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Caporale AS, Chiarelli AM, Biondetti E, Villani A, Lipp I, Di Censo D, Tomassini V, Wise RG. Changes of brain parenchyma free water fraction reflect tissue damage and impaired processing speed in multiple sclerosis. Hum Brain Mapp 2024; 45:e26761. [PMID: 38895882 PMCID: PMC11187860 DOI: 10.1002/hbm.26761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 05/13/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
Free water fraction (FWF) represents the amount of water per unit volume of brain parenchyma, which is not bound to macromolecules. Its excess in multiple sclerosis (MS) is related to increased tissue loss. The use of mcDESPOT (multicomponent driven single pulse observation of T1 and T2), a 3D imaging method which exploits both the T1 and T2 contrasts, allows FWF to be derived in clinically feasible times. However, this method has not been used to quantify changes of FWF and their potential clinical impact in MS. The aim of this study is to investigate the changes in FWF in MS patients and their relationship with tissue damage and cognition, under the hypothesis that FWF is a proxy of clinically meaningful tissue loss. To this aim, we tested the relationship between FWF, MS lesion burden and information processing speed, evaluated via the Symbol Digit Modalities Test (SDMT). In addition to standard sequences, used for T1- and T2-weighted lesion delineation, the mcDESPOT sequence with 1.7 mm isotropic resolution and a diffusion weighted imaging protocol (b = 0, 1200 s/mm2, 40 diffusion directions) were employed at 3 T. The fractional anisotropy map derived from diffusion data was used to define a subject-specific white matter (WM) atlas. Brain parenchyma segmentation returned masks of gray matter (GM) and WM, and normal-appearing WM (NAWM), in addition to the T1 and T2 lesion masks (T1L and T2L, respectively). Ninety-nine relapsing-remitting MS patients (age = 43.3 ± 9.9 years, disease duration 12.3 ± 7.7 years) were studied, together with twenty-five healthy controls (HC, age = 38.8 ± 11.0 years). FWF was higher in GM and NAWM of MS patients, compared to GM and WM of HC (both p < .001). In MS patients, FWF was the highest in the T1L and GM, followed by T2L and NAWM, respectively. FWF increased significantly with T1L and T2L volume (ρ ranging from 0.40 to 0.58, p < .001). FWF in T2L was strongly related to both T1L volume and the volume ratio T1L/T2L (ρ = 0.73, p < .001). MS patients performed worse than HC in the processing speed test (mean ± SD: 54.1 ± 10.3 for MS, 63.8 ± 10.8 for HC). FWF in GM, T2L, perilesional tissue and NAWM increased with SDMT score reduction (ρ = -0.30, -0.29, -0.33 respectively and r = -.30 for T2L, all with p < .005). A regional analysis, conducted to determine which NAWM regions were of particular importance to explain the relationship between FWF and cognitive impairment, revealed that FWF spatial variance was negatively related to SDMT score in the corpus callosum and the superior longitudinal fasciculus, WM structures known to be associated with cognitive impairment, in addition to the left corticospinal tract, the sagittal stratum, the right anterior limb of internal capsule. In conclusion, we found excess free water in brain parenchyma of MS patients, an alteration that involved not only MS lesions, but also the GM and NAWM, impinging on brain function and negatively associated with cognitive processing speed. We suggest that the FWF metric, derived from noninvasive, rapid MRI acquisitions and bearing good biological interpretability, may prove valuable as an MRI biomarker of tissue damage and associated cognitive impairment in MS.
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Affiliation(s)
- Alessandra Stella Caporale
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
| | - Antonio Maria Chiarelli
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
| | - Emma Biondetti
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
| | - Alessandro Villani
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
| | - Ilona Lipp
- Department of NeurophysicsMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Davide Di Censo
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
| | - Valentina Tomassini
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical Neurology‘SS. Annunziata’ University HospitalChietiItaly
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of PsychologyCardiff UniversityCardiffUK
| | - Richard Geoffrey Wise
- Department of Neuroscience, Imaging and Clinical Sciences‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical Technologies (ITAB)‘G. d'Annunzio University’ of Chieti‐PescaraChietiItaly
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of PsychologyCardiff UniversityCardiffUK
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Mascali D, Villani A, Chiarelli AM, Biondetti E, Lipp I, Digiovanni A, Pozzilli V, Caporale AS, Rispoli MG, Ajdinaj P, D'Apolito M, Grasso E, Sensi SL, Murphy K, Tomassini V, Wise RG. Pathophysiology of multiple sclerosis damage and repair: Linking cerebral hypoperfusion to the development of irreversible tissue loss in multiple sclerosis using magnetic resonance imaging. Eur J Neurol 2023; 30:2348-2356. [PMID: 37154298 PMCID: PMC7615142 DOI: 10.1111/ene.15827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/10/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND PURPOSE Reduced cerebral perfusion has been observed in multiple sclerosis (MS) and may contribute to tissue loss both acutely and chronically. Here, we test the hypothesis that hypoperfusion occurs in MS and relates to the presence of irreversible tissue damage. METHODS In 91 patients with relapsing MS and 26 healthy controls (HC), gray matter (GM) cerebral blood flow (CBF) was assessed using pulsed arterial spin labeling. GM volume, T1 hypointense and T2 hyperintense lesion volumes (T1LV and T2LV, respectively), and the proportion of T2-hyperintense lesion volume that appears hypointense on T1-weighted magnetic resonance imaging (T1LV/T2LV) were quantified. GM CBF and GM volume were evaluated globally, as well as regionally, using an atlas-based approach. RESULTS Global GM CBF was lower in patients (56.9 ± 12.3 mL/100 g/min) than in HC (67.7 ± 10.0 mL/100 g/min; p < 0.001), a difference that was widespread across brain regions. Although total GM volume was comparable between groups, significant reductions were observed in a subset of subcortical structures. GM CBF negatively correlated with T1LV (r = -0.43, p = 0.0002) and T1LV/T2LV (r = -0.37, p = 0.0004), but not with T2LV. CONCLUSIONS GM hypoperfusion occurs in MS and is associated with irreversible white matter damage, thus suggesting that cerebral hypoperfusion may actively contribute and possibly precede neurodegeneration by hampering tissue repair abilities in MS.
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Affiliation(s)
- Daniele Mascali
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Alessandro Villani
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Antonio M. Chiarelli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Emma Biondetti
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Ilona Lipp
- Department of NeurophysicsMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Anna Digiovanni
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Valeria Pozzilli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Alessandra S. Caporale
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Marianna G. Rispoli
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Paola Ajdinaj
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Maria D'Apolito
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Eleonora Grasso
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Department of PaediatricsSS. Annunziata University HospitalChietiItaly
| | - Stefano L. Sensi
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Centre for Advanced Studies and TechnologyG. d'Annunzio University of Chieti‐PescaraChietiItaly
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre, School of Physics and AstronomyCardiff UniversityCardiffUK
| | - Valentina Tomassini
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
- MS Centre, Department of Clinical NeurologySS. Annunziata University HospitalChietiItaly
| | - Richard G. Wise
- Department of Neurosciences, Imaging, and Clinical SciencesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Institute for Advanced Biomedical TechnologiesG. d'Annunzio University of Chieti‐PescaraChietiItaly
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
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Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:293-311. [PMID: 36803817 DOI: 10.1016/b978-0-323-85555-6.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The improved understanding of multiple sclerosis (MS) neurobiology alongside the development of novel markers of disease will allow precision medicine to be applied to MS patients, bringing the promise of improved care. Combinations of clinical and paraclinical data are currently used for diagnosis and prognosis. The addition of advanced magnetic resonance imaging and biofluid markers has been strongly encouraged, since classifying patients according to the underlying biology will improve monitoring and treatment strategies. For example, silent progression seems to contribute significantly more than relapses to overall disability accumulation, but currently approved treatments for MS act mainly on neuroinflammation and offer only a partial protection against neurodegeneration. Further research, involving traditional and adaptive trial designs, should strive to halt, repair or protect against central nervous system damage. To personalize new treatments, their selectivity, tolerability, ease of administration, and safety must be considered, while to personalize treatment approaches, patient preferences, risk-aversion, and lifestyle must be factored in, and patient feedback used to indicate real-world treatment efficacy. The use of biosensors and machine-learning approaches to integrate biological, anatomical, and physiological parameters will take personalized medicine a step closer toward the patient's virtual twin, in which treatments can be tried before they are applied.
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Affiliation(s)
- Marianna G Rispoli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Maria D'Apolito
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valeria Pozzilli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy.
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Cerebrovascular reactivity in multiple sclerosis is restored with reduced inflammation during immunomodulation. Sci Rep 2022; 12:15453. [PMID: 36104366 PMCID: PMC9474533 DOI: 10.1038/s41598-022-19113-8] [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: 04/04/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Cerebrovascular reactivity (CVR) reflects the capacity of the brain’s vasculature to increase blood flow following a vasodilatory stimulus. Reactivity is an essential property of the brain’s blood vessels that maintains nutrient supplies in the face of changing demand. In Multiple Sclerosis (MS), CVR may be diminished with brain inflammation and this may contribute to neurodegeneration. We test the hypothesis that CVR is altered with MS neuroinflammation and that it is restored when inflammation is reduced. Using a breath-hold task during functional Magnetic Resonance Imaging (MRI), we mapped grey matter and white matter CVRs (CVRGM and CVRWM, respectively) in 23 young MS patients, eligible for disease modifying therapy, before and during Interferon beta treatment. Inflammatory activity was inferred from the presence of Gadolinium enhancing lesions at MRI. Eighteen age and gender-matched healthy controls (HC) were also assessed. Enhancing lesions were observed in 12 patients at the start of the study and in 3 patients during treatment. Patients had lower pre-treatment CVRGM (p = 0.04) and CVRWM (p = 0.02) compared to HC. In patients, a lower pre-treatment CVRGM was associated with a lower GM volume (r = 0.60, p = 0.003). On-treatment, there was an increase in CVRGM (p = 0.02) and CVRWM (p = 0.03) that negatively correlated with pre-treatment CVR (GM: r = − 0.58, p = 0.005; WM: r = − 0.60, p = 0.003). CVR increased when enhancing lesions reduced in number (GM: r = − 0.48, p = 0.02, WM: r = − 0.62, p = 0.003). Resolution of inflammation may restore altered cerebrovascular function limiting neurodegeneration in MS. Imaging of cerebrovascular function may thereby inform tissue physiology and improve treatment monitoring.
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5
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Wijeyaratnam DO, Edwards T, Pilutti LA, Cressman EK. Assessing visually guided reaching in people with multiple sclerosis with and without self-reported upper limb impairment. PLoS One 2022; 17:e0262480. [PMID: 35061785 PMCID: PMC8782348 DOI: 10.1371/journal.pone.0262480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
The ability to accurately complete goal-directed actions, such as reaching for a glass of water, requires coordination between sensory, cognitive and motor systems. When these systems are impaired, like in people with multiple sclerosis (PwMS), deficits in movement arise. To date, the characterization of upper limb performance in PwMS has typically been limited to results attained from self-reported questionnaires or clinical tools. Our aim was to characterize visually guided reaching performance in PwMS. Thirty-six participants (12 PwMS who reported upper limb impairment (MS-R), 12 PwMS who reported not experiencing upper limb impairment (MS-NR), and 12 age- and sex-matched control participants without MS (CTL)) reached to 8 targets in a virtual environment while seeing a visual representation of their hand in the form of a cursor on the screen. Reaches were completed with both the dominant and non-dominant hands. All participants were able to complete the visually guided reaching task, such that their hand landed on the target. However, PwMS showed noticeably more atypical reaching profiles when compared to control participants. In accordance with these observations, analyses of reaching performance revealed that the MS-R group was more variable with respect to the time it took to initiate and complete their movements compared to the CTL group. While performance of the MS-NR group did not differ significantly from either the CTL or MS-R groups, individuals in the MS-NR group were less consistent in their performance compared to the CTL group. Together these findings suggest that PwMS with and without self-reported upper limb impairment have deficits in the planning and/or control of their movements. We further argue that deficits observed during movement in PwMS who report upper limb impairment may arise due to participants compensating for impaired movement planning processes.
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Affiliation(s)
- Darrin O. Wijeyaratnam
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara A. Pilutti
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin K. Cressman
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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6
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Diagnosis and management of multiple sclerosis: MRI in clinical practice. J Neurol 2020; 267:2917-2925. [PMID: 32472179 PMCID: PMC7501096 DOI: 10.1007/s00415-020-09930-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Background Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres. Methods MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol. Results We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated. Conclusions The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach.
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7
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Lipp I, Jones DK, Bells S, Sgarlata E, Foster C, Stickland R, Davidson AE, Tallantyre EC, Robertson NP, Wise RG, Tomassini V. Comparing MRI metrics to quantify white matter microstructural damage in multiple sclerosis. Hum Brain Mapp 2019; 40:2917-2932. [PMID: 30891838 PMCID: PMC6563497 DOI: 10.1002/hbm.24568] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/10/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Quantifying white matter damage in vivo is becoming increasingly important for investigating the effects of neuroprotective and repair strategies in multiple sclerosis (MS). While various approaches are available, the relationship between MRI‐based metrics of white matter microstructure in the disease, that is, to what extent the metrics provide complementary versus redundant information, remains largely unexplored. We obtained four microstructural metrics from 123 MS patients: fractional anisotropy (FA), radial diffusivity (RD), myelin water fraction (MWF), and magnetisation transfer ratio (MTR). Coregistration of maps of these four indices allowed quantification of microstructural damage through voxel‐wise damage scores relative to healthy tissue, as assessed in a group of 27 controls. We considered three white matter tissue‐states, which were expected to vary in microstructural damage: normal appearing white matter (NAWM), T2‐weighted hyperintense lesional tissue without T1‐weighted hypointensity (T2L), and T1‐weighted hypointense lesional tissue with corresponding T2‐weighted hyperintensity (T1L). All MRI indices suggested significant damage in all three tissue‐states, the greatest damage being in T1L. The correlations between indices ranged from r = 0.18 to r = 0.87. MWF was most sensitive when differentiating T2L from NAWM, while MTR was most sensitive when differentiating T1L from NAWM and from T2L. Combining the four metrics into one, through a principal component analysis, did not yield a measure more sensitive to damage than any single measure. Our findings suggest that the metrics are (at least partially) correlated with each other, but sensitive to the different aspects of pathology. Leveraging these differences could be beneficial in clinical trials testing the effects of therapeutic interventions.
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Affiliation(s)
- Ilona Lipp
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Sonya Bells
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK.,Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Eleonora Sgarlata
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Catherine Foster
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Rachael Stickland
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Alison E Davidson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Emma C Tallantyre
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Neil P Robertson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
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8
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Wynford-Thomas R, Jacob A, Tomassini V. Neurological update: MOG antibody disease. J Neurol 2018; 266:1280-1286. [PMID: 30569382 PMCID: PMC6469662 DOI: 10.1007/s00415-018-9122-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/25/2022]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD) is now recognised as a nosological entity with specific clinical and paraclinical features to aid early diagnosis. Although no age group is exempt, median age of onset is within the fourth decade of life, with optic neuritis being the most frequent presenting phenotype. Disease course can be either monophasic or relapsing, with subsequent relapses most commonly involving the optic nerve. Residual disability develops in 50-80% of patients, with transverse myelitis at onset being the most significant predictor of long-term outcome. Recent advances in MOG antibody testing offer improved sensitivity and specificity. To avoid misdiagnosis, MOG antibody testing should be undertaken in selected cases presenting clinical and paraclinical features that are felt to be in keeping with MOG-AD, using a validated cell-based assay. MRI characteristics can help in differentiating MOG-AD from other neuroinflammatory disorders, including multiple sclerosis and neuromyelitis optica. Cerebrospinal fluid oligoclonal bands are uncommon. Randomised control trials are limited, but observational open-label experience suggests a role for high-dose steroids and plasma exchange in the treatment of acute attacks, and for immunosuppressive therapies, such as steroids, oral immunosuppressants and rituximab as maintenance treatment.
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Affiliation(s)
- Ray Wynford-Thomas
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Anu Jacob
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK. .,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK. .,Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, UK.
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9
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Abstract
RATIONAL Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is believed to be an autosomal recessive genetic disease, with disorders in multisystem organs. Its characteristic neurological disorders manifested on neuroimaging are a triad of leukoencephalopathy, intracranial calcifications, and parenchymal cysts. In this paper, we report a CRMCC patient with multisystem involvement, focusing on the neuroimaging features, to get a better understanding of the rare disease and improve our diagnostic ability. PATIENT CONCERNS The 23-year-old female patient firstly presented with an adolescence onset of ophthalmological manifestations. Four years later, hematological and neurological disorders occurred, the latter of which demonstrated a relatively slow progression in the following 7 years preceding her presentation to our hospital. INTERVENTIONS During hospitalization, disorders involving digestive, cardiovascular and respiratory systems were also detected. In addition, a more comprehensive depiction of neurological disorders on neuroimaging was also obtained. DIAGNOSES On the basis of multiple system disorders and the detection of mutations in conserved telomere maintenance component 1(CTC1) gene, a diagnosis of CRMCC was made. OUTCOMES After supportive therapy during her 4-week hospitalization, the patient's general condition improved and was released from the hospital. LESSONS CRMCC could be primarily diagnosed with the aid of its multiple system disorders and remarkable neuroimaging features. Cerebral micro hemorrhages determined by the combination of CT and T2-weighted magnetic resonance images in our case could provide some additional information for diagnosis. Furthermore, several other associated disorders were depicted for the first time in our case, expanding the clinical spectrum of CRMCC.
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Affiliation(s)
| | | | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences (PUMC&CAMS), Beijing, People's Republic of China
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10
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Tomassini V, d'Ambrosio A, Petsas N, Wise RG, Sbardella E, Allen M, Tona F, Fanelli F, Foster C, Carnì M, Gallo A, Pantano P, Pozzilli C. The effect of inflammation and its reduction on brain plasticity in multiple sclerosis: MRI evidence. Hum Brain Mapp 2016; 37:2431-45. [PMID: 26991559 PMCID: PMC5069650 DOI: 10.1002/hbm.23184] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022] Open
Abstract
Brain plasticity is the basis for systems‐level functional reorganization that promotes recovery in multiple sclerosis (MS). As inflammation interferes with plasticity, its pharmacological modulation may restore plasticity by promoting desired patterns of functional reorganization. Here, we tested the hypothesis that brain plasticity probed by a visuomotor adaptation task is impaired with MS inflammation and that pharmacological reduction of inflammation facilitates its restoration. MS patients were assessed twice before (sessions 1 and 2) and once after (session 3) the beginning of Interferon beta (IFN beta), using behavioural and structural MRI measures. During each session, 2 functional MRI runs of a visuomotor task, separated by 25‐minutes of task practice, were performed. Within‐session between‐run change in task‐related functional signal was our imaging marker of plasticity. During session 1, patients were compared with healthy controls. Comparison of patients' sessions 2 and 3 tested the effect of reduced inflammation on our imaging marker of plasticity. The proportion of patients with gadolinium‐enhancing lesions reduced significantly during IFN beta. In session 1, patients demonstrated a greater between‐run difference in functional MRI activity of secondary visual areas and cerebellum than controls. This abnormally large practice‐induced signal change in visual areas, and in functionally connected posterior parietal and motor cortices, was reduced in patients in session 3 compared with 2. Our results suggest that MS inflammation alters short‐term plasticity underlying motor practice. Reduction of inflammation with IFN beta is associated with a restoration of this plasticity, suggesting that modulation of inflammation may enhance recovery‐oriented strategies that rely on patients' brain plasticity. Hum Brain Mapp 37:2431–2445, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Valentina Tomassini
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, United Kingdom.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Alessandro d'Ambrosio
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, United Kingdom.,Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Italy
| | - Nikolaos Petsas
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, United Kingdom
| | - Emilia Sbardella
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Marek Allen
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, United Kingdom
| | - Francesca Tona
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Fulvia Fanelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Catherine Foster
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University School of Psychology, United Kingdom
| | - Marco Carnì
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Antonio Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Italy
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.,IRCCS NeuroMed, Pozzilli, IS
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
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11
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Mottron L, Duret P, Mueller S, Moore RD, Forgeot d'Arc B, Jacquemont S, Xiong L. Sex differences in brain plasticity: a new hypothesis for sex ratio bias in autism. Mol Autism 2015; 6:33. [PMID: 26052415 PMCID: PMC4456778 DOI: 10.1186/s13229-015-0024-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/27/2015] [Indexed: 01/13/2023] Open
Abstract
Several observations support the hypothesis that differences in synaptic and regional cerebral plasticity between the sexes account for the high ratio of males to females in autism. First, males are more susceptible than females to perturbations in genes involved in synaptic plasticity. Second, sex-related differences in non-autistic brain structure and function are observed in highly variable regions, namely, the heteromodal associative cortices, and overlap with structural particularities and enhanced activity of perceptual associative regions in autistic individuals. Finally, functional cortical reallocations following brain lesions in non-autistic adults (for example, traumatic brain injury, multiple sclerosis) are sex-dependent. Interactions between genetic sex and hormones may therefore result in higher synaptic and consecutively regional plasticity in perceptual brain areas in males than in females. The onset of autism may largely involve mutations altering synaptic plasticity that create a plastic reaction affecting the most variable and sexually dimorphic brain regions. The sex ratio bias in autism may arise because males have a lower threshold than females for the development of this plastic reaction following a genetic or environmental event.
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Affiliation(s)
- Laurent Mottron
- Centre d'excellence en Troubles envahissants du dévelopement de l'Université de Montréal (CETEDUM), Montréal, Canada.,Hôpital Rivière-des-Prairies, Département de Psychiatrie, Montréal, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Québec, Canada.,Department of Psychiatry, University of Montreal, Québec, Canada
| | - Pauline Duret
- Centre d'excellence en Troubles envahissants du dévelopement de l'Université de Montréal (CETEDUM), Montréal, Canada.,Hôpital Rivière-des-Prairies, Département de Psychiatrie, Montréal, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Québec, Canada.,Department of Psychiatry, University of Montreal, Québec, Canada.,Département de Biologie, École Normale Supérieure de Lyon, Lyon, CEDEX 07 France
| | - Sophia Mueller
- Institute of Clinical Radiology, University Hospitals, Munich, Germany.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129 USA.,Harvard University, Center for Brain Science, Cambridge, MA 02138 USA
| | - Robert D Moore
- Department of Psychiatry, University of Montreal, Québec, Canada.,Department of Health Sciences, University of Montreal, Montreal, Canada.,College of Applied Health Sciences, University of Illinois, Urbana-Champaign, USA
| | - Baudouin Forgeot d'Arc
- Centre d'excellence en Troubles envahissants du dévelopement de l'Université de Montréal (CETEDUM), Montréal, Canada.,Hôpital Rivière-des-Prairies, Département de Psychiatrie, Montréal, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Québec, Canada.,Department of Psychiatry, University of Montreal, Québec, Canada
| | - Sebastien Jacquemont
- Department of Psychiatry, University of Montreal, Québec, Canada.,Centre de recherche, Centre Hospitalier Universitaire Sainte Justine, Montréal, Canada.,Service of Medical Genetics, University Hospital of Lausanne, University of Lausanne, Lausanne, 1011 Switzerland
| | - Lan Xiong
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Québec, Canada.,Department of Psychiatry, University of Montreal, Québec, Canada
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12
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Lipp I, Tomassini V. Neuroplasticity and motor rehabilitation in multiple sclerosis. Front Neurol 2015; 6:59. [PMID: 25852638 PMCID: PMC4364082 DOI: 10.3389/fneur.2015.00059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ilona Lipp
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine , Cardiff , UK ; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University , Cardiff , UK
| | - Valentina Tomassini
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine , Cardiff , UK ; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University , Cardiff , UK ; IRCCS Fondazione Santa Lucia , Rome , Italy
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13
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Willis MD, Harding KE, Wardle M, Pickersgill TP, Tomassini V, Loveless S, Robertson NP. Site-specific clinical disease onset in multiple sclerosis. Eur J Neurol 2014; 22:732-5. [PMID: 25196326 DOI: 10.1111/ene.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis is a chronic inflammatory disorder of the central nervous system characterized by acute episodes of neurological dysfunction thought to reflect focal areas of demyelination occurring in clinically eloquent areas. These symptomatic relapses are generally considered to be random clinical events occurring without discernible pattern. The hypothesis that relapses may follow a predetermined sequence and may provide insights into underlying pathological processes was investigated. METHODS Employing prospective clinical database data from 1482 patients who had experienced one or more consecutive relapses were analysed. Using regression analysis, site and symptom of index event were compared with those of first relapse. RESULTS It is demonstrated that following disease ignition subsequent relapses may not be random events but dependent on characteristics of the index event. All anatomical sites were more likely to be affected in the first relapse if that site had been involved in the index event with a similar association observed when comparing by symptoms. CONCLUSION These findings have importance in understanding the evolution of the disease and predicting individual disease progression and may aid with patient counselling and management.
