Friday, 31 May 2013

Brain damage and motor and cognitive function in MS

MRI is the window in the MSer brain; it is surprising how much damage MS causes. #MSBlog #MSResearch

Sbardella et al. Assessing the Correlation between Grey and White Matter Damage with Motor and Cognitive Impairment in Multiple Sclerosis Patients.PLoS One. 2013 May 16;8(5):e63250.

BACKGROUND: MS is characterized by demyelinating and degenerative processes within the central nervous system. Unlike conventional MRI, new advanced imaging techniques improve pathological specificity and better highlight the relationship between anatomical damage and clinical impairment.

OBJECTIVE: To investigate the relationship between clinical disability and both grey (GM) and white matter (WM) regional damage in MSers.

METHODS: Thirty-six RRMSers and 25 sex- and age-matched controls were enrolled. All MSers were clinically evaluated by the Expanded Disability Status Scale and the Multiple Sclerosis Functional Composite (MSFC) scale, which includes the 9-hole peg test (9HPT), the timed 25-feet walking test (T25FW) and the paced auditory serial addition test (PASAT). All subjects were imaged by a 3.0 T scanner: dual-echo fast spin-echo, 3DT1-weighted and diffusion-tensor imaging (DTI) sequences were acquired. Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analyses were run for regional GM and WM assessment, respectively. T2 lesion volumes were also calculated, by using a semi-automated technique.

3D = three-dimensional; 3D imaging is higher resolution.

T1-weighted = The MRI sequence that shows up MS lesions as black holes.

DTI = diffusion tensor imaging allows you to measure the integrity of  white matter tracts to see if they are intact or damaged.


VBM = voxel based morphometry morphs the brain onto a standard template and looks for subtle anatomical variations, for example shrinkage of the brain in a specific region.


TBSS = tract-based spatial statistics is a measure of how intact a particular nerve pathway is as well as its connections, for example the corticospinal tract from the cerebral cortex in the brain to the spinal cord, this is the tract that carries motor fibres. Damage to the corticospinal tract results in weakness, spasticity and so called clonic spasms.


RESULTS: Brain volumetric assessment of GM and DTI measures revealed significant differences between MSers and controls. In MSers, different measures of WM damage correlated each-other (p<0.0001), whereas none of them correlated with GM volume. In MSers, focal GM atrophy and widespread WM damage significantly correlated with clinical measures. In particular, VBM analysis revealed a significant correlation (p<0.05) between GM volume and 9HPT in cerebellum and between GM volume and PASAT in orbito-frontal cortex. TBSS showed significant correlations between DTI metrics with 9HPT and PASAT scores in many WM bundles (p<0.05), including corpus callosum, internal capsule, posterior thalamic radiations, cerebral peduncles.

CONCLUSIONS: Selective GM atrophy and widespread WM tracts damage are associated with functional impairment of upper-limb motion and cognition. The combined analysis of volumetric and DTI data may help to better understand structural alterations underlying physical and cognitive dysfunction in MS.

"This study is showing what we already know; MS is associated with widespread damage on MRI that correlates with clinical outcomes, for example upper-limb function (speed and accuracy of movement) and cognition. Cognition refers to the complex mental processes that include attention, memory, producing and understanding language, learning, reasoning, problem solving, and decision making."

"It is becoming increasingly clear that MRI is a window into the brain; what we are seeing on MRI is the pathology. This is not what some people in the field would like you to believe. What you see clinically is the tip of the iceberg and often reflects how well you adapt to damage. Some MSers have incredible functional reserve and cope with extraordinary amount of damage when their MRIs show major damage. The problem with this is that ultimately that MSer's coping mechanisms eventually fail and they develop overt disabilities and often appear to go downhill very rapidly. They go down rapidly because they accumulated so much damage in the past and it manifests itself as soon as a threshold is seen."

10 comments:

  1. The neurologists who say "I treat the patient, not the MRI" need to change

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  2. Which is why it's a shame my neurologist didn't ever offer DMTs...

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  3. So how do you get your neuro to sanction a new MRI? (And how do you get them to discuss the many they did 4 years ago, when they thought you had a brain tumour, and wanted to carry out a craniotomy?)
    I may need to stop copaxone, because of side-effects, but without any clinical evidence of relapses, my options for future treatment are limited, and if I then get put back into the 'let's see if you have any relapses, and how severe they are' pile, well then, how many potential steps backwards. But an MRI would show if there had been any new damage, or indeed if there are any signs of improvement.
    And once again, what was that phrase coined by Joseph Heller......

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    Replies
    1. It's 'Catch-22'.

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    2. show-off, just 'cos your cognition is still working....

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  4. This post has really depressed me! I thought I was coping well but after reading this I'm wondering if it's just 'functional reserve' and when I do decline, I'll go downhill really fast. Probably shouldn't read this blog as much as I do!!

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    1. I believe it's important to "use it or lose it" when dealing with cognitive impairment. Just like physical decline. Hopefully the newer meds like Natalizumab will reduce brain inflammation. That's the best we got.

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    2. Yes.I got gloomy too but still prefer to see this blog than be left in the dark as during first 20 years! And everyone on here seems pretty damn sparky Neuro Cog wise ! x

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  5. http://www.ncbi.nlm.nih.gov/pubmed/22807471 Natalizumab DEATHS

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  6. When you post a link please tell us what it says.....otherwise it is likely to be deleted. as an advert or some type of spam

    This link is meaningless out of context as it is part of a debate that happens ever month in multiple sclerosis journal some one says YES someone says NO and then there is a COMMENTARY.

    The debate could be MS is easy to treat some one will say YES some on will say NO.

    Deaths and disability from natalizumab are no longer tolerable:
    Commentary = Hutchinson M. PMID: 22807472
    No - (they can be avoided) = Sørensen PS. PMID: 22807471 [
    Yes = Duquette P.PMID: 22807470

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