Methods: 12 RR-MSc and 14 demographically, clinically, and radiologically, matched RR-MSnc and 20 controls were investigated. All MSers underwent neuropsychological assessment. After refilling of FLAIR lesions on the 3D T1-weighted images, VBM was performed using SPM8 and DARTEL. A correlation analysis was performed between VBM results and neuropsychological variables characterizing RR-MSc patients.
Results: Despite a similar clinical status, RR-MSc were characterized by more severe cognitive damages in attention and language domains with respect to RR-MSnc and controls. With respect to controls, RR-MSnc were characterized by a specific atrophy of the bilateral thalami that became more widespread (including motor cortex) in the RR-MSc group (FWE < 0.05). However, consistent with their well-defined neuropsychological deficits, RR-MSc group showed atrophies in the prefrontal and temporal cortical areas when directly compared with RR-MSnc group.
Conclusion: These results demonstrated that RR-MSers with cerebellar signs were characterized by a distinct neuroanatomical profile, mainly involving cortical regions underpinning executive functions and verbal fluency.
"I have always had an inkling about this! When I was a trainee neurologist I was struck by how slow people with cerebellar dysfunction thinking was. They tend to be vague and can't recall the correct temporal sequence of events. For example, they find it difficult to tell you when they had a relapse or their last fall. In addition, MSers with cerebellar dysfunction tend to do poorly. We treat cerebellar dysfunction as a poor prognostic sign. Disappointingly, we don't have any effective treatment for cerebellar dysfunction. For example, the symptomatic treatments we use to control the tremor are not effective and are associated with side effects. The main treatment is physical therapy."
"It is better to try and prevent cerebellar damage by treating early and aggressively."