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Májovská J, Nestrašil I, Ahmed A, Bondy MT, Klempíř J, Jahnová H, Schneider SA, Horáková D, Krásenský J, Ješina P, Vaneckova M, Nascene DR, Whitley CB, Jarnes JR, Magner M, Dušek P. Quantitative brain morphometry identifies cerebellar, cortical, and subcortical gray and white matter atrophy in late-onset Tay-Sachs disease. J Inherit Metab Dis 2024; 47:327-339. [PMID: 38112342 PMCID: PMC10947897 DOI: 10.1002/jimd.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Cerebellar atrophy is a characteristic sign of late-onset Tay-Sachs disease (LOTS). Other structural neuroimaging abnormalities are inconsistently reported. Our study aimed to perform a detailed whole-brain analysis and quantitatively characterize morphometric changes in LOTS patients. Fourteen patients (8 M/6F) with LOTS from three centers were included in this retrospective study. For morphometric brain analyses, we used deformation-based morphometry, voxel-based morphometry, surface-based morphometry, and spatially unbiased cerebellar atlas template. The quantitative whole-brain morphometric analysis confirmed the finding of profound pontocerebellar atrophy with most affected cerebellar lobules V and VI in LOTS patients. Additionally, the atrophy of structures mainly involved in motor control, including bilateral ventral and lateral thalamic nuclei, primary motor and sensory cortex, supplementary motor area, and white matter regions containing corticospinal tract, was present. The atrophy of the right amygdala, hippocampus, and regions of occipital, parietal and temporal white matter was also observed in LOTS patients in contrast with controls (p < 0.05, FWE corrected). Patients with dysarthria and those initially presenting with ataxia had more severe cerebellar atrophy. Our results show predominant impairment of cerebellar regions responsible for speech and hand motor function in LOTS patients. Widespread morphological changes of motor cortical and subcortical regions and tracts in white matter indicate abnormalities in central motor circuits likely coresponsible for impaired speech and motor function.
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Affiliation(s)
- Jitka Májovská
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Monica T Bondy
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Helena Jahnová
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | | | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Jan Krásenský
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Pavel Ješina
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David R Nascene
- Department of Neuroradiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Chester B Whitley
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Gene Therapy and Diagnostic Laboratory, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Jeanine R Jarnes
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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2
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Ravano V, Piredda GF, Krasensky J, Andelova M, Uher T, Srpova B, Havrdova EK, Vodehnalova K, Horakova D, Nytrova P, Disselhorst JA, Hilbert T, Maréchal B, Thiran JP, Kober T, Richiardi J, Vaneckova M. Tract-wise microstructural analysis informs on current and future disability in early multiple sclerosis. J Neurol 2024; 271:631-641. [PMID: 37819462 PMCID: PMC10827809 DOI: 10.1007/s00415-023-12023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Microstructural characterization of patients with multiple sclerosis (MS) has been shown to correlate better with disability compared to conventional radiological biomarkers. Quantitative MRI provides effective means to characterize microstructural brain tissue changes both in lesions and normal-appearing brain tissue. However, the impact of the location of microstructural alterations in terms of neuronal pathways has not been thoroughly explored so far. Here, we study the extent and the location of tissue changes probed using quantitative MRI along white matter (WM) tracts extracted from a connectivity atlas. METHODS We quantified voxel-wise T1 tissue alterations compared to normative values in a cohort of 99 MS patients. For each WM tract, we extracted metrics reflecting tissue alterations both in lesions and normal-appearing WM and correlated these with cross-sectional disability and disability evolution after 2 years. RESULTS In early MS patients, T1 alterations in normal-appearing WM correlated better with disability evolution compared to cross-sectional disability. Further, the presence of lesions in supratentorial tracts was more strongly associated with cross-sectional disability, while microstructural alterations in infratentorial pathways yielded higher correlations with disability evolution. In progressive patients, all major WM pathways contributed similarly to explaining disability, and correlations with disability evolution were generally poor. CONCLUSIONS We showed that microstructural changes evaluated in specific WM pathways contribute to explaining future disability in early MS, hence highlighting the potential of tract-wise analyses in monitoring disease progression. Further, the proposed technique allows to estimate WM tract-specific microstructural characteristics in clinically compatible acquisition times, without the need for advanced diffusion imaging.
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Affiliation(s)
- Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petra Nytrova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jonathan A Disselhorst
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Motyl J, Friedova L, Ganapathy Subramanian R, Vaneckova M, Fuchs TA, Krasensky J, Blahova Dusankova J, Kubala Havrdova E, Horakova D, Uher T. Brain MRI disease burden and sex differences in cognitive performance of patients with multiple sclerosis. Acta Neurol Belg 2024; 124:109-118. [PMID: 37552396 DOI: 10.1007/s13760-023-02350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Although there is evidence that shows worse cognitive functioning in male patients with multiple sclerosis (MS), the role of brain pathology in this context is under-investigated. OBJECTIVE To investigate sex differences in cognitive performance of MS patients, in the context of brain pathology and disease burden. METHODS Brain MRI, neurological examination, neuropsychological assessment (Brief International Cognitive Assessment in MS-BICAMS, and Paced Auditory Verbal Learning Test-PASAT), and patient-reported outcome questionnaires were performed/administered in 1052 MS patients. RESULTS Females had higher raw scores in the Symbol Digit Modalities Test (SDMT) (57.0 vs. 54.0; p < 0.001) and Categorical Verbal Learning Test (CVLT) (63.0 vs. 57.0; p < 0.001), but paradoxically, females evaluated their cognitive performance by MS Neuropsychological Questionnaire as being worse (16.6 vs 14.5, p = 0.004). Females had a trend for a weaker negative correlation between T2 lesion volume and SDMT ([Formula: see text] = - 0.37 in females vs. - 0.46 in men; interaction p = 0.038). On the other hand, women had a trend for a stronger correlation between Brain Parenchymal Fraction (BPF) and a visual memory test (Spearman's [Formula: see text] = 0.31 vs. 0.21; interaction p = 0.016). All these trends were not significant after correction for false discovery rate. CONCLUSIONS Although, females consider their cognition as worse, males had at a group level slightly worse verbal memory and information processing speed. However, the sex differences in cognitive performance were smaller than the variability of scores within the same sex group. Brain MRI measures did not explain the sex differences in cognitive performance among MS patients.
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Affiliation(s)
- Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic
| | - Ranjani Ganapathy Subramanian
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tom A Fuchs
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Multiple Sclerosis Center, Charles University and General University Hospital, Katerinska 30, 120 00, Prague, Czech Republic.
- Department of Physiotherapy, Faculty of Health Care, University of Presov, Prešov, Slovak Republic.
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Fleischer V, Gonzalez-Escamilla G, Pareto D, Rovira A, Sastre-Garriga J, Sowa P, Høgestøl EA, Harbo HF, Bellenberg B, Lukas C, Ruggieri S, Gasperini C, Uher T, Vaneckova M, Bittner S, Othman AE, Collorone S, Toosy AT, Meuth SG, Zipp F, Barkhof F, Ciccarelli O, Groppa S. Prognostic value of single-subject grey matter networks in early multiple sclerosis. Brain 2024; 147:135-146. [PMID: 37642541 PMCID: PMC10766234 DOI: 10.1093/brain/awad288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
The identification of prognostic markers in early multiple sclerosis (MS) is challenging and requires reliable measures that robustly predict future disease trajectories. Ideally, such measures should make inferences at the individual level to inform clinical decisions. This study investigated the prognostic value of longitudinal structural networks to predict 5-year Expanded Disability Status Scale (EDSS) progression in patients with relapsing-remitting MS (RRMS). We hypothesized that network measures, derived from MRI, outperform conventional MRI measurements at identifying patients at risk of developing disability progression. This longitudinal, multicentre study within the Magnetic Resonance Imaging in MS (MAGNIMS) network included 406 patients with RRMS (mean age = 35.7 ± 9.1 years) followed up for 5 years (mean follow-up = 5.0 ± 0.6 years). EDSS was determined to track disability accumulation. A group of 153 healthy subjects (mean age = 35.0 ± 10.1 years) with longitudinal MRI served as controls. All subjects underwent MRI at baseline and again 1 year after baseline. Grey matter atrophy over 1 year and white matter lesion load were determined. A single-subject brain network was reconstructed from T1-weighted scans based on grey matter atrophy measures derived from a statistical parameter mapping-based segmentation pipeline. Key topological measures, including network degree, global efficiency and transitivity, were calculated at single-subject level to quantify network properties related to EDSS progression. Areas under receiver operator characteristic (ROC) curves were constructed for grey matter atrophy and white matter lesion load, and the network measures and comparisons between ROC curves were conducted. The applied network analyses differentiated patients with RRMS who experience EDSS progression over 5 years through lower values for network degree [H(2) = 30.0, P < 0.001] and global efficiency [H(2) = 31.3, P < 0.001] from healthy controls but also from patients without progression. For transitivity, the comparisons showed no difference between the groups [H(2) = 1.5, P = 0.474]. Most notably, changes in network degree and global efficiency were detected independent of disease activity in the first year. The described network reorganization in patients experiencing EDSS progression was evident in the absence of grey matter atrophy. Network degree and global efficiency measurements demonstrated superiority of network measures in the ROC analyses over grey matter atrophy and white matter lesion load in predicting EDSS worsening (all P-values < 0.05). Our findings provide evidence that grey matter network reorganization over 1 year discloses relevant information about subsequent clinical worsening in RRMS. Early grey matter restructuring towards lower network efficiency predicts disability accumulation and outperforms conventional MRI predictors.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Barbara Bellenberg
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Serena Ruggieri
- Department of Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sara Collorone
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Ahmed T Toosy
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Frederik Barkhof
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, 1100 DD Amsterdam, Netherlands
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Rekova P, Kovarova I, Uher T, Srpova B, Dostalova G, Linhart A, Vaneckova M, Stastna D. Missed diagnosis of Fabry disease: should we screen patients with multiple sclerosis? Neurol Sci 2024; 45:231-239. [PMID: 37480392 PMCID: PMC10761551 DOI: 10.1007/s10072-023-06962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Fabry disease (FD) can be undiagnosed in the context of multiple sclerosis (MS) due to similar clinical and paraclinical features. Our study aimed to determine the prevalence (and the necessity of screening) of FD among patients with possible or definite MS. METHODS In this prospective monocentric observational study, we included consecutive patients enrolled between May 2017 and May 2019 after the first clinical event suggestive of MS. All patients underwent FD screening using dried blood spots in a stepwise manner combining genetic and enzyme testing. Patients were followed until May 2022. RESULTS We included 160 patients (73.1% female, mean age 33.9 years). The 2017 revised McDonald's criteria for definite MS were fulfilled by 74 (46.3%) patients at the time of study recruitment and 89 (55.6%) patients after 3-5 years of follow-up. None of the patients had a pathogenic GLA variant, and four (2.5%) had a variant of unknown significance (p.A143T, p.S126G, 2 × p.D313Y). In two of these patients, the intrathecal synthesis of oligoclonal bands was absent, and none had hyperproteinorachia or pleocytosis in cerebrospinal fluid. Detailed examination of FD organ manifestations revealed only discrete ocular and kidney involvement in two patients. CONCLUSION The prevalence of FD in the population of suspected or definite MS patients does not appear to be high. Our results do not support routine FD screening in all patients with a possible diagnosis of MS, but there is an urgent need to search for red flags and include FD in the differential diagnosis of MS.