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Affiliation(s)
- M D Willis
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
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14
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Giorgio A, Stromillo ML, Bartolozzi ML, Rossi F, Battaglini M, De Leucio A, Guidi L, Maritato P, Portaccio E, Sormani MP, Amato MP, De Stefano N. Relevance of hypointense brain MRI lesions for long-term worsening of clinical disability in relapsing multiple sclerosis. Mult Scler 2013; 20:214-9. [PMID: 23877971 DOI: 10.1177/1352458513494490] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accrual of brain focal pathology is considered a good substrate of disability in relapsing-remitting multiple sclerosis (RRMS). However, knowledge on long-term lesion evolution and its relationship with disability progression is poor. OBJECTIVE The objective of this paper is to evaluate in RRMS the long-term clinical relevance of brain lesion evolution. METHODS In 58 RRMS patients we acquired, using the same scanner and protocol, brain magnetic resonance imaging (MRI) at baseline and 10±0.5 years later. MRI data were correlated with disability changes as measured by the Expanded Disability Status Scale (EDSS). RESULTS The annualized 10-year lesion volume (LV) growth was +0.25±0.5 cm(3) (+6.7±8.7%) for T2-weighted (T2-W) lesions and +0.20±0.31 cm(3) (+11.5±12.3%) for T1-weighted (T1-W) lesions. The univariate analysis showed moderate correlations between baseline MRI measures and EDSS at 10 years (p < 0.001). Also, 10-year EDSS worsening correlated with LV growth and the number of new/enlarging lesions measured over the same period (p < 0.005). In the stepwise multiple regression analysis, EDSS worsening over 10 years was best correlated with the combination of baseline T1-W lesion count and increasing T1-W LV (R = 0.61, p < 0.001). CONCLUSION In RRMS patients, long-term brain lesion accrual is associated with worsening in clinical disability. This is particularly true for hypointense, destructive lesions.
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Affiliation(s)
- Antonio Giorgio
- Department of Neurological and Behavioral Sciences, University of Siena, Italy
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15
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Tomassini V, Matthews PM, Thompson AJ, Fuglø D, Geurts JJ, Johansen-Berg H, Jones DK, Rocca MA, Wise RG, Barkhof F, Palace J. Neuroplasticity and functional recovery in multiple sclerosis. Nat Rev Neurol 2012; 8:635-46. [PMID: 22986429 PMCID: PMC3770511 DOI: 10.1038/nrneurol.2012.179] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The development of therapeutic strategies that promote functional recovery is a major goal of multiple sclerosis (MS) research. Neuroscientific and methodological advances have improved our understanding of the brain's recovery from damage, generating novel hypotheses about potential targets and modes of intervention, and laying the foundation for development of scientifically informed recovery-promoting strategies in interventional studies. This Review aims to encourage the transition from characterization of recovery mechanisms to development of strategies that promote recovery in MS. We discuss current evidence for functional reorganization that underlies recovery and its implications for development of new recovery-oriented strategies in MS. Promotion of functional recovery requires an improved understanding of recovery mechanisms that can be modulated by interventions and the development of robust measurements of therapeutic effects. As imaging methods can be used to measure functional and structural alterations associated with recovery, this Review discusses their use to obtain reliable markers of the effects of interventions.
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16
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17
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Gelineau-Morel R, Tomassini V, Jenkinson M, Johansen-Berg H, Matthews PM, Palace J. The effect of hypointense white matter lesions on automated gray matter segmentation in multiple sclerosis. Hum Brain Mapp 2011; 33:2802-14. [PMID: 21976406 DOI: 10.1002/hbm.21402] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/28/2011] [Accepted: 06/09/2011] [Indexed: 01/27/2023] Open
Abstract
Previous imaging studies assessing the relationship between white matter (WM) damage and matter (GM) atrophy have raised the concern that Multiple Sclerosis (MS) WM lesions may affect measures of GM volume by inducing voxel misclassification during intensity-based tissue segmentation. Here, we quantified this misclassification error in simulated and real MS brains using a lesion-filling method. Using this method, we also corrected GM measures in patients before comparing them with controls in order to assess the impact of this lesion-induced misclassification error in clinical studies. We found that higher WM lesion volumes artificially reduced total GM volumes. In patients, this effect was about 72% of that predicted by simulation. Misclassified voxels were located at the GM/WM border and could be distant from lesions. Volume of individual deep gray matter (DGM) structures generally decreased with higher lesion volumes, consistent with results from total GM. While preserving differences in GM volumes between patients and controls, lesion-filling correction revealed more lateralised DGM shape changes in patients, which were not evident with the original images. Our results confirm that WM lesions can influence MRI measures of GM volume and shape in MS patients through their effect on intensity-based GM segmentation. The greater effect of lesions at increasing levels of damage supports the use of lesion-filling to correct for this problem and improve the interpretability of the results. Volumetric or morphometric imaging studies, where lesion amount and characteristics may vary between groups of patients or change over time, may especially benefit from this correction.
