Friday, 23 November 2012

Research: brain sizes in unaffected twins

Kuusisto et al. Volumetric MRI assessment of brain and spinal cord in finnish twins discordant for multiple sclerosis. Medicina (Kaunas). 2012;48:437-41.

BACKGROUND: Brain size, white matter hyperintensity, and the development of brain atrophy are known to be highly heritable. The decrease of brain volume starts from the very onset of MS and is 10-fold compared with normal ageing  


AIM: The aim of this study was to assess whether the brain and spinal cord volumes and the volume of white matter lesions differed between twins with MS and their asymptomatic co-twins. 

MATERIAL AND METHODS: A co-twin control method was used to evaluate whether the brain and spinal cord volumes differ between twins with MS and their co-twins. Nineteen twin pairs were studied neurologically, and the volumes of T1, T2, FLAIR, and gadolinium-enhanced lesions and those of the brain and the spinal cord were obtained by magnetic resonance imaging. 

RESULTS: Significant differences in the brain (P=0.064) or spinal cord (P=0.648) volumes were not detected. Four of the 7 monozygotic/identical and 5 of the 12 dizygotic/non-identical co-twins had focal brain white matter lesions, but none fulfilled the MRI criteria of Barkhof. Spinal cord lesions were not seen in any of the co-twins. 

CONCLUSIONS: The absence of a significant difference in the brain or spinal cord volume between the twins with multiple sclerosis and their co-twins supports the recent observation of brain size and the development of brain atrophy being highly heritable.


"A very interesting study and suggest the unaffected co-twins have sub-clinical brain atrophy despite not having MS. Does this mean they have MS that has not manifested? It would be interesting to see this study reproduced in a larger number of twins."

10 comments:

  1. 19 twin pairs, 7 identical and 12 non-identical
    -7/7 non-MS identical twins had brain lesions
    -5/12 non-MS non-identical twins had brain lesions
    -Meaning at least 12/19 'non-MS' twins probably have MS too

    Do you expect similar results will be the same if the study was done sibling?Because a non-identical twin is the same as any other sibling

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    Replies
    1. They are not the same; non-identical twins, unlike siblings, share the in utero environment and therefore have a higher risk of MS. The month of birth effect is an indicator that things that happen in utero, or dueing pregnancy, affect MS risk. We are actually doing a sibling study at present and will be able to give you some answers in relation to this. If you have sibling who do not have MS please get them to stop smoking, if they do, and to make sure they are vD replete (5000IU vD3 per day).

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  2. So could this point to something like birth defects ? and away from a virus / infection ?

    Regards

    ReplyDelete
    Replies
    1. Probably genes and environmental effects acting in utero!

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    2. Prof G,

      So why are you persisting with the Charcot Project if it all seems to be set up in the womb i.e we are destined to get MS?

      Does Vit D really have such an impact? I remember you saying that if an individual (approx 5% of the population) wasn't infected with EBV, their chance of getting MS was almost zero. This would suggest that Vit D has a minor role i.e. if you aren't infected with EBV it doesn't matter if you are Vit D deificnet!

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  3. Interesting re the possible hereditary connection. When my wife was dx it was considered not the case at all and all the stories of siblings , parents etc having MS were considered merely coincidental and anecdotal. It's very interesting how things can effect us even before birth, I'm looking forward to a large scale study and hope it will give us some answers. No womb for complacency.

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  4. I'd be more interested in the best ways to combat the atrophy now we're alive and can make choices than why it might have happened in the first place.

    I've heard more cardiovascular exercise combats 'normal' brain atrophy in the elderly. I assume this can't do any harm to an MS'd brain either?

    Could we assume that an increase in blood circulation/O2 delivery is a good thing and if it is how else can we increase it?

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    Replies
    1. O2 deliver the UK Society is funding research in this area, but not from a CCSVI point of view

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    2. who said anything about ccsvi?
      O2 delivery is worth investigating?
      HBOT
      increasing NO production?
      eating more beetroot!
      doing regular, varied exercise at the most beneficial intensity.
      Using acupressure at the back/base of the skull? (get those syrinxes in the CSF moving(?) as they must have an effect on circulation in the head?
      Acupuncture, which has an effect on the delivery of blood (forget the bad translation by a 19thC frenchman which talks about the fluffy and indistinct 'flow of chi') The flow of calories and O2 through blood circulation can also be about delivering energy more efficiently.

      In my experience these are all things (as well as clear, sunny days!) that have helped me feel better (even if only for a matter of hours) I guess the trouble is 'feeling better' is not very measurable.

      But these are all things that are worth exploring by the patient before trying out an untested procedure that costs and breaks the skin.

      Are they perhaps approaches that could be usefully studied to potentially improve the quality of life of patients living right now?

      If increasing O2 delivery is worthy of further investigation (and surely science is all about asking questions and testing hypotheses?) then that would include investigating all forms of treatment/procedure that aims to address delivery of O2?
      Didn't Charcot notice poorly performing veins over 150 years ago?
      Do you think now could be a time to follow these possible lines of investigation?

      Delete
  5. Dr. I am a woman who suffers from multiple sclerosis, many symptoms, I have a few injuries and no identical twin brother you think you need to assess it becometh greetings studies ....

    ReplyDelete

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