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Affiliation(s)
- Petra Rekova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ivana Kovarova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Tomas Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Gabriela Dostalova
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ales Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Dominika Stastna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
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Uher T, Adzima A, Srpova B, Noskova L, Maréchal B, Maceski AM, Krasensky J, Stastna D, Andelova M, Novotna K, Vodehnalova K, Motyl J, Friedova L, Lindner J, Ravano V, Burgetova A, Dusek P, Fialova L, Havrdova EK, Horakova D, Kober T, Kuhle J, Vaneckova M. Diagnostic delay of multiple sclerosis: prevalence, determinants and consequences. Mult Scler 2023; 29:1437-1451. [PMID: 37840276 PMCID: PMC10580682 DOI: 10.1177/13524585231197076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Early diagnosis and treatment of patients with multiple sclerosis (MS) are associated with better outcomes; however, diagnostic delays remain a major problem. OBJECTIVE Describe the prevalence, determinants and consequences of delayed diagnoses. METHODS This single-centre ambispective study analysed 146 adult relapsing-remitting MS patients (2016-2021) for frequency and determinants of diagnostic delays and their associations with clinical, cognitive, imaging and biochemical measures. RESULTS Diagnostic delays were identified in 77 patients (52.7%), including 42 (28.7%) physician-dependent cases and 35 (24.0%) patient-dependent cases. Diagnosis was delayed in 22 (15.1%) patients because of misdiagnosis by a neurologist. A longer diagnostic delay was associated with trends towards greater Expanded Disability Status Scale (EDSS) scores (B = 0.03; p = 0.034) and greater z-score of the blood neurofilament light chain (B = 0.35; p = 0.031) at the time of diagnosis. Compared with patients diagnosed at their first clinical relapse, patients with a history of >1 relapse at diagnosis (n = 63; 43.2%) had a trend towards greater EDSS scores (B = 0.06; p = 0.006) and number of total (B = 0.13; p = 0.040) and periventricular (B = 0.06; p = 0.039) brain lesions. CONCLUSION Diagnostic delays in MS are common, often determined by early misdiagnosis and associated with greater disease burden.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Adrian Adzima
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Libuse Noskova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Aleksandra Maleska Maceski
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Dominika Stastna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jiri Lindner
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Andrea Burgetova
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic/Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Lenka Fialova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland/Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
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7
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Rekova P, Dostalova G, Rob D, Vaneckova M, Pavlicova M, Linhart A, Kemlink D. Cerebrovascular Phenotype in Fabry Disease Patients Assessed by Ultrasound. J Ultrasound Med 2023; 42:2315-2330. [PMID: 37209359 DOI: 10.1002/jum.16254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Fabry disease (FD) is a rare X-linked lysosomal storage disorder with variable phenotypes, including neurological symptoms. These can be influenced by vascular impairment. Extracranial and transcranial vascular sonography is an effective and noninvasive method for measuring arterial structures and blood flow. The study aims to investigate cerebrovascular phenotype characteristics in FD patients compared to controls using neurosonology. METHODS This is a single-center, cross-sectional study of 130 subjects-65 patients (38 females), with genetically confirmed FD, and 65 sex- and age-matched controls. Using ultrasonography, we measured structural and hemodynamic parameters, including distal common carotid artery intima-media thickness, inner vertebral artery diameter, resting blood flow velocity, pulsatility index, and cerebral vasoreactivity (CVR) in the middle cerebral artery. To assess differences between FD and controls and to identify factors influencing investigated outcomes, unadjusted and adjusted regression analyses were performed. RESULTS In comparison to sex- and age-matched controls, FD patients displayed significantly increased carotid artery intima-media thickness (observed FD 0.69 ± 0.13 mm versus controls 0.63 ± 0.12 mm; Padj = .0014), vertebral artery diameter (observed FD 3.59 ± 0.35 mm versus controls 3.38 ± 0.33 mm; Padj = .0002), middle cerebral artery pulsatility index (observed FD 0.98 ± 0.19 versus controls 0.87 ± 0.11; Padj < .0001), and significantly decreased CVR (observed FD 1.21 ± 0.49 versus controls 1.35 ± 0.38; Padj = .0409), when adjusted by age, BMI, and sex. Additionally, FD patients had significantly more variable CVR (0.48 ± 0.25 versus 0.21 ± 0.14; Padj < .0001). CONCLUSIONS Our results suggest the presence of multiple vascular abnormalities and changes in hemodynamic parameters of cerebral arteries in patients with FD.
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Affiliation(s)
- Petra Rekova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Dostalova
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Daniel Rob
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Ales Linhart
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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8
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Burgetova A, Dusek P, Uher T, Vaneckova M, Vejrazka M, Burgetova R, Horakova D, Srpova B, Kalousova M, Noskova L, Levova K, Krasensky J, Lambert L. CSF Markers of Oxidative Stress Are Associated with Brain Atrophy and Iron Accumulation in a 2-Year Longitudinal Cohort of Early MS. Int J Mol Sci 2023; 24:10048. [PMID: 37373196 DOI: 10.3390/ijms241210048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
In this prospective longitudinal study, we quantified regional brain volume and susceptibility changes during the first two years after the diagnosis of multiple sclerosis (MS) and identified their association with cerebrospinal fluid (CSF) markers at baseline. Seventy patients underwent MRI (T1 and susceptibility weighted images processed to quantitative susceptibility maps, QSM) with neurological examination at the diagnosis and after two years. In CSF obtained at baseline, the levels of oxidative stress, products of lipid peroxidation, and neurofilaments light chain (NfL) were determined. Brain volumetry and QSM were compared with a group of 58 healthy controls. In MS patients, regional atrophy was identified in the striatum, thalamus, and substantia nigra. Magnetic susceptibility increased in the striatum, globus pallidus, and dentate and decreased in the thalamus. Compared to controls, MS patients developed greater atrophy of the thalamus, and a greater increase in susceptibility in the caudate, putamen, globus pallidus and a decrease in the thalamus. Of the multiple calculated correlations, only the decrease in brain parenchymal fraction, total white matter, and thalamic volume in MS patients negatively correlated with increased NfL in CSF. Additionally, negative correlation was found between QSM value in the substantia nigra and peroxiredoxin-2, and QSM value in the dentate and lipid peroxidation levels.
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Affiliation(s)
- Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Petr Dusek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Martin Vejrazka
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Romana Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
- Department of Radiology, Third Faculty of Medicine, Charles University, 100 34 Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Marta Kalousova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Libuse Noskova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Katerina Levova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic
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9
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Reis LM, Maheshwari M, Capasso J, Atilla H, Dudakova L, Thompson S, Zitano L, Lay-Son G, Lowry RB, Black J, Lee J, Shue A, Kremlikova Pourova R, Vaneckova M, Skalicka P, Jedlickova J, Trkova M, Williams B, Richard G, Bachman K, Seeley AH, Costakos D, Glaser TM, Levin AV, Liskova P, Murray JC, Semina EV. Axenfeld-Rieger syndrome: more than meets the eye. J Med Genet 2023; 60:368-379. [PMID: 35882526 PMCID: PMC9912354 DOI: 10.1136/jmg-2022-108646] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Axenfeld-Rieger syndrome (ARS) is characterised by typical anterior segment anomalies, with or without systemic features. The discovery of causative genes identified ARS subtypes with distinct phenotypes, but our understanding is incomplete, complicated by the rarity of the condition. METHODS Genetic and phenotypic characterisation of the largest reported ARS cohort through comprehensive genetic and clinical data analyses. RESULTS 128 individuals with causative variants in PITX2 or FOXC1, including 81 new cases, were investigated. Ocular anomalies showed significant overlap but with broader variability and earlier onset of glaucoma for FOXC1-related ARS. Systemic anomalies were seen in all individuals with PITX2-related ARS and the majority of those with FOXC1-related ARS. PITX2-related ARS demonstrated typical umbilical anomalies and dental microdontia/hypodontia/oligodontia, along with a novel high rate of Meckel diverticulum. FOXC1-related ARS exhibited characteristic hearing loss and congenital heart defects as well as previously unrecognised phenotypes of dental enamel hypoplasia and/or crowding, a range of skeletal and joint anomalies, hypotonia/early delay and feeding disorders with structural oesophageal anomalies in some. Brain imaging revealed highly penetrant white matter hyperintensities, colpocephaly/ventriculomegaly and frequent arachnoid cysts. The expanded phenotype of FOXC1-related ARS identified here was found to fully overlap features of De Hauwere syndrome. The results were used to generate gene-specific management plans for the two types of ARS. CONCLUSION Since clinical features of ARS vary significantly based on the affected gene, it is critical that families are provided with a gene-specific diagnosis, PITX2-related ARS or FOXC1-related ARS. De Hauwere syndrome is proposed to be a FOXC1opathy.
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Affiliation(s)
- Linda M Reis
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohit Maheshwari
- Department of Pediatric Radiology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenina Capasso
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Golisano Children's Hospital and University of Rochester, Rochester, New York, USA
| | - Huban Atilla
- Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey
| | - Lubica Dudakova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Samuel Thompson
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Lia Zitano
- Department of Medical Genetics, Spectrum Health, Grand Rapids, Michigan, USA
| | - Guillermo Lay-Son
- Unidad de Genética, División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Brian Lowry
- Department of Clinical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jennifer Black
- Center for Development, Behavior, and Genetics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph Lee
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ann Shue
- Byers Eye Institute, Department of Ophthalmology, Stanford University and Stanford Children's Health, Stanford, California, USA
| | - Radka Kremlikova Pourova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavlina Skalicka
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jana Jedlickova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marie Trkova
- Gennet, Centre for Fetal Medicine and Reproductive Genetics, Prague, Czech Republic
| | | | | | - Kristine Bachman
- Department of Pediatrics, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Andrea H Seeley
- Department of Pediatrics, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Deborah Costakos
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas M Glaser
- Department of Cell Biology and Human Anatomy, UC-Davis School of Medicine, Davis, California, USA
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Golisano Children's Hospital and University of Rochester, Rochester, New York, USA
| | - Petra Liskova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Elena V Semina
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Oship D, Jakimovski D, Bergsland N, Horakova D, Uher T, Vaneckova M, Havrdova E, Dwyer MG, Zivadinov R. Assessment of T2 lesion-based disease activity volume outcomes in predicting disease progression in multiple sclerosis over 10 years. Mult Scler Relat Disord 2022; 67:104187. [PMID: 36150263 DOI: 10.1016/j.msard.2022.104187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/16/2022] [Accepted: 09/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND New/enlarging T2 lesion count and T2-lesion volume (LV) are used as conventional secondary endpoints in clinical trials of patients with multiple sclerosis (PwMS). However, those outcomes may have several limitations, such as inability to account for heterogeneity of lesion formation/enlargement frequency and their dynamic volumetric behavior. Measurement of volume rather than count of new/enlarging lesions may be more representative outcome of dynamic changes over time. OBJECTIVES To investigate whether new/enlarging T2-LV is more predictive of confirmed disability progression (CDP), compared to total T2-LV or new/enlarging T2 lesion count over long-term follow-up. METHODS We studied 176 early relapsing-remitting PwMS who were followed with annual MRI examinations over 10 years. T2-LV, new/enlarging T2-LV, and new/enlarging lesion count were determined. Cumulative count/volumes were obtained. 10-year CDP was confirmed after 48-weeks. ANCOVA analysis detected MRI outcome differences in stable (n = 76) and CDP (n = 100) groups at different time points, after correction for multiple comparisons. RESULTS PwMS with CDP had greater cumulative new/enlarging T2-LV at 4 years (p = 0.049), and enlarging T2-LV at 4- (p = 0.039) and 6-year follow-up (p = 0.032), compared to stable patients. PwMS with CDP did not differ from stable ones in new/enlarging T2 lesion count or total T2-LV at any of the study timepoints. PwMS with Expanded Disability Status Scale change >2.0 had significantly greater enlarging T2 lesion count (p = 0.01) and enlarging T2-LV (p = 0.038) over the 10-year follow-up. CONCLUSION Enlargement of T2 lesions is more strongly associated with long-term disability progression compared to other conventional T2 lesion-based outcomes.
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Affiliation(s)
- Devon Oship
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States.
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11
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Andelova M, Vodehnalova K, Krasensky J, Hardubejova E, Hrnciarova T, Srpova B, Uher T, Menkyova I, Stastna D, Friedova L, Motyl J, Lizrova Preiningerova J, Kubala Havrdova E, Maréchal B, Fartaria MJ, Kober T, Horakova D, Vaneckova M. Brainstem lesions are associated with diffuse spinal cord involvement in early multiple sclerosis. BMC Neurol 2022; 22:270. [PMID: 35854235 PMCID: PMC9297663 DOI: 10.1186/s12883-022-02778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early infratentorial and focal spinal cord lesions on magnetic resonance imaging (MRI) are associated with a higher risk of long-term disability in patients with multiple sclerosis (MS). The role of diffuse spinal cord lesions remains less understood. The purpose of this study was to evaluate focal and especially diffuse spinal cord lesions in patients with early relapsing-remitting MS and their association with intracranial lesion topography, global and regional brain volume, and spinal cord volume. Methods We investigated 58 MS patients with short disease duration (< 5 years) from a large academic MS center and 58 healthy controls matched for age and sex. Brain, spinal cord, and intracranial lesion volumes were compared among patients with- and without diffuse spinal cord lesions and controls. Binary logistic regression models were used to analyse the association between the volume and topology of intracranial lesions and the presence of focal and diffuse spinal cord lesions. Results We found spinal cord involvement in 75% of the patients (43/58), including diffuse changes in 41.4% (24/58). Patients with diffuse spinal cord changes exhibited higher volumes of brainstem lesion volume (p = 0.008). The presence of at least one brainstem lesion was associated with a higher probability of the presence of diffuse spinal cord lesions (odds ratio 47.1; 95% confidence interval 6.9–321.6 p < 0.001) as opposed to focal spinal cord lesions (odds ratio 0.22; p = 0.320). Patients with diffuse spinal cord lesions had a lower thalamus volume compared to patients without diffuse spinal cord lesions (p = 0.007) or healthy controls (p = 0.002). Conclusions Diffuse spinal cord lesions are associated with the presence of brainstem lesions and with a lower volume of the thalamus. This association was not found in patients with focal spinal cord lesions. If confirmed, thalamic atrophy in patients with diffuse lesions could increase our knowledge on the worse prognosis in patients with infratentorial and SC lesions. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02778-z.
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Affiliation(s)
- Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic.
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eliska Hardubejova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tereza Hrnciarova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Ingrid Menkyova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic.,2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Dominika Stastna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Jana Lizrova Preiningerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, Praha 2, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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12
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Dudakova L, Tuft S, Cheong S, Skalicka P, Jedlickova J, Fichtl M, Hlozanek M, Filous A, Vaneckova M, Vincent AL, Hardcastle AJ, Davidson AE, Liskova P. Novel disease-causing variants and phenotypic features of X-linked megalocornea. Acta Ophthalmol 2022; 100:431-439. [PMID: 34644435 DOI: 10.1111/aos.15022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the study was to describe the phenotype and molecular genetic causes of X-linked megalocornea (MGC1). We recruited four British, one New Zealand, one Vietnamese and four Czech families. METHODS All probands and three female carriers underwent ocular examination and Sanger sequencing of the CHRDL1 gene. Two of the probands also had magnetic resonance imaging (MRI) of the brain. RESULTS We identified nine pathogenic or likely pathogenic and one variant of uncertain significance in CHRDL1, of which eight are novel. Three probands had ocular findings that have not previously been associated with MGC1, namely pigmentary glaucoma, unilateral posterior corneal vesicles, unilateral keratoconus and unilateral Fuchs heterochromic iridocyclitis. The corneal diameters of the three heterozygous carriers were normal, but two had abnormally thin corneas, and one of these was also diagnosed with unilateral keratoconus. Brain MRI identified arachnoid cysts in both probands, one also had a neuroepithelial cyst, while the second had a midsagittal neurodevelopmental abnormality (cavum septum pellucidum et vergae). CONCLUSION The study expands the spectrum of pathogenic variants and the ocular and brain abnormalities that have been identified in individuals with MGC1. Reduced corneal thickness may represent a mild phenotypic feature in some heterozygous female carriers of CHRDL1 pathogenic variants.
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Affiliation(s)
- Lubica Dudakova
- Research Unit for Rare Diseases Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | | | - Pavlina Skalicka
- Research Unit for Rare Diseases Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Jana Jedlickova
- Research Unit for Rare Diseases Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Marek Fichtl
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Martin Hlozanek
- Department of Ophthalmology Second Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic
- Ophthalmology Department Third Faculty of Medicine Charles University and Teaching Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ales Filous
- Department of Ophthalmology Second Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic
| | - Manuela Vaneckova
- Department of Radiodiagnostics First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Andrea L. Vincent
- Department of Ophthalmology New Zealand National Eye Centre University of Auckland Auckland New Zealand
| | | | | | - Petra Liskova
- Research Unit for Rare Diseases Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
- UCL Institute of Ophthalmology London UK
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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13
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Vaneckova M, Piredda GF, Andelova M, Krasensky J, Uher T, Srpova B, Havrdova EK, Vodehnalova K, Horakova D, Hilbert T, Maréchal B, Fartaria MJ, Ravano V, Kober T. Periventricular gradient of T 1 tissue alterations in multiple sclerosis. Neuroimage Clin 2022; 34:103009. [PMID: 35561554 PMCID: PMC9112026 DOI: 10.1016/j.nicl.2022.103009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023]
Abstract
T1 relaxation times alterations were assessed based on a study-specific atlas. T1 alterations depend on distance from lateral ventricles (“periventricular gradient”). Gradient parameters correlate better with disability compared to conventional MRI.
Objective Pathology in multiple sclerosis is not homogenously distributed. Recently, it has been shown that structures adjacent to CSF are more severely affected. A gradient of brain tissue involvement was shown with more severe pathology in periventricular areas and in proximity to brain surfaces such as the subarachnoid spaces and ependyma, and hence termed the “surface–in” gradient. Here, we study whether (i) the surface-in gradient of periventricular tissue alteration measured by T1 relaxometry is already present in early multiple sclerosis patients, (ii) how it differs between early and progressive multiple sclerosis patients, and (iii) whether the gradient-derived metrics in normal-appearing white matter and lesions correlate better with physical disability than conventional MRI-based metrics. Methods Forty-seven patients with early multiple sclerosis, 52 with progressive multiple sclerosis, and 92 healthy controls were included in the study. Isotropic 3D T1 relaxometry maps were obtained using the Magnetization-Prepared 2 Rapid Acquisition Gradient Echoes sequence at 3 T. After spatially normalizing the T1 maps into a study-specific common space, T1 inter-subject variability within the healthy cohort was modelled voxel-wise, yielding a normative T1 atlas. Individual comparisons of each multiple sclerosis patient against the atlas were performed by computing z-scores. Equidistant bands of voxels were defined around the ventricles in the supratentorial white matter; the z-scores in these bands were analysed and compared between the early and progressive multiple sclerosis cohorts. Correlations between both conventional and z-score-gradient-derived MRI metrics and the Expanded Disability Status Scale were assessed. Results Patients with early and progressive multiple sclerosis demonstrated a periventricular gradient of T1 relaxation time z-scores. In progressive multiple sclerosis, z-score-derived metrics reflecting the gradient of tissue abnormality in normal-appearing white matter were more strongly correlated with disability (maximal rho = 0.374) than the conventional lesion volume and count (maximal rho = 0.189 and 0.21 respectively). In early multiple sclerosis, the gradient of normal-appearing white matter volume with z-scores > 2 at baseline correlated with clinical disability assessed at two years follow-up. Conclusion Our results suggest that the surface-in white matter gradient of tissue alteration is detectable with T1 relaxometry and is already present at clinical disease onset. The periventricular gradients correlate with clinical disability. The periventricular gradient in normal-appearing white matter may thus qualify as a promising biomarker for monitoring of disease activity from an early stage in all phenotypes of multiple sclerosis.
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Affiliation(s)
- Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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14
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Carolus K, Fuchs TA, Bergsland N, Ramasamy D, Tran H, Uher T, Horakova D, Vaneckova M, Havrdova E, Benedict RHB, Zivadinov R, Dwyer MG. Time course of lesion-induced atrophy in multiple sclerosis. J Neurol 2022; 269:4478-4487. [PMID: 35394170 DOI: 10.1007/s00415-022-11094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE White matter (WM) tract disruption impacts volume loss in connected deep gray matter (DGM) over 5 years in people with multiple sclerosis (PwMS). However, the timeline of this phenomenon remains poorly characterized. MATERIALS AND METHODS Annual serial MRI for 181 PwMS was retrospectively analyzed from a 10-year clinical trial database. Annualized thalamic atrophy, DGM atrophy, and disruption of connected WM tracts were measured. For time series analysis, ~700 epochs were collated using a sliding 5-year window, and regression models predicting 1-year atrophy were applied to characterize the influence of new tract disruption from preceding years, while controlling for whole brain atrophy and other relevant factors. RESULTS Disruptions of WM tracts connected to the thalamus were significantly associated with thalamic atrophy 1 year later (β: 0.048-0.103). This effect was not observed for thalamic tract disruption concurrent with the time of atrophy nor for thalamic tract disruption preceding the atrophy by 2-4 years. Similarly, disruptions of white matter tracts connected to the DGM were significantly associated with DGM atrophy 1 year later (β: 0.078-0.111), but not for tract disruption concurrent with, nor preceding the atrophy by 2-4 years. CONCLUSION Increased rates of thalamic and DGM atrophy were restricted to 1 year following newly developed disruption in connected WM tracts. In research and clinical settings, additional gray matter atrophy may be expected 1 year following new lesion growth in connected white matter.
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Affiliation(s)
- Keith Carolus
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Tom A Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Deepa Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Hoan Tran
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ralph H B Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.
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15
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Ravano V, Andelova M, Fartaria MJ, Mahdi MFAW, Maréchal B, Meuli R, Uher T, Krasensky J, Vaneckova M, Horakova D, Kober T, Richiardi J. Validating atlas-based lesion disconnectomics in multiple sclerosis: A retrospective multi-centric study. Neuroimage Clin 2022; 32:102817. [PMID: 34500427 PMCID: PMC8429972 DOI: 10.1016/j.nicl.2021.102817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
Structural disconnectomes can be modelled without diffusion using tractography atlases. Atlas-based and DTI-derived disconnectome topological metrics correlate strongly. MS patient disconnectomes relate to clinical scores.
The translational potential of MR-based connectivity modelling is limited by the need for advanced diffusion imaging, which is not part of clinical protocols for many diseases. In addition, where diffusion data is available, brain connectivity analyses rely on tractography algorithms which imply two major limitations. First, tracking algorithms are known to be sensitive to the presence of white matter lesions and therefore leading to interpretation pitfalls and poor inter-subject comparability in clinical applications such as multiple sclerosis. Second, tractography quality is highly dependent on the acquisition parameters of diffusion sequences, leading to a trade-off between acquisition time and tractography precision. Here, we propose an atlas-based approach to study the interplay between structural disconnectivity and lesions without requiring individual diffusion imaging. In a multi-centric setting involving three distinct multiple sclerosis datasets (containing both 1.5 T and 3 T data), we compare our atlas-based structural disconnectome computation pipeline to disconnectomes extracted from individual tractography and explore its clinical utility for reducing the gap between radiological findings and clinical symptoms in multiple sclerosis. Results using topological graph properties showed that overall, our atlas-based disconnectomes were suitable approximations of individual disconnectomes from diffusion imaging. Small-worldness was found to decrease for larger total lesion volumes thereby suggesting a loss of efficiency in brain connectivity of MS patients. Finally, the global efficiency of the created brain graph, combined with total lesion volume, allowed to stratify patients into subgroups with different clinical scores in all three cohorts.
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Affiliation(s)
- Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- MR unit, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- MR unit, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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16
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Uher T, Kubala Havrdova E, Vodehnalova K, Krasensky J, Capek V, Vaneckova M, Horakova D. Pregnancy-induced brain MRI changes in women with multiple sclerosis. Eur J Neurol 2022; 29:1446-1456. [PMID: 35015921 DOI: 10.1111/ene.15245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of pregnancy on brain changes and radiological disease activity in women with multiple sclerosis (MS) is not well understood. AIMS To describe the dynamic of lesion activity and brain volume changes during the pregnancy and postpartum periods. METHODS This observational study of 62 women with relapsing-remitting MS included MRI (221 scans) as well as clinical visits at baseline (<24 and >6 months before), prepregnancy (<6 months before), postpartum (<3 months after), and the follow-up (>12 and <24 months after delivery) period. RESULTS The majority of women had a mild disability and a short disease duration (median 5.5 years). Eighteen (29.0%) women had a relapse during the year preceding pregnancy onset, 9 (14.5%) during pregnancy, and 20 (32.3%) in the year following delivery. Disability status remained unchanged during follow-up. Women in the postpartum period (n=62) had higher T2 lesion volume (median: 0.94 ml vs. 1.18 ml), greater annualized T2 lesion volume increase (0.0 ml vs. 0.23 ml), lower brain parenchymal fraction (86.4% vs. 85.6%) and greater annualized brain volume loss (-0.16% vs. -1.74%) compared with the prepregnancy period (all p<0.001). At 12-24 months after delivery women (n=41) had higher T2 lesion volume (1.0 ml vs. 1.16 ml) and lower brain parenchymal fraction (86.5% vs. 86.0%) compared to the prepregnancy period (both p<0.001). CONCLUSIONS The postpartum period was associated with an increase in T2 lesion volume and accelerated brain volume loss in a considerable proportion of women. This should be considered in treatment decision-making and designing clinical trials.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Vaclav Capek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
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Uher T, Havrdova EK, Benkert P, Bergsland N, Krasensky J, Srpova B, Dwyer M, Tyblova M, Meier S, Vaneckova M, Horakova D, Zivadinov R, Leppert D, Kalincik T, Kuhle J. Measurement of neurofilaments improves stratification of future disease activity in early multiple sclerosis. Mult Scler 2021; 27:2001-2013. [PMID: 34612753 DOI: 10.1177/13524585211047977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The added value of neurofilament light chain levels in serum (sNfL) to the concept of no evidence of disease activity-3 (NEDA-3) has not yet been investigated in detail. OBJECTIVE To assess whether combination of sNfL with NEDA-3 status improves identification of patients at higher risk of disease activity during the following year. METHODS We analyzed 369 blood samples from 155 early relapsing-remitting MS patients on interferon beta-1a. We compared disease activity, including the rate of brain volume loss in subgroups defined by NEDA-3 status and high or low sNfL (> 90th or < 90th percentile). RESULTS In patients with disease activity (EDA-3), those with higher sNFL had higher odds of EDA-3 in the following year than those with low sNFL (86.5% vs 57.9%; OR = 4.25, 95% CI: [2.02, 8.95]; p = 0.0001) and greater whole brain volume loss during the following year (β = -0.36%; 95% CI = [-0.60, -0.13]; p = 0.002). Accordingly, NEDA-3 patients with high sNfL showed numerically higher disease activity (EDA-3) in the following year compared with those with low sNfL (57.1% vs 31.1%). CONCLUSION sNfL improves the ability to identify patients at higher risk of future disease activity, beyond their NEDA-3 status. Measurement of sNfL may assist clinicians in decision-making by providing more sensitive prognostic information.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic.,Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic/CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Michaela Tyblova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Stephanie Meier
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Leppert
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
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18
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Burgetova R, Dusek P, Burgetova A, Pudlac A, Vaneckova M, Horakova D, Krasensky J, Varga Z, Lambert L. Age-related magnetic susceptibility changes in deep grey matter and cerebral cortex of normal young and middle-aged adults depicted by whole brain analysis. Quant Imaging Med Surg 2021; 11:3906-3919. [PMID: 34476177 DOI: 10.21037/qims-21-87] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022]
Abstract
Background Iron accumulates in brain tissue in healthy subjects during aging. Our goal was to conduct a detailed analysis of iron deposition patterns in the cerebral deep grey matter and cortex using region-based and whole-brain analyses of brain magnetic susceptibility. Methods Brain MRI was performed in 95 healthy individuals aged between 21 and 58 years on a 3T scanner. MRI protocol included T1-weighted (T1W) magnetization-prepared rapid acquisition with gradient echo images and 3D flow-compensated multi-echo gradient-echo images for quantitative susceptibility mapping (QSM). In the region-based analysis, QSM and T1W images entered an automated multi-atlas segmentation pipeline and regional mean bulk susceptibility values were calculated. The whole-brain analysis included a non-linear transformation of QSM images to the standard MNI template. For the whole-brain analysis voxel-wise maps of linear regression slopes β and P values were calculated. Regional masks of cortical voxels with a significant association between susceptibility and age were created and further analyzed. Results In cortical regions, the highest increase of susceptibility values with age was found in areas involved in motor functions (precentral and postcentral areas, premotor cortex), in cognitive processing (prefrontal cortex, superior temporal gyrus, insula, precuneus), and visual processing (occipital gyri, cuneus, posterior cingulum, fusiform, calcarine and lingual gyrus). Thalamic susceptibility increased until the fourth decade and decreased thereafter with the exception of the pulvinar where susceptibility increase was observed throughout the adult lifespan. Deep grey matter structures with the highest increase of susceptibility values with age included the red nucleus, putamen, substantia nigra, dentate nucleus, external globus pallidus, caudate nucleus, and the subthalamic nucleus in decreasing order. Conclusions Accumulation of iron in basal ganglia follows a linear pattern whereas in the thalamus, pulvinar, precentral cortex, and precuneus, it follows a quadratic or exponential pattern. Age-related changes of iron content are different in the pulvinar and the rest of the thalamus as well as in internal and external globus pallidus. In the cortex, areas involved in motor and cognitive functions and visual processing show the highest iron increase with aging. We suggest that the departure from normal patterns of regional brain iron trajectories during aging may be helpful in the detection of subtle neurodegenerative and neuroinflammatory processes.
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Affiliation(s)
- Romana Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Dusek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Adam Pudlac
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zsoka Varga
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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19
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Srpova B, Sobisek L, Novotna K, Uher T, Friedova L, Vaneckova M, Krasensky J, Kubala Havrdova E, Horakova D. The clinical and paraclinical correlates of employment status in multiple sclerosis. Neurol Sci 2021; 43:1911-1920. [PMID: 34392392 DOI: 10.1007/s10072-021-05553-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify the clinical and paraclinical markers of employment status in multiple sclerosis (MS). METHODS This was a cross-sectional sub-study investigating 1226 MS patients. To minimalized confounding effect, two groups of patients, matched by sex, age, and education, were selected: 307 patients with full time employment and 153 unemployed patients receiving disability pension. We explored associations between employment status and Expanded Disability Status Scale (EDSS), 25 Foot Walk Test (25FWT), Nine Hole Peg Test (9HPT), Brief International Cognitive Assessment for MS (BICAMS), Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), SLOAN charts (SLOAN), and brain volumetric MRI measures. RESULTS Both groups differed significantly on all variables of interest (p < 0.001). In the univariate analyses, EDSS, SDMT (Symbol Digit Modalities Test) adjusted for BDI, 25FWT, and 9HPT best explained variability in vocational status. In multivariate analyses, the combination of EDSS, 25FWT, SDMT, BDI, and corpus callosum fraction (CCF) explained the greatest variability. As a next step, after patients were matched by EDSS, differences in SDMT, 25FWT (both p < 0.001), 9HPT, CCF, and T2 lesion volume were still present (all p < 0.005) between both groups. The best multivariate model consisted of SDMT, BDI, and T2 lesion volume. CONCLUSIONS EDSS, walking ability, cognitive performance, and MRI volumetric parameters are independently associated with employment status.
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Affiliation(s)
- Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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20
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Reková P, Dostálová G, Kemlink D, Paulasová Schwabová J, Dubská Z, Vaneckova M, Mašek M, Kodet O, Poupětová H, Mazurová S, Rajdova A, Vlckova E, Táboříková A, Fafejtová Š, Nevsimalova M, Linhart A, Tomek A. Detailed Phenotype of GLA Variants Identified by the Nationwide Neurological Screening of Stroke Patients in the Czech Republic. J Clin Med 2021; 10:jcm10163543. [PMID: 34441839 PMCID: PMC8396867 DOI: 10.3390/jcm10163543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant’s pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.
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Affiliation(s)
- Petra Reková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Gabriela Dostálová
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-22-496-5512
| | - Jaroslava Paulasová Schwabová
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic
| | - Zora Dubská
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Martin Mašek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Ondřej Kodet
- Department of Dermatovenerology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Biotechnology and Biomedicine Centre, Academy of Science, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy First Faculty of Medicine, Charles University in Prague, 128 08 Prague, Czech Republic
| | - Helena Poupětová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Stella Mazurová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Aneta Rajdova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Eva Vlckova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Alena Táboříková
- Department of Neurology and Stroke Centre, Country Hospital Chomutov, 430 12 Chomutov, Czech Republic;
| | - Štěpánka Fafejtová
- Department of Neurology and Stroke Centre, Hospital Karlovy Vary, 360 01 Karlovy Vary, Czech Republic;
| | - Miroslava Nevsimalova
- Department of Neurology, Hospital Ceske Budejovice, 370 01 České Budějovice, Czech Republic;
| | - Aleš Linhart
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - Aleš Tomek
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
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21
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Dudakova L, Stranecky V, Piherova L, Palecek T, Pontikos N, Kmoch S, Skalicka P, Vaneckova M, Davidson AE, Liskova P. Non-Penetrance for Ocular Phenotype in Two Individuals Carrying Heterozygous Loss-of-Function ZEB1 Alleles. Genes (Basel) 2021; 12:genes12050677. [PMID: 33946386 PMCID: PMC8146820 DOI: 10.3390/genes12050677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023] Open
Abstract
ZEB1 loss-of-function (LoF) alleles are known to cause a rare autosomal dominant disorder—posterior polymorphous corneal dystrophy type 3 (PPCD3). To date, 50 pathogenic LoF variants have been identified as disease-causing and familial studies have indicated that the PPCD3 phenotype is penetrant in approximately 95% of carriers. In this study, we interrogated in-house exomes (n = 3616) and genomes (n = 88) for the presence of putative heterozygous LoF variants in ZEB1. Next, we performed detailed phenotyping in a father and his son who carried a novel LoF c.1279C>T; p.(Glu427*) variant in ZEB1 (NM_030751.6) absent from the gnomAD v.2.1.1 dataset. Ocular examination of the two subjects did not show any abnormalities characteristic of PPCD3. GnomAD (n = 141,456 subjects) was also interrogated for LoF ZEB1 variants, notably 8 distinct heterozygous changes presumed to lead to ZEB1 haploinsufficiency, not reported to be associated with PPCD3, have been identified. The NM_030751.6 transcript has a pLI score ≥ 0.99, indicating extreme intolerance to haploinsufficiency. In conclusion, ZEB1 LoF variants are present in a general population at an extremely low frequency. As PPCD3 can be asymptomatic, the true penetrance of ZEB1 LoF variants remains currently unknown but is likely to be lower than estimated by the familial led approaches adopted to date.
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Affiliation(s)
- Lubica Dudakova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
| | - Viktor Stranecky
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
| | - Lenka Piherova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
| | - Tomas Palecek
- Second Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic;
| | - Nikolas Pontikos
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (N.P.); (A.E.D.)
| | - Stanislav Kmoch
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
| | - Pavlina Skalicka
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Katerinska 30, 128 08 Prague, Czech Republic;
| | - Alice E. Davidson
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (N.P.); (A.E.D.)
| | - Petra Liskova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 2, 128 08 Prague, Czech Republic; (L.D.); (V.S.); (L.P.); (S.K.); (P.S.)
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (N.P.); (A.E.D.)
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
- Correspondence: ; Tel.: +420-22496-7139
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22
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Uher T, Krasensky J, Malpas C, Bergsland N, Dwyer MG, Kubala Havrdova E, Vaneckova M, Horakova D, Zivadinov R, Kalincik T. Evolution of Brain Volume Loss Rates in Early Stages of Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/3/e979. [PMID: 33727311 PMCID: PMC7984675 DOI: 10.1212/nxi.0000000000000979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
Objective To describe the dynamics of brain volume loss (BVL) at different stages of relapsing-remitting multiple sclerosis (RRMS), to describe the association between BVL and clinical measures, and to investigate an effect of treatment escalation on the rate of BVL. Methods Together, 1903 patients predominantly with RRMS from the Avonex-Steroids-Azathioprine cohort (N = 166), the study of early IFN-β1a treatment cohort (N = 180), and the quantitative MRI cohort (N = 1,557) with ≥2 MRI scans and ≥1-year of follow-up were included. Brain MRI scans (N = 7,203) were performed using a single 1.5-T machine. Relationships between age or disease duration and global and tissue-specific BVL rates were analyzed using mixed models. Results Age was not associated with the rate of BVL (β = −0.003; Cohen f2 = 0.0005; adjusted p = 0.39). Although disease duration was associated with the rate of BVL, its effect on the BVL rate was minimal (β = −0.012; Cohen f2 = 0.004; adjusted p = 4 × 10−5). Analysis of association between tissue-specific brain volume changes and age (β = −0.019 to −0.011; adjusted p = 0.028–1.00) or disease duration (β = −0.028 to −0.008; adjusted p = 0.16–0.96) confirmed these results. Although increase in the relapse rate (β = 0.10; adjusted p = 9 × 10−9), Expanded Disability Status Scale (EDSS; β = 0.17; adjusted p = 8 × 10−5), and EDSS change (β = 0.15; adjusted p = 2 × 10−5) were associated with accelerated rate of BVL, their effect on the rate of BVL was minimal (all Cohen f2 ≤ 0.007). In 94 patients who escalated therapy, the rate of BVL decreased following treatment escalation by 0.29% (β = −0.29; Cohen f2 = 0.133; p = 5.5 × 10−8). Conclusions The rate of BVL is relatively stable throughout the course of RRMS. The accelerated BVL is weakly associated with concurrent higher disease activity, and timely escalation to high-efficacy immunotherapy helps decrease the rate of BVL.
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Affiliation(s)
- Tomas Uher
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia.
| | - Jan Krasensky
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Charles Malpas
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Niels Bergsland
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Michael G Dwyer
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Eva Kubala Havrdova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Manuela Vaneckova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Dana Horakova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Robert Zivadinov
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Tomas Kalincik
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
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23
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Motyl J, Friedova L, Vaneckova M, Krasensky J, Lorincz B, Blahova Dusankova J, Andelova M, Fuchs TA, Kubala Havrdova E, Benedict RHB, Horakova D, Uher T. Isolated Cognitive Decline in Neurologically Stable Patients with Multiple Sclerosis. Diagnostics (Basel) 2021; 11:diagnostics11030464. [PMID: 33800075 PMCID: PMC7999620 DOI: 10.3390/diagnostics11030464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Cognitive deterioration is an important marker of disease activity in multiple sclerosis (MS). It is vital to detect cognitive decline as soon as possible. Cognitive deterioration can take the form of isolated cognitive decline (ICD) with no other clinical signs of disease progression present. (2) Methods: We investigated 1091 MS patients from the longitudinal GQ (Grant Quantitative) study, assessing their radiological, neurological, and neuropsychological data. Additionally, the confirmatory analysis was conducted. Clinical disease activity was defined as the presence of new relapse or disability worsening. MRI activity was defined as the presence of new or enlarged T2 lesions on brain MRI. (3) Results: Overall, 6.4% of patients experienced cognitive decline and 4.0% experienced ICD without corresponding clinical activity. The vast majority of cognitively worsening patients showed concomitant progression in other neurological and radiologic measures. There were no differences in disease severity between completely stable patients and cognitively worsening patients but with normal cognition at baseline. (4) Conclusions: Only a small proportion of MS patients experience ICD over short-term follow-up. Patients with severe MS are more prone to cognitive decline; however, patients with normal cognitive performance and mild MS might benefit from the early detection of cognitive decline the most.