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Affiliation(s)
- Rose Gelineau-Morel
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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18
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Abstract
Multiple sclerosis is a debilitating disease of the central nervous system that has been characteristically classified as an immune-mediated destruction of myelin, the protective coating on nerve fibers. Although the mechanisms responsible for the immune attack to central nervous system myelin have been the subject of intense investigation, more recent studies have focused on the neurodegenerative component, which is cause of clinical disability in young adults and appears to be only partially controlled by immunomodulatory therapies. Here, we review distinct, but not mutually exclusive, mechanisms of pathogenesis of axonal damage in multiple sclerosis patients that are either consequent to long-term demyelination or independent from it. We propose that the complexity of axonal degeneration and the heterogeneity of the underlying pathogenetic mechanisms should be taken into consideration for the design of targeted therapeutic intervention.
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Affiliation(s)
- Jeffery D Haines
- Departments of Neuroscience Neurology and Genetics and Genomics, Mount Sinai School of Medicine, New York, NY, USA
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19
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Sbardella E, Tomassini V, Stromillo ML, Filippini N, Battaglini M, Ruggieri S, Ausili Cefaro L, Raz E, Gasperini C, Sormani MP, Pantano P, Pozzilli C, De Stefano N. Pronounced focal and diffuse brain damage predicts short-term disease evolution in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2011; 17:1432-40. [DOI: 10.1177/1352458511414602] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In clinically isolated syndrome (CIS), the role of quantitative magnetic resonance imaging (MRI) in detecting prognostic markers is still debated. Objective: To evaluate measures of diffuse brain damage (such as brain atrophy and the ratio of N-acetylaspartate to creatine (NAA/Cr)) in patients with CIS, in addition to focal lesions, as predictors of 1-year disease evolution. Methods: 49 patients with CIS underwent MRI scans to quantify T2-lesions (T2-L) and gadolinium-enhanced lesion (GEL) number at baseline and after 1 year. Along with 25 healthy volunteers, they also underwent combined MRI/magnetic resonance spectroscopy examination to measure normalized brain volumes (NBVs) and NAA/Cr. Occurrence of relapses and new T2-L was recorded over 1 year to assess disease evolution. Results: Occurrence of relapses and/or new T2-L over 1 year divided patients with CIS into ‘active’ and ‘stable’ groups. Active patients had lower baseline NAA/Cr and NBV. Baseline T2-L number, GEL, NAA/Cr and NBV predicted subsequent disease activity. Multivariable logistic regression models showed that both ‘focal damage’ (based on T2-L number and GEL) and ‘diffuse damage’ (based on NBV and NAA/Cr) models predicted disease activity at 1 year with great sensitivity, specificity and accuracy. This was best when the four MRI measures were combined (80% sensitivity, 89% specificity, 83% accuracy). Conclusions: Quantitative MRI measures of diffuse tissue damage such as brain atrophy and NAA/Cr, in addition to measures of focal demyelinating lesions, may predict short-term disease evolution in patients with CIS, particularly when used in combination. If confirmed in larger studies, these findings may have important clinical and therapeutic implications.
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Affiliation(s)
- E Sbardella
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Italy
| | - V Tomassini
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
| | - ML Stromillo
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - N Filippini
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, UK
- Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M Battaglini
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - S Ruggieri
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - E Raz
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - MP Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | - C Pozzilli
- S. Andrea Hospital, “Sapienza” University of Rome, Italy
| | - N De Stefano
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
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Hagman S, Raunio M, Rossi M, Dastidar P, Elovaara I. Disease-associated inflammatory biomarker profiles in blood in different subtypes of multiple sclerosis: Prospective clinical and MRI follow-up study. J Neuroimmunol 2011; 234:141-7. [DOI: 10.1016/j.jneuroim.2011.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/03/2011] [Accepted: 02/15/2011] [Indexed: 12/29/2022]
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