Thursday, 2 July 2015

Brain atrophy and CIS

MRI lesion load at baseline predicts brain volume loss in the future. #MSResearch #MSBlog

"The following study in CISers shows a link between focal lesion load at baseline and brain atrophy in the future; CISers with the highest lesion count at baseline had the greatest brain volume loss over the next 4 years. This shows that brain volume changes are primed by past inflammatory lesions and indicates that we will need to adjust how we use brain volume changes in clinical trials. We have to take into account the therapeutic lag associated with brain volume changes; i.e. brain volume loss in this year and possibly next year will be primed by inflammatory lesions in the past few years. Why the lag? I suspect it relates to the delayed biological vacuum cleaner; it takes many months to clear up the debris from inflammatory lesions and hence to feed through into brain volume loss."

"This study is a stark reminder of how much damage may have already occurred prior to the first clinical event (CIS). In the majority of CISers the pathology of MS has been present for many years and explains why so many CISers already have cognitive deficits at presentation. The latter observations are why we have to treat MS early and effectively and if possible suppress all inflammatory activity; zero tolerance with treat-2-target of NEDA (no evident disease activity)."

"On a positive note CISers are lucky in that the disease declares itself early. In comparison PPMSers only get to know about their disease many years later after they have lost their reserve capacity and present with progressive disease. We need to do something about the latter? If only we could get to PPMS in the asymptomatic phase of the disease."

Epub: Varosanec et al. Longitudinal Mixed-Effect Model Analysis of the Association between Global and Tissue-Specific Brain Atrophy and Lesion Accumulation in Patients with Clinically Isolated Syndrome. AJNR Am J Neuroradiol. 2015.

BACKGROUND AND PURPOSE: The relationship between lesion formation and brain atrophy development in the early phase of multiple sclerosis is unclear. We investigated the association between new lesion accumulation and brain atrophy progression in patients with clinically isolated syndrome over 48 months.

MATERIALS AND METHODS: Patients with clinically isolated syndrome (n = 210) were evaluated with 1.5T MR imaging at baseline and at 6, 12, 24, 36, and 48 months as part of a multicenter observational study of early administration of intramuscular interferon β-1a. Mixed-effect model analyses, adjusted for age, sex, and treatment status, investigated the association between accumulation of contrast-enhancing and T2 lesions and brain-volume percent changes in a 48-month period.

RESULTS: In patients with clinically isolated syndrome, the average whole-brain volume decreased 2.5%, the mean lateral ventricle volume increased 16.9%, and a mean of 7.7 new/enlarging T2 lesions accumulated over the follow-up period. Patients with clinically isolated syndrome who showed greater percentages of change in whole-brain, white and gray matter, cortical, and lateral ventricle volumes over the follow-up period had more severe lesion outcomes at baseline (all P < .007). There were significant associations between decreased individual brain-volume measures at baseline and greater percentages of change during follow-up (P < .05). We found a significant association between the total cumulative number of new/enlarging T2 lesions and the evolution of whole-brain (P < .001), lateral ventricle (P = .007), gray matter and thalamic (P = .013), subcortical deep gray matter (P = .015), and cortical (P = .036) volumes over the follow-up period.

CONCLUSIONS: Lesion accumulation and brain-volume changes occur simultaneously in the early phase of clinically isolated syndrome. More severe lesion and brain-volume outcomes at baseline were associated with greater development of brain atrophy over the follow-up period in patients with clinically isolated syndrome.

Brain functions and the unemployed

van der Hiele K, van Gorp D, Ruimschotel R, Kamminga N, Visser L, Middelkoop H.Work Participation and Executive Abilities in Patients with Relapsing-Remitting Multiple Sclerosis.
PLoS One. 2015 ;10(6):e0129228

The majority of patients with Multiple Sclerosis (MS) are unable to retain employment within 10 years from disease onset. Executive abilities, such as planning, working memory, attention, problem solving, inhibition and mental flexibility may have a direct impact on the ability to maintain a job. This study investigated differences in subjective and objective executive abilities between relapsing-remitting MS patients with and without a paid job. We included 55 relapsing-remitting MS patients from a community-based sample (47 females; mean age: 47 years; 36% employed). Patients underwent neurological, cognitive and psychological assessments at their homes, including an extensive executive test battery. We found that unemployed patients had a longer disease duration (t(53)=2.76, p=0.008) and reported more organising and planning problems (χ2(1)=6.3, p=0.012), higher distractibility (Kendall's tau-b= -0.24, p=0.03) and more cognitive fatigue (U=205.0, p=0.028, r=-0.30) than employed patients. Unemployed patients completed slightly less categories on the Wisconsin Card Sorting Test (U=243.5, p=0.042, r=-0.28). Possible influential factors such as age, educational level, physical functioning, depression and anxiety did not differ between groups. In conclusion, while relapsing-remitting MS patients without a paid job reported more executive problems and cognitive fatigue than patients with a paid job, little differences were found in objective executive abilities. 

This is saying what we have heard before an know already that that MS can affect cognitive functions as well as movement problems and this can impact on your ability to work

MS Frontiers 2015. Who won the debate?

Here are the results of the the vote before and after the debate

The question was about transplanted stem cells

Speaking for A: Gianvito Martino
Speaking for B: Prof G
Speaking for C: Prof Coles
The winner was Prof Martino from Milan on both the popular vote and the swing, so well one to love-in  I can assure you and ProfGs ego has taken a beating as he hates to lose debates 

Thanks to Emma from MS Soc for providing the figures