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Affiliation(s)
- Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (M.V.); (J.K.)
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (M.V.); (J.K.)
| | - Balazs Lorincz
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Tom A. Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (T.A.F.); (R.H.B.B.)
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Ralph H. B. Benedict
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (T.A.F.); (R.H.B.B.)
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, 128 21 Prague, Czech Republic; (J.M.); (L.F.); (B.L.); (J.B.D.); (M.A.); (E.K.H.); (D.H.)
- Correspondence: ; Tel.: +420-224-966-515
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24
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Majovska J, Nestrasil I, Paulson A, Nascene D, Jurickova K, Hlavata A, Lund T, Orchard PJ, Vaneckova M, Zeman J, Magner M, Dusek P. White matter alteration and cerebellar atrophy are hallmarks of brain MRI in alpha-mannosidosis. Mol Genet Metab 2021; 132:189-197. [PMID: 33317989 DOI: 10.1016/j.ymgme.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Despite profound neurological symptomatology there are only few MRI studies focused on the brain abnormalities in alpha-mannosidosis (AM). Our aim was to characterize brain MRI findings in a large cohort of AM patients along with clinical manifestations. METHODS Twenty-two brain MRIs acquired in 13 untreated AM patients (8 M/5F; median age 17 years) were independently assessed by three experienced readers and compared to 16 controls. RESULTS Focal and/or diffuse hyperintense signals in the cerebral white matter were present in most (85%) patients. Cerebellar atrophy was common (62%), present from the age of 5 years. Progression was observed in two out of 6 patients with follow-up scans. Cortical atrophy (62%) and corpus callosum thinning (23%) were already present in a 13-month-old child. The presence of low T2 signal intensity in basal ganglia and thalami was excluded by the normalized signal intensity profiling. The enlargement of perivascular spaces in white matter (38%), widening of perioptic CSF spaces (62%), and enlargement of cisterna magna (85%) were also observed. Diploic space thickening (100%), mucosal thickening (69%) and sinus hypoplasia (54%) were the most frequent non-CNS abnormalities. CONCLUSION White matter changes and cerebellar atrophy are proposed to be the characteristic brain MRI features of AM. The previously reported decreased T2 signal intensity in basal ganglia and thalami was not detected in this quantitative study. Rather, this relative MR appearance seems to be related to the diffuse high T2 signal in the adjacent white matter and not the gray matter iron deposition that has been hypothesized.
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Affiliation(s)
- Jitka Majovska
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Igor Nestrasil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Amy Paulson
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - David Nascene
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Katarina Jurickova
- Center for Inherited Metabolic Disorders, Department of Paediatrics, National Institute of Children's Diseases and Faculty of Human Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Anna Hlavata
- Center for Inherited Metabolic Disorders, Department of Paediatrics, National Institute of Children's Diseases and Faculty of Human Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Troy Lund
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Paul J Orchard
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Zeman
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Pediatrics, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
| | - Petr Dusek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
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25
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Uher T, Bergsland N, Krasensky J, Dwyer MG, Andelova M, Sobisek L, Havrdova EK, Horakova D, Zivadinov R, Vaneckova M. Interpretation of Brain Volume Increase in Multiple Sclerosis. J Neuroimaging 2020; 31:401-407. [PMID: 33314460 DOI: 10.1111/jon.12816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE A high variability of brain MRI volume change measurement renders challenging its interpretation in multiple sclerosis (MS). Occurrence and clinical relevance of observed apparent brain volume increase (BVI) in MS patients have not been investigated yet. The objective was to quantify the prevalence and factors associated with BVI. METHODS We examined 366 MS patients (2,317 scans) and 44 controls (132 scans). Volumetric analysis of brain volume changes was performed by SIENA and ScanView. BVI was defined as brain volume change >0%. We compared characteristics of patients with and without BVI. RESULTS BVI was found in 26.3% (from 1,951) longitudinal scans (SIENA). If BVI occurred, a probability that BVI will be repeated consecutively more than or equal to two times was 15.9%. The repeated BVI was associated with clinical disease activity in 50% of cases. BVI was associated with shorter time and lower T2 lesion volume increase between two MRI scans, and higher normalized brain volume (all P < .0001). A proportion of scans with BVI was higher when analyzed by ScanView (35.3%) and in controls (36.4% by SIENA). CONCLUSIONS BVI occurs in a great proportion of MR scans over short-term follow-up and is not associated with disease stabilization. Although BVI can be caused by several factors, the results indicate that measurement error may contribute to BVI in the majority of cases. Clinicians should be aware of the frequent occurrence of apparent BVI, interpret brain volume changes in MS patients with great caution, and use methods with precise quantification of brain volume changes.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, University Hospital in Prague, Prague, Czech Republic
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General, University Hospital in Prague, Prague, Czech Republic
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, Buffalo, NY
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, University Hospital in Prague, Prague, Czech Republic
| | - Lukas Sobisek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, University Hospital in Prague, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, University Hospital in Prague, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, University Hospital in Prague, Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, Buffalo, NY
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General, University Hospital in Prague, Prague, Czech Republic
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26
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McComb M, Krikheli M, Uher T, Browne RW, Srpova B, Oechtering J, Maceski AM, Tyblova M, Jakimovski D, Ramasamy DP, Bergsland N, Krasensky J, Noskova L, Fialova L, Weinstock-Guttman B, Havrdova EK, Vaneckova M, Zivadinov R, Horakova D, Kuhle J, Ramanathan M. Neuroprotective associations of apolipoproteins A-I and A-II with neurofilament levels in early multiple sclerosis. J Clin Lipidol 2020; 14:675-684.e2. [DOI: 10.1016/j.jacl.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
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27
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Kotikova K, Zogala D, Ptacnik V, Trnka J, Kupka K, Vaneckova M, Seidl Z, Diblik P, Heissigerova J, Navratil T, Komarc M, Zak I, Polakova K, Brozova H, Zakharov S. Efficiency of 123I-ioflupane SPECT as the marker of basal ganglia damage in acute methanol poisoning: 6-year prospective study. Clin Toxicol (Phila) 2020; 59:235-245. [PMID: 32762574 DOI: 10.1080/15563650.2020.1802033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Investigate whether 123I-ioflupane SPECT (DaT SPECT) has the potential as a marker of basal ganglia damage in acute methanol poisoning. METHODS Prospective, single-centre, cohort study of patients with confirmed methanol poisoning was conducted. DaT SPECT was performed twice with semi-quantification using DaTQUANTTM and MRI-based volumetry was calculated. Specific binding ratios (SBR) of striatum, caudate nucleus, and putamen were correlated with laboratory parameters of outcome, volumetric data, and retinal nerve fibres layer (RNFL) thickness measurements. RESULTS Forty-two patients (mean age 46.3 ± 4.2 years; 8 females), including 15 with MRI-detected putamen lesions (group I) and 27 patients with intact putamen (group II), underwent DaT SPECT. Volumetry was calculated in 35 of the patients assessed. SBR values for the left putamen correlated with putamen volume (r = 0.665; p < 0.001). Decreased bilateral SBR values were determined for the striatum and the putamen, but not for the nucleus caudate, in group I (p < 0.05). Significant correlation was observed between the SBR of the posterior putamen and arterial blood pH (r = 0.574; p < 0.001) and other toxicological parameters of severity of poisoning/outcome including serum lactate, glucose, and creatinine concentrations (p < 0.05). The SBR of the posterior putamen positively correlated with the global RNFL thickness (p < 0.05). ROC analysis demonstrated a significant discriminatory ability of SBR of the posterior putamen with AUC = 0.753 (95%CI 0.604-0.902; p = 0.007). The multivariate regression model demonstrated that arterial blood pH, age, and gender were the most significant factors associated with SBR of the posterior putamen. CONCLUSION DaT SPECT demonstrates significant potential for the diagnosis of methanol-induced basal ganglia damage.
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Affiliation(s)
- Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - David Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vaclav Ptacnik
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Trnka
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Kupka
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Electrochemistry at the Nanoscale, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Ivan Zak
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Kamila Polakova
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Brozova
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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28
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Hlusicka J, Mana J, Vaneckova M, Kotikova K, Diblik P, Urban P, Navratil T, Marechal B, Kober T, Zakharov S. MRI-based brain volumetry and retinal optical coherence tomography as the biomarkers of outcome in acute methanol poisoning. Neurotoxicology 2020; 80:12-19. [PMID: 32554081 DOI: 10.1016/j.neuro.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Basal ganglia lesions are typical findings on magnetic resonance imaging (MRI) of the brain in survivors of acute methanol poisoning. However, no data are available on the association between the magnitude of damaged brain regions, serum concentrations of markers of acute methanol toxicity, oxidative stress, neuroinflammation, and the rate of retinal nerve ganglion cell loss. OBJECTIVES To investigate the association between MRI-based volumetry of the basal ganglia, retinal nerve fibre layer (RNFL) thickness and prognostic laboratory markers of outcomes in acute methanol poisoning. METHODS MRI-based volumetry of putamen, nucleus caudatus and globus pallidus was performed and compared with laboratory parameters of severity of poisoning and acute serum markers of oxidative damage of lipids (8-isoprostan, MDA, HHE, HNE), nucleic acids (8-OHdG, 8-OHG, 5-OHMU), proteins (o-Thyr, NO-Thyr, Cl-Thyr) and leukotrienes (LTC4, LTD4, LTE4, LTB4), as well as with the results of RNFL measurements by optic coherence tomography (OCT) in 16 patients with acute methanol poisoning (Group I) and in 28 survivors of poisoning two years after discharge with the same markers measured within the follow-up examination (Group II). The control group consisted of 28 healthy subjects without methanol poisoning. RESULTS The survivors of acute methanol poisoning had significantly lower volumes of basal ganglia than the controls. The patients with MRI signs of methanol-induced toxic brain damage had significantly lower volumes of basal ganglia than those without these signs. A positive correlation was found between the volume of putamen and arterial blood pH on admission (r = 0.45; p = 0.02 and r = 0.44; p = 0.02 for left and right putamen, correspondingly). A negative correlation was present between the volumes of putamen and acute serum lactate (r = -0.63; p < 0.001 and r = -0.59; p = 0.01), creatinine (r = -0.53; p = 0.01 and r = -0.47; p = 0.01) and glucose (r = -0.55; p < 0.001 and r = -0.50; p = 0.01) concentrations. The volume of basal ganglia positively correlated with acute concentrations of markers of lipoperoxidation (8-isoprostan: r = 0.61; p < 0.05 and r = 0.59; p < 0.05 for left and right putamen, correspondingly) and inflammation (leukotriene LTB4: r = 0.61; p < 0.05 and r = 0.61; p < 0.05 for left and right putamen, correspondingly). The higher the volume of the basal ganglia, the higher the thickness of the RNFL, with the strongest positive association between global RNFL and the volume of putamen bilaterally (all p < 0.01). In the follow-up markers of oxidative stress and inflammation, only o-Thyr concentration negatively correlated with the volume of putamen bilaterally (r = -0.39; p < 0.05 and r = -0.37; p < 0.05 for left and right putamen, correspondingly). CONCLUSION In survivors of acute methanol poisoning with signs of toxic brain damage, the magnitude of affected areas correlated with acute parameters of severity of poisoning, markers of oxidative stress and neuroinflammation. There was a positive association between the basal ganglia volume and the thickness of RNFL, making OCT an important screening test and MRI-based volumetry the confirmative diagnostic method for the detection of CNS sequelae of methanol poisoning.
