Thursday, 12 November 2015

ResearchSpeak: the impact of childhood MS on the cerebellum

The shredder slows cerebellar development in children with MS. #ResearchSpeak #MSResearch #MSBlog

"The following study shows that in children with MS the cerebellum (mini-brain at the back of the brain), that is involved in balance, eye movements, coordination and cognition, has a reduced volume in children with MS compared to controls. Are you surprised? MS is a chronic disease that damages the nervous system; most of the lesions are microscopic and involve the gray matter, hence can't be seen using conventional MRI. We capture the effect of these lesions with brain volume measurements. In this study the lower cerebellar volumes, in children with MS, did not correlate with disability as measured clinically, nor with the burden of disease as measured by T2 MS lesion volumes (white matter lesions)."

"Unfortunately, our clinical disability measurements are quite crude and not very sensitive to change, which makes me wonder what will happen to these children with time? I suspect the reduced brain reserve will have an impact as they older. I wonder if their ability to learn complex motor tasks will be impaired; for example, what are the chances of a child MSer with a smaller cerebellum of becoming an acrobat or gymnast?"

"What this study also shows that a lot of the impact MS has is at a microscopic level and is simply not captured by the so called T2 lesion load (white matter lesions). It is becoming increasingