR 35–58). Interrater reliability was moderate with a Fleiss' Kappa of 0.45 (95%CI 0.3–0.59). Overall, 85% of all ratings in the MS group and 75% in the FD group were correct. However, only 38% of patients with MS and 33% of patients with FD were correctly identified by all 6 raters. WML involving the corpus callosum (p < 0.001) as well as juxtacortical (p < 0.001) and infratentorial lesions (p = 0.03) were more frequently observed in MS patients. Conclusion Interrater reliability regarding visual differentiation of WML in MS from vascular WML in FD on standard axial FLAIR images alone is only moderate, despite the distinctive features of lesions in each group.
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Brainstem syndrome at onset is related to an early MS diagnosis in Peru: A national referral center cohort. Heliyon 2021; 7:e08069. [PMID: 34765756 PMCID: PMC8569397 DOI: 10.1016/j.heliyon.2021.e08069] [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: 02/23/2021] [Revised: 04/05/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background MS is unpredictable regarding clinical symptoms; however, certain symptoms represent the preferred localization of white matter lesions such as brainstem, spinal cord; or optic nerve. Objectives To investigate the epidemiological, clinical, and imaging characteristics of MS patients in a national referral center in Peru, and to evaluate whether the type of symptom at onset relates with the time to making an MS diagnosis. Methods Retrospective study of MS patients at the Instituto Nacional de Ciencias Neurológicas between January 2010 and December 2018. Four different syndromes were selected for analysis as symptom onset (optic neuritis, brainstem syndrome, myelitis, and others). Results we identified 268 patients for whom a diagnosis of MS had been given; after excluding misdiagnosed patients (33 Neuromyelitis optica), lost or incomplete records, 121 patients were included. The majority of patients (46.6%) were born in Lima. Female to male ratio was 1.37 to 1, mean age at diagnosis was 31 years. At onset, myelitis was present in 35% of RRMS patients, followed by brainstem syndrome (25%) and optic neuritis (18%). Brainstem syndrome was statistically significant predictor for earlier diagnosis (adjusted HR: 2.09; p = 0.015). Conclusion Brainstem syndrome as an initial presentation of MS in Peru is related to an earlier diagnosis. In Peru, the epidemiology of MS is still a major neglected topic. Brainstem syndrome as an initial presentation of MS in Peru is related to an early diagnosis. Our population represents different regions of our country. Similar clinical, epidemiological and imaging characteristic to other Latin American countries were found. We found a misdiagnosis rate of 36.2%, which remains a contemporary problem in MS diagnosis.
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Siger M, Owidzka M, Świderek-Matysiak M, Omulecki W, Stasiołek M. Optical Coherence Tomography in the Differential Diagnosis of Patients with Multiple Sclerosis and Patients with MRI Nonspecific White Matter Lesions. SENSORS 2021; 21:s21217127. [PMID: 34770434 PMCID: PMC8588219 DOI: 10.3390/s21217127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
In the differential diagnosis of nonspecific white matter lesions (NSWMLs) detected on magnetic resonance imaging (MRI), multiple sclerosis (MS) should be taken into consideration. Optical coherence tomography (OCT) is a promising tool applied in the differential diagnostic process of MS. We tested whether OCT may be useful in distinguishing between MS and NSWMLs patients. In patients with MS (n = 41) and NSWMLs (n = 19), the following OCT parameters were measured: thickness of the peripapillary Retinal Nerve Fibre Layer (pRNFL) in superior, inferior, nasal, and temporal segments; thickness of the ganglion cell-inner plexiform layer (GCIPL); thickness of macular RNFL (mRNFL); and macular volume (MV). In MS patients, GCIPL was significantly lower than in NSWMLs patients (p = 0.024). Additionally, in MS patients, mRNFL was significantly lower than in NSWMLs patients (p = 0.030). The average segmental pRNFL and MV did not differ between MS and NSWMLs patients (p > 0.05). GCIPL and macular RNFL thinning significantly influenced the risk of MS (18.6% [95% CI 2.7%, 25.3%]; 27.4% [95% CI 4.5%, 62.3%]), and reduced GCIPL thickness appeared to be the best predictor of MS. We conclude that OCT may be helpful in the differential diagnosis of MS and NSWMLs patients in real-world settings.
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Affiliation(s)
- Małgorzata Siger
- Department of Neurology, Medical University of Lodz, 90-419 Lodz, Poland; (M.Ś.-M.); (M.S.)
- Correspondence:
| | - Marta Owidzka
- Department of Eye Disease, Medical University of Lodz, 90-419 Lodz, Poland; (M.O.); (W.O.)
| | | | - Wojciech Omulecki
- Department of Eye Disease, Medical University of Lodz, 90-419 Lodz, Poland; (M.O.); (W.O.)
| | - Mariusz Stasiołek
- Department of Neurology, Medical University of Lodz, 90-419 Lodz, Poland; (M.Ś.-M.); (M.S.)
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Absence of latitudinal gradient in oligoclonal bands prevalence in Argentina. Mult Scler Relat Disord 2020; 46:102582. [DOI: 10.1016/j.msard.2020.102582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
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