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Affiliation(s)
- Jiri Hlusicka
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centre for Industrial Hygiene and Occupational Medicine, National Institute of Public Health, Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic; Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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29
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Uher T, Schaedelin S, Srpova B, Barro C, Bergsland N, Dwyer M, Tyblova M, Vodehnalova K, Benkert P, Oechtering J, Leppert D, Naegelin Y, Krasensky J, Vaneckova M, Kubala Havrdova E, Kappos L, Zivadinov R, Horakova D, Kuhle J, Kalincik T. Monitoring of radiologic disease activity by serum neurofilaments in MS. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/4/e714. [PMID: 32273481 PMCID: PMC7176248 DOI: 10.1212/nxi.0000000000000714] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
Objective To determine whether serum neurofilament light chain (sNfL) levels are associated with recent MRI activity in patients with relapsing-remitting MS (RRMS). Methods This observational study included 163 patients (405 samples) with early RRMS from the Study of Early interferon-beta1a (IFN-β1a) Treatment (SET) cohort and 179 patients (664 samples) with more advanced RRMS from the Genome-Wide Association Study of Multiple Sclerosis (GeneMSA) cohort. Based on annual brain MRI, we assessed the ability of sNfL cutoffs to reflect the presence of combined unique active lesions, defined as new/enlarging lesion compared with MRI in the preceding year or contrast-enhancing lesion. The probability of active MRI lesions among patients with different sNfL levels was estimated with generalized estimating equations models. Results From the sNfL samples ≥90th percentile, 81.6% of the SET (OR = 3.4, 95% CI = 1.8-6.4) and 48.9% of the GeneMSA cohort samples (OR = 2.6, 95% CI = 1.7-3.9) was associated with radiological disease activity on MRI. The sNfL level between the 10th and 30th percentile was reflective of negligible MRI activity: 1.4% (SET) and 6.5% (GeneMSA) of patients developed ≥3 active lesions, 5.8% (SET) and 6.5% (GeneMSA) developed ≥2 active lesions, and 34.8% (SET) and 11.8% (GeneMSA) showed ≥1 active lesion on brain MRI. The sNfL level <10th percentile was associated with even lower MRI activity. Similar results were found in a subgroup of clinically stable patients. Conclusions Low sNfL levels (≤30th percentile) help identify patients with MS with very low probability of recent radiologic disease activity during the preceding year. This result suggests that in future, sNfL assessment may substitute the need for annual brain MRI monitoring in considerable number (23.1%–36.4%) of visits in clinically stable patients.
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Affiliation(s)
- Tomas Uher
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia.
| | - Sabine Schaedelin
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Barbora Srpova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Christian Barro
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Niels Bergsland
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Michael Dwyer
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Michaela Tyblova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Karolina Vodehnalova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Pascal Benkert
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Johanna Oechtering
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - David Leppert
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Yvonne Naegelin
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Jan Krasensky
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Manuela Vaneckova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Eva Kubala Havrdova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Ludwig Kappos
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Robert Zivadinov
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Dana Horakova
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Jens Kuhle
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
| | - Tomas Kalincik
- From the Department of Medicine (T.U., T.K.), CORe, The University of Melbourne, Victoria, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., B.S., M.T., K.V., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Clinical Trial Unit (S.S., P.B.), Department of Clinical Research, University Hospital Basel, University of Basel; Departments of Medicine, Biomedicine and Clinical Research (C.B., J.O., D.L., Y.N., L.K., J. Kuhle), Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Switzerland; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences (N.B., M.D., R.Z.), Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo; IRCCS "S. Maria Nascente" (N.B.), Don Carlo Gnocchi Foundation, Milan, Italy; Department of Radiology (J. Krasensky, M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, NY; and Department of Neurology (T.K.), The Royal Melbourne Hospital, Victoria, Australia
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Uher T, McComb M, Galkin S, Srpova B, Oechtering J, Barro C, Tyblova M, Bergsland N, Krasensky J, Dwyer M, Havrdova EK, Posova H, Vaneckova M, Zivadinov R, Horakova D, Kuhle J, Ramanathan M. Neurofilament levels are associated with blood–brain barrier integrity, lymphocyte extravasation, and risk factors following the first demyelinating event in multiple sclerosis. Mult Scler 2020; 27:220-231. [DOI: 10.1177/1352458520912379] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Increased blood brain barrier (BBB) permeability, CNS inflammation and neuroaxonal damage are pathological hallmarks in early multiple sclerosis (MS). Objective: To investigate the associations of neurofilament light chain (NfL) levels with measures of BBB integrity and central nervous system (CNS) inflammation in MS during the first demyelinating event. Methods: Blood and cerebrospinal fluid (CSF) were obtained from 142 MS (McDonald 2017) treatment-naive patients from the SET study (63% female; age: 29.7 ± 7.9 years) following the disease onset. NfL, albumin, immunoglobulin G (IgG), and immunoglobulin M (IgM) levels were measured in CSF and blood samples. Albumin quotient was computed as a marker of BBB integrity. Immune cell subset counts in CSF were measured using flow cytometry. MS risk factors, such as Human leukocyte antigen DRB1 locus gene ( HLA DRB1)*1501, anti-Epstein–Barr virus (EBV) antibodies, and 25-hydroxy vitamin D3, were also measured. Results: Higher serum NfL (sNfL) levels were associated with higher albumin quotient ( p < 0.001), CSF CD80+ ( p = 0.012), and CD80+ CD19+ ( p = 0.015) cell frequency. sNfL levels were also associated with contrast-enhancing and T2 lesions on brain magnetic resonance imaging (MRI; all p ⩽ 0.001). Albumin quotient was not associated with any of the MS risk factors assessed. sNfL levels were associated with anti-EBV viral capsid antigen (VCA) IgG levels ( p = 0.0026). Conclusion: sNfL levels during the first demyelinating event of MS are associated with greater impairment of BBB integrity, immune cell extravasation, and brain lesion activity on MRI.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Mason McComb
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Shery Galkin
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Johanna Oechtering
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michaela Tyblova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, The State University of New York, Buffalo, NY, USA/IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Helena Posova
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, The State University of New York, Buffalo, NY, USA/Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, The State University of New York, Buffalo, NY, USA/Department of Neurology, The State University of New York, Buffalo, NY, USA
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Srpova B, Uher T, Hrnciarova T, Barro C, Andelova M, Michalak Z, Vaneckova M, Krasensky J, Noskova L, Havrdova EK, Kuhle J, Horakova D. Serum neurofilament light chain reflects inflammation-driven neurodegeneration and predicts delayed brain volume loss in early stage of multiple sclerosis. Mult Scler 2020; 27:52-60. [DOI: 10.1177/1352458519901272] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury. There is a lack of studies investigating the dynamics of relationships between sNfL levels and radiological disease activity over long-term follow-up in multiple sclerosis (MS). Objectives: To investigate the relationship among repeated measures of sNfL, lesion burden accumulation, brain volume loss and clinical measures. Methods: We investigated 172 patients in the early stages of MS (McDonald 2017 criteria). Clinical exams were performed every 3 months and brain magnetic resonance imaging (MRI) scans were collected annually over 48 months. sNfL levels were measured in serum by Simoa assay at the time of treatment initiation and then annually over 36 months. Results: In repeated-measures analysis, considering all time points, we found a strong relationship between percentage changes of sNfL and lesion burden accumulation assessed by T1 lesion volume ( p < 0.001) and T2 lesion number ( p < 0.001). There was no relationship between percentage changes of sNfL and brain volume loss over 36 months ( p > 0.1). Early sNfL levels were associated with delayed brain volume loss after 48 months ( p < 0.001). Patients with No Evidence of Disease Activity (NEDA-3) status showed lower sNfL levels compared with active MS patients. Conclusions: sNfL is associated with ongoing neuroinflammation and predictive of future neurodegeneration in early MS.
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Affiliation(s)
- Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tereza Hrnciarova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zuzanna Michalak
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Libuse Noskova
- Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Rulisek J, Waldauf P, Belohlavek J, Balik M, Kotikova K, Hlusicka J, Vaneckova M, Seidl Z, Diblik P, Bydzovsky J, Heissigerova J, Urban P, Miovsky M, Sejvl J, Pelclova D, Zakharov S. Health-related quality of life determinants in survivors of a mass methanol poisoning outbreak: six-year prospective cohort study. Clin Toxicol (Phila) 2020; 58:870-880. [PMID: 31913708 DOI: 10.1080/15563650.2019.1702994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose: The effect of acute methanol poisoning on the follow-up quality of life of survivors in mass poisoning outbreaks is not known. The objective of this is to study the impact of visual and central nervous system (CNS) sequelae of methanol poisoning on long-term health-related quality of life (QoL) of survivors, its clinical determinants, and dynamics.Materials and methods: A total of 54 patients with confirmed methanol poisoning (mean age 46.7 ± 13.4 years, 9 females) were examined consequently three times within six-year prospective cohort study and compared to 23 controls with the history of chronic alcohol abuse. The following tests were performed: SF-36 QoL questionnaire, visual evoked potentials (VEP) of optic nerve, ocular examination with retinal nerve fiber layer (RNFL) thickness measurement, brain magnetic resonance imaging (MRI), and biochemical and toxicological tests.Results: Acute methanol poisoning led to significant decrease in physical component summary (PCS) compared to PCS of age-adjusted controls (mean score with SD 46.8 ± 11.0 versus 52.3 ± 9.4 points; p = .003). In 17/40 (42.5%) patients with three rounds of examination, signs of severe disability (≤30 points in at least one score) were present six years after discharge, with negative dynamics of PCS score during the observation period. The patients with abnormal RNFL thickness had lower PCS (mean difference 10.5 points; 95%CI 3.5-17.5, p = .004) and mental component summary score (9.5 points; 95%CI 1.9-17.1, p = .015) compared to the patients with normal RNFL. Signs of physical and mental adaptation to long-term visual sequelae were registered with gradual reduction of difference in most of physical and mental components scores compared to the patients with normal RNFL during six years of observation. Signs of hemorrhagic brain lesions were associated with permanent decrease of PCS score (mean difference 7.4 points; 95%CI 0.6-14.0; p = .033), bodily pain (8.7 points; 95%CI 1.6-17.6; p = .018), and social functioning (8.2 points; 95%CI 3.0-17.4; p = .005) six years after discharge. No effect of type of antidote (fomepizole versus ethanol) and extracorporeal enhanced elimination modality (intermittent hemodialysis versus continuous renal replacement therapy) applied in hospital on long-term QoL was found (all p > .05).Conclusion: Acute methanol poisoning was associated with a significant decrease of health-related quality of life of survivors persisting for at least six years after discharge. The more pronounced decrease in QoL scores was observed in the patients with hemorrhagic brain lesions and visual sequelae of poisoning with abnormal RNFL thickness.
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Affiliation(s)
- Jan Rulisek
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and Royal Vinohrady Teaching Hospital, Prague, Czech Republic
| | - Jan Belohlavek
- Department of Cardiology and Angiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Balik
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Jiri Hlusicka
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Michal Miovsky
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslav Sejvl
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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33
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Vaneckova M, Klempir J, Pelclova D, Bezdicek O, Liskova I, Brozova H, Polakova K, Diblik P, Miovsky M, Hubacek J, Hlusicka J, Kotikova K, Ruzicka E, Seidl Z, Marechal B, Kober T, Zacharov S. The spectrum of brain MRI findings of methanol intoxication after the methanol affair in the Czech Republic. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Andelova M, Uher T, Krasensky J, Sobisek L, Kusova E, Srpova B, Vodehnalova K, Friedova L, Motyl J, Preiningerova JL, Kubala Havrdova E, Horakova D, Vaneckova M. Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis. Front Neurol 2019; 10:820. [PMID: 31447759 PMCID: PMC6691803 DOI: 10.3389/fneur.2019.00820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Spinal cord (SC) pathology is strongly associated with disability in multiple sclerosis (MS). We aimed to evaluate the association between focal and diffuse SC abnormalities and spinal cord volume and to assess their contribution to physical disability in MS patients. Methods: This large sample-size cross-sectional study investigated 1,249 patients with heterogeneous MS phenotypes. Upper cervical-cord cross-sectional area (MUCCA) was calculated on an axial 3D-T2w-FatSat sequence acquired at 3T using a novel semiautomatic edge-finding tool. SC images were scored for the presence of sharply demarcated hyperintense areas (focal lesions) and homogenously increased signal intensity (diffuse changes). Patients were dichotomized according EDSS in groups with mild (EDSS up to 3.0) and moderate (EDSS ≥ 3.5) physical disability. Analysis of covariance was used to identify factors associated with dichotomized MUCCA. In binary logistic regression, the SC imaging parameters were entered in blocks to assess their individual contribution to risk of moderate disability. In order to assess the risk of combined SC damage in terms of atrophy and lesional pathology on disability, secondary analysis was carried out where patients were divided into four categories (SC phenotypes) according to median dichotomized MUCCA and presence/absence of focal and/or diffuse changes. Results: MUCCA was strongly associated with total intracranial volume, followed by presence of diffuse SC pathology, and disease duration. Compared to the reference group (normally appearing SC, MUCCA>median), patients with the most severe SC changes (SC affected with focal and/or diffuse lesions, MUCCA<median) had an almost 5-times higher risk of having moderate disability (OR 4.75, 95% CI 3.07–7.49, p < 0.001). Patients with normally appearing SC and MUCCA below the median had a 2-fold increased risk of being in the moderate disability group when compared to the reference patients (OR 2.15, 95% CI 1.26–3.67, p < 0.001). In contrast, patients with MUCCA above the median with SC lesions/diffuse changes did not differ significantly from the reference group. Conclusion: Low cervical SC volume is a strong independent predictor of physical disability in MS patients. The contribution of focal SC lesions and diffuse changes to the worse disability outcomes is limited and present especially in patients with low SC volume.
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Affiliation(s)
- Michaela Andelova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tomas Uher
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | | | - Eliska Kusova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Karolina Vodehnalova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucie Friedova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jiri Motyl
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jana Lizrova Preiningerova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Eva Kubala Havrdova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Dana Horakova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
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35
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Diblik P, Urban P, Navratil T, Kacer P, Kacerova T, Zakharov S. Reactive carbonyl compounds, carbonyl stress, and neuroinflammation in methyl alcohol intoxication. Monatsh Chem 2019. [DOI: 10.1007/s00706-019-02429-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Zakharov S, Rulisek J, Hlusicka J, Kotikova K, Navratil T, Komarc M, Vaneckova M, Seidl Z, Diblik P, Bydzovsky J, Heissigerova J, Zogala D, Hubacek JA, Miovsky M, Sejvl J, Vojtova L, Pelclova D. The impact of co-morbidities on a 6-year survival after methanol mass poisoning outbreak: possible role of metabolic formaldehyde. Clin Toxicol (Phila) 2019; 58:241-253. [PMID: 31298045 DOI: 10.1080/15563650.2019.1637525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known.Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality.Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan-Meier method.Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years; p = .159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years; p = .044) survived. The hospital mortality was 22%, the follow-up mortality was 18%; the total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p < .05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22; 1.00-1.48 95% CI; p = .046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan-Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p = .027) or moderate (p = .020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths.Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation.
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Affiliation(s)
- Sergey Zakharov
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Jan Rulisek
- Department of Anesthesia and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Hlusicka
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Biomimetic Electrochemistry, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michal Miovsky
- Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jaroslav Sejvl
- Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Lucie Vojtova
- Institute of Clinical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Toxicological Information Centre, General University Hospital, Prague, Czech Republic
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37
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Rusz J, Vaneckova M, Benova B, Tykalova T, Novotny M, Ruzickova H, Uher T, Andelova M, Novotna K, Friedova L, Motyl J, Kucerova K, Krasensky J, Horakova D. Brain volumetric correlates of dysarthria in multiple sclerosis. Brain Lang 2019; 194:58-64. [PMID: 31102976 DOI: 10.1016/j.bandl.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Although dysarthria is a common pattern in multiple sclerosis (MS), the contribution of specific brain areas to key factors of dysarthria remains unknown. Speech data were acquired from 123 MS patients with Expanded Disability Status Scale (EDSS) ranging from 1 to 6.5 and 60 matched healthy controls. Results of computerized acoustic analyses of subtests on spastic and ataxic aspects of dysarthria were correlated with MRI-based brain volume measurements. Slow articulation rate during reading was associated with bilateral white and grey matter loss whereas reduced maximum speed during oral diadochokinesis was related to greater cerebellar involvement. Articulation rate showed similar correlation to whole brain atrophy (r = 0.46, p < 0.001) as the standard clinical scales such as EDSS (r = -0.45, p < 0.001). Our results support the critical role of the pyramidal tract and cerebellum in the modification of motor speech timing in MS.
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Affiliation(s)
- Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic; Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Benova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tereza Tykalova
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Michal Novotny
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Hana Ruzickova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lucie Friedova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Kucerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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38
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Mana J, Vaneckova M, Klempíř J, Lišková I, Brožová H, Poláková K, Seidl Z, Miovský M, Pelclová D, Bukačová K, Maréchal B, Kober T, Zakharov S, Růžička E, Bezdicek O. Methanol Poisoning as an Acute Toxicological Basal Ganglia Lesion Model: Evidence from Brain Volumetry and Cognition. Alcohol Clin Exp Res 2019; 43:1486-1497. [DOI: 10.1111/acer.14077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Manuela Vaneckova
- MR Unit Department of Radiodiagnostics First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Jiří Klempíř
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
- Institute of Anatomy First Faculty of Medicine Charles University Prague Czech Republic
| | - Irena Lišková
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Hana Brožová
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Kamila Poláková
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Zdeněk Seidl
- MR Unit Department of Radiodiagnostics First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Michal Miovský
- Department of Addictology Charles University First Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Daniela Pelclová
- Toxicological Information Centre Department of Occupational Medicine First Faculty of Medicine Charles University and General University Hospital Prague Czech Republic
| | - Kateřina Bukačová
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology Siemens Healthcare AG Lausanne Switzerland
- Department of Radiology University Hospital Lausanne (CHUV) Lausanne Switzerland
- Signal Processing Laboratory (LTS 5) École Polytechnique Fédérale de Lausanne (EPFL) Lausanne Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology Siemens Healthcare AG Lausanne Switzerland
- Department of Radiology University Hospital Lausanne (CHUV) Lausanne Switzerland
- Signal Processing Laboratory (LTS 5) École Polytechnique Fédérale de Lausanne (EPFL) Lausanne Switzerland
| | - Sergey Zakharov
- Toxicological Information Centre Department of Occupational Medicine First Faculty of Medicine Charles University and General University Hospital Prague Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
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39
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Battaglini M, Gentile G, Luchetti L, Giorgio A, Vrenken H, Barkhof F, Cover KS, Bakshi R, Chu R, Sormani MP, Enzinger C, Ropele S, Ciccarelli O, Wheeler-Kingshott C, Yiannakas M, Filippi M, Rocca MA, Preziosa P, Gallo A, Bisecco A, Palace J, Kong Y, Horakova D, Vaneckova M, Gasperini C, Ruggieri S, De Stefano N. Lifespan normative data on rates of brain volume changes. Neurobiol Aging 2019; 81:30-37. [PMID: 31207467 DOI: 10.1016/j.neurobiolaging.2019.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 04/19/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Abstract
We provide here normative values of yearly percentage brain volume change (PBVC/y) as obtained with Structural Imaging Evaluation, using Normalization, of Atrophy, a widely used open-source software, developing a PBVC/y calculator for assessing the deviation from the expected PBVC/y in patients with neurological disorders. We assessed multicenter (34 centers, 11 acquisition protocols) magnetic resonance imaging data of 720 healthy participants covering the whole adult lifespan (16-90 years). Data of 421 participants with a follow-up > 6 months were used to obtain the normative values for PBVC/y and data of 392 participants with a follow-up <1 month were selected to assess the intrasubject variability of the brain volume measurement. A mixed model evaluated PBVC/y dependence on age, sex, and magnetic resonance imaging parameters (scan vendor and magnetic field strength). PBVC/y was associated with age (p < 0.001), with 60- to 70-year-old participants showing twice more volume decrease than participants aged 30-40 years. PBVC/y was also associated with magnetic field strength, with higher decreases when measured by 1.5T than 3T scanners (p < 0.001). The variability of PBVC/y normative percentiles was narrower as the interscan interval was longer (e.g., 80th normative percentile was 50% smaller for participants with 2-year than with 1-year follow-up). The use of these normative data, eased by the freely available calculator, might help in better discriminating pathological from physiological conditions in the clinical setting.
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Affiliation(s)
- Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giordano Gentile
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ludovico Luchetti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, the Netherlands; Institutes of Neurology and Healthcare Engineering, UCL London, UK; National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| | - Keith S Cover
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Renxin Chu
- Laboratory for Neuroimaging Research, Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular & Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College, London, UK; National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| | - Claudia Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College, London, UK; Brain MRI 3T, UK Research Center, C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marios Yiannakas
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College, London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Yazhuo Kong
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiodiagnostics, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Claudio Gasperini
- Department of Neurosciences S Camillo Forlanini Hospital, Rome, Italy
| | - Serena Ruggieri
- Department of Neurosciences S Camillo Forlanini Hospital, Rome, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
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Zivadinov R, Horakova D, Bergsland N, Hagemeier J, Ramasamy DP, Uher T, Vaneckova M, Havrdova E, Dwyer MG. A Serial 10-Year Follow-Up Study of Atrophied Brain Lesion Volume and Disability Progression in Patients with Relapsing-Remitting MS. AJNR Am J Neuroradiol 2019; 40:446-452. [PMID: 30819766 DOI: 10.3174/ajnr.a5987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Disappearance of T2 lesions into CSF spaces is frequently observed in patients with MS. Our aim was to investigate temporal changes of cumulative atrophied brain T2 lesion volume and 10-year confirmed disability progression. MATERIALS AND METHODS We studied 176 patients with relapsing-remitting MS who underwent MR imaging at baseline, 6 months, and then yearly for 10 years. Occurrence of new/enlarging T2 lesions, changes in T2 lesion volume, and whole-brain, cortical and ventricle volumes were assessed yearly between baseline and 10 years. Atrophied T2 lesion volume was calculated by combining baseline lesion masks with follow-up CSF partial volume maps. Ten-year confirmed disability progression was confirmed after 48 weeks. ANCOVA detected MR imaging outcome differences in stable (n = 76) and confirmed disability progression (n = 100) groups at different time points; hierarchic regression determined the unique additive variance explained by atrophied T2 lesion volume regarding the association with confirmed disability progression, in addition to other MR imaging metrics. Cox regression investigated the association of early MR imaging outcome changes and time to development of confirmed disability progression. RESULTS The separation of stable-versus-confirmed disability progression groups became significant even in the first 6 months for atrophied T2 lesion volume (140% difference, Cohen d = 0.54, P = .004) and remained significant across all time points (P ≤ .007). The hierarchic model, including all other MR imaging outcomes during 10 years predicting confirmed disability progression, improved significantly after adding atrophied T2 lesion volume (R 2 = 0.27, R 2 change 0.11, P = .009). In Cox regression, atrophied T2 lesion volume in 0-6 months (hazard ratio = 4.23, P = .04) and 0-12 months (hazard ratio = 2.41, P = .022) was the only significant MR imaging predictor of time to confirmed disability progression. CONCLUSIONS Atrophied T2 lesion volume is a robust and early marker of disability progression in relapsing-remitting MS.
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Affiliation(s)
- R Zivadinov
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R., M.G.D.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York .,Center for Biomedical Imaging at Clinical Translational Research Center (R.Z.), State University of New York, Buffalo, New York
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience (D.H., T.U., E.H.)
| | - N Bergsland
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R., M.G.D.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - J Hagemeier
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R., M.G.D.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - D P Ramasamy
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R., M.G.D.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - T Uher
- Department of Neurology and Center of Clinical Neuroscience (D.H., T.U., E.H.)
| | - M Vaneckova
- Department of Radiology (M.V.), First Faculty of Medicine, Charles and General University Hospital in Prague, Prague, Czech Republic
| | - E Havrdova
- Department of Neurology and Center of Clinical Neuroscience (D.H., T.U., E.H.)
| | - M G Dwyer
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R., M.G.D.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Diblik P, Urban P, Navratil T, Kacer P, Kacerova T, Zakharov S. Markers of nucleic acids and proteins oxidative damage in acute methanol poisoning. Monatsh Chem 2019. [DOI: 10.1007/s00706-019-2370-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zakharov S, Hlusicka J, Nurieva O, Kotikova K, Lischkova L, Kacer P, Kacerova T, Urban P, Vaneckova M, Seidl Z, Diblik P, Kuthan P, Heissigerova J, Lesovsky J, Rulisek J, Vojtova L, Hubacek JA, Navratil T. Neuroinflammation markers and methyl alcohol induced toxic brain damage. Toxicol Lett 2018; 298:60-69. [DOI: 10.1016/j.toxlet.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/22/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
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Nurieva O, Hubacek JA, Urban P, Hlusicka J, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Vojtova L, Zakharov S. Clinical and genetic determinants of chronic visual pathway changes after methanol - induced optic neuropathy: four-year follow-up study. Clin Toxicol (Phila) 2018; 57:387-397. [PMID: 30451020 DOI: 10.1080/15563650.2018.1532083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Methanol poisoning induces acute optic neuropathy with possible long-term visual damage. OBJECTIVE To study the dynamics and key determinants of visual pathway functional changes during 4 years after acute methanol poisoning. METHODS A total of 42 patients with confirmed methanol poisoning (mean age 45.7 ± 4.4 years) were examined 4.9 ± 0.6, 25.0 ± 0.6, and 49.9 ± 0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping. RESULTS Abnormal VEP P1 latency was registered in 18/42 right eyes (OD) and 21/42 left eyes (OS), abnormal N1P1 amplitude in 10/42 OD and OS. Mean P1 latency shortening during the follow-up was 15.0 ± 2.0 ms for 36/42 (86%) OD and 14.9 ± 2.4 ms for 35/42 (83%) OS, with maximum shortening up to 35.0 ms. No significant change of mean N1P1 amplitude was registered during follow-up. A further decrease in N1P1 amplitude ≥1.0 mcV in at least one eye was observed in 17 of 36 patients (47%) with measurable amplitude (mean decrease -1.11 ± 0.83 (OD)/-2.37 ± 0.66 (OS) mcV versus -0.06 ± 0.56 (OD)/-0.83 ± 0.64 (OS) mcV in the study population; both p < .001). ApoE4 allele carriers had lower global and temporal RNFL thickness and longer initial P1 latency compared to the non-carriers (all p < .05). The odds ratio for abnormal visual function was 8.92 (3.00-36.50; 95%CI) for ApoE4 allele carriers (p < .001). The presence of ApoE4 allele was further associated with brain necrotic lesions (r = 0.384; p = .013) and brain hemorrhages (r = 0.395; p = .011). CONCLUSIONS Improvement of optic nerve conductivity occurred in more than 80% of patients, but evoked potential amplitude tended to decrease during the 4 years of observation. ApoE4 allele carriers demonstrated lower RNFL thickness, longer P1 latency, and more frequent methanol-induced brain damage compared to non-carriers.
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Affiliation(s)
- Olga Nurieva
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jaroslav A Hubacek
- b Center for Experimental Medicine , Institute for Clinical and Experimental Medicine , Prague , Czech Republic
| | - Pavel Urban
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic.,c Centre for Industrial Hygiene and Occupational Medicine , National Institute of Public Health , Prague , Czech Republic
| | - Jiri Hlusicka
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Pavel Diblik
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Pavel Kuthan
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Petr Sklenka
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Martin Meliska
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jan Bydzovsky
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Jarmila Heissigerova
- d Clinic of Ophthalmology, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Katerina Kotikova
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
| | - Tomas Navratil
- e Department of Biomimetic Electrochemistry , J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences , Prague , Czech Republic.,f Institute of Medical Biochemistry and Laboratory Medicine, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic
| | - Martin Komarc
- g Department of Methodology, Faculty of Physical Education and Sport , Charles University , Prague , Czech Republic
| | - Zdenek Seidl
- h Department of Radiology, First Faculty of Medicine , Charles University in Prague and General University Hospital , Prague , Czech Republic
| | - Manuela Vaneckova
- h Department of Radiology, First Faculty of Medicine , Charles University in Prague and General University Hospital , Prague , Czech Republic
| | - Lucie Vojtova
- i First Faculty of Medicine, Institute of Clinical Biochemistry and Laboratory Diagnostics , Charles University and General University Hospital , Prague , Czech Republic
| | - Sergey Zakharov
- a Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine , Charles University and General University Hospital , Prague , Czech Republic
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Zakharov S, Nurieva O, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Urban P, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Pelclova D. Reply. Am J Ophthalmol 2018; 195:247-248. [PMID: 30253843 DOI: 10.1016/j.ajo.2018.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Nurieva O, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Urban P, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Pelclova D, Zakharov S. Progressive Chronic Retinal Axonal Loss Following Acute Methanol-induced Optic Neuropathy: Four-Year Prospective Cohort Study. Am J Ophthalmol 2018; 191:100-115. [PMID: 29709459 DOI: 10.1016/j.ajo.2018.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/03/2018] [Accepted: 04/19/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To study the dynamics and clinical determinants of chronic retinal nerve fiber layer thickness (RNFL) loss after methanol-induced optic neuropathy. DESIGN Prospective cohort study. METHODS All patients underwent complete ophthalmic evaluation including spectral-domain optical coherence tomography 3 times during 4 years of observation: 4.9 (±0.6), 25.0 (±0.6), and 49.9 (±0.5) months after discharge. PARTICIPANTS Eighty-four eyes of 42 survivors of methanol poisoning, mean age (standard deviation) of 45.7 (±4.4) years; and 82 eyes of 41 controls, mean age 44.0 (±4.2) years. MAIN OUTCOME MEASURES Global and temporal RNFL loss. RESULTS Abnormal RNFL thickness was registered in 13 of 42 (31%) survivors of methanol poisoning and chronic axonal loss in 10 of 42 (24%) patients. Significant decrease of global/temporal RNFL thickness during the observation period was found in the study population compared to the controls (P < .001). The risk estimate of chronic global RNFL loss for arterial blood pH < 7.3 at admission was 11.65 (95% confidence interval 1.91-71.12) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated progressive visual loss in 7 of 10 cases. The patients with abnormal RNFL thickness had magnetic resonance signs of brain damage in 10 of 13 vs 8 of 29 cases with normal RNFL thickness (P = .003). Signs of brain hemorrhages were present in 7 of 13 patients with abnormal RNFL thickness vs 5 of 29 cases with normal RNFL thickness (P = .015). CONCLUSIONS Methanol-induced optic neuropathy may lead to chronic retinal axonal loss during the following years. Arterial blood pH on admission is the strongest predictor of chronic RNFL thickness decrease. Chronic retinal neurodegeneration is associated with the progressive loss of visual functions and necrotic brain lesions.
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Affiliation(s)
- Olga Nurieva
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Diblik
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Kuthan
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Sklenka
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Meliska
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Bydzovsky
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Urban
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Katerina Kotikova
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Navratil
- Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Daniela Pelclova
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
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Hlusicka J, Loster T, Lischkova L, Vaneckova M, Seidl Z, Diblik P, Kuthan P, Urban P, Navratil T, Kacer P, Zakharov S. Role of activation of lipid peroxidation in the mechanisms of acute methanol poisoning. Clin Toxicol (Phila) 2018; 56:893-903. [DOI: 10.1080/15563650.2018.1455980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jiri Hlusicka
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Loster
- Faculty of Informatics and Statistics, Department of Statistics and Probability, University of Economics, Prague, Czech Republic
| | - Lucie Lischkova
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Kuthan
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Centre for Industrial Hygiene and Occupational Medicine, National Institute of Public Health, Prague, Czech Republic
| | - Tomas Navratil
- J. Heyrovsky Institute of Physical Chemistry, Czech Academy of Sciences, Prague, Czech Republic
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Kacer
- Biocev, First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital in Prague, Prague, Czech Republic
- Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Kadrnozkova L, Vaneckova M, Sobisek L, Benova B, Kucerova K, Motyl J, Andelova M, Novotna K, Lizrova Preiningerova J, Krasensky J, Havrdova E, Horakova D, Uher T. Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year employment status in multiple sclerosis patients. J Neurol Sci 2018; 388:87-93. [PMID: 29627038 DOI: 10.1016/j.jns.2018.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/11/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is frequently diagnosed in the most productive years of adulthood and is often associated with worsening employment status. However, reliable predictors of employment status change are lacking. OBJECTIVE To identify early clinical and brain magnetic resonance imaging (MRI) markers of employment status worsening in MS patients at 12-year follow-up. METHODS A total of 145 patients with early relapsing-remitting MS from the original Avonex-Steroids-Azathioprine (ASA) study were included in this prospective, longitudinal, observational cohort study. Cox models were conducted to identify MRI and clinical predictors (at baseline and during the first 12 months) of worsening employment status (patients either (1) working full-time or part-time with no limitations due to MS and retaining this status during the course of the study, or (2) patients working full-time or part-time with no limitations due to MS and switching to being unemployed or working part-time due to MS). RESULTS In univariate analysis, brain parenchymal fraction, T1 and T2 lesion volume were the best MRI predictors of worsening employment status over the 12-year follow-up period. MS duration at baseline (hazard ratio (HR) = 1.10, 95% confidence interval (CI) 1.03-1.18; p = 0.040) was the only significant clinical predictor. Having one extra milliliter of T1 lesion volume was associated with a 53% greater risk of worsening employment status (HR = 1.53, 95% CI 1.16-2.02; p = 0.018). A brain parenchymal fraction decrease of 1% increased the risk of worsening employment status by 22% (HR = 0.78, 95% CI 0.65-0.95; p = 0.034). CONCLUSION Brain atrophy and lesion load were significant predictors of worsening employment status in MS patients. Using a combination of clinical and MRI markers may improve the early prediction of an employment status change over long-term follow-up.
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Affiliation(s)
- Lucie Kadrnozkova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic.
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability, University of Economics, Nam.W. Churchilla, 4130 67 Prague, Czech Republic
| | - Barbora Benova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Karolina Kucerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Jiri Motyl
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Jana Lizrova Preiningerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Katerinska 30, 120 00 Prague, Czech Republic
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Uher T, Krasensky J, Sobisek L, Seidl Z, Bergsland N, Dwyer MG, Kubala Havrdova E, Zivadinov R, Horakova D, Vaneckova M. The Role of High-Frequency MRI Monitoring in the Detection of Brain Atrophy in Multiple Sclerosis. J Neuroimaging 2018; 28:328-337. [PMID: 29485230 DOI: 10.1111/jon.12505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/31/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE A relatively high intraindividual variability of longitudinal magnetic resonance imaging (MRI) of brain volume loss (BVL) measurements over time renders challenging its application to individual multiple sclerosis (MS) patients. Objective of this study was to investigate if high-frequency brain MRI monitoring affects identification of pathological BVL in an individual patient. METHODS One hundred fifty-seven relapsing-remitting MS patients had seven MRI scans over 12 months follow-up. All 1,585 MRI scans were performed on the same 1.5T scanner using an identical scanning protocol. Volumetric analysis was performed by ScanView and SIENA software. Linear regression analysis was used for estimation of annualized BVL, with a cutoff greater than .4% defined as pathological. We compared proportions of patients with pathological BVL obtained by analysis of different number of MRI time-points. RESULTS An analysis of seven MRI scans (months 0, 2, 4, 6, 8, 10, and 12) showed pathological BVL in 105 (65%) of patients. When three MRI scans were included (months 0, 6, and 12), we found 10 (6.4%) false negative and 9 (5.7%) false positive results compared with the analysis of seven MRI scans, used as a reference for assessment of pathological BVL. Analysis of two MRI time-points (months 0 and 12) showed 10 (6.4%) false negative and 13 (8.3%) false positive results compared with analysis of seven MRI time-points. Change in the accuracy of pathological BVL between results obtained by analysis of seven and two time-points was 14.7%. CONCLUSIONS High-frequency MRI monitoring may have a considerable effect on improving the precision of precisely identifying pathological BVL in individual patients. However, limitations in translation to clinical practice remain.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiodiagnostic, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - Zdenek Seidl
- Department of Radiodiagnostic, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,Translational Imaging Center at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiodiagnostic, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Dwyer MG, Hagemeier J, Bergsland N, Horakova D, Korn JR, Khan N, Uher T, Medin J, Silva D, Vaneckova M, Havrdova EK, Zivadinov R. Establishing pathological cut-offs for lateral ventricular volume expansion rates. Neuroimage Clin 2018. [PMID: 29527505 PMCID: PMC5842310 DOI: 10.1016/j.nicl.2018.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background A percent brain volume change (PBVC) cut-off of −0.4% per year has been proposed to distinguish between pathological and physiological changes in multiple sclerosis (MS). Unfortunately, standardized PBVC measurement is not always feasible on scans acquired outside research studies or academic centers. Percent lateral ventricular volume change (PLVVC) is a strong surrogate measure of PBVC, and may be more feasible for atrophy assessment on real-world scans. However, the PLVVC rate corresponding to the established PBVC cut-off of −0.4% is unknown. Objective To establish a pathological PLVVC expansion rate cut-off analogous to −0.4% PBVC. Methods We used three complementary approaches. First, the original follow-up-length-weighted receiver operating characteristic (ROC) analysis method establishing whole brain atrophy rates was adapted to a longitudinal ventricular atrophy dataset of 177 relapsing-remitting MS (RRMS) patients and 48 healthy controls. Second, in the same dataset, SIENA PBVCs were used with non-linear regression to directly predict the PLVVC value corresponding to −0.4% PBVC. Third, in an unstandardized, real world dataset of 590 RRMS patients from 33 centers, the cut-off maximizing correspondence to PBVC was found. Finally, correspondences to clinical outcomes were evaluated in both datasets. Results ROC analysis suggested a cut-off of 3.09% (AUC = 0.83, p < 0.001). Non-linear regression R2 was 0.71 (p < 0.001) and a − 0.4% PBVC corresponded to a PLVVC of 3.51%. A peak in accuracy in the real-world dataset was found at a 3.51% PLVVC cut-off. Accuracy of a 3.5% cut-off in predicting clinical progression was 0.62 (compared to 0.68 for PBVC). Conclusions Ventricular expansion of between 3.09% and 3.51% on T2-FLAIR corresponds to the pathological whole brain atrophy rate of 0.4% for RRMS. A conservative cut-off of 3.5% performs comparably to PBVC for clinical outcomes. Pathological atrophy in MS can be measured on clinical T2-FLAIR images alone. Ventricular enlargement of 3.5% per year separates MS/HC as well as PBVC on T1 images. Ventricular cut-offs also correspond to clinical outcome. This cut-off can substitute in NEDA-4 when only clinical T2-FLAIR images are available.
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Affiliation(s)
- Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | | | | | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | | | - Diego Silva
- Novartis Pharmaceuticals AG, Basel, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Translational Imaging Center at Clinical and Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
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Rusz J, Benova B, Ruzickova H, Novotny M, Tykalova T, Hlavnicka J, Uher T, Vaneckova M, Andelova M, Novotna K, Kadrnozkova L, Horakova D. Characteristics of motor speech phenotypes in multiple sclerosis. Mult Scler Relat Disord 2018; 19:62-69. [DOI: 10.1016/j.msard.2017.11.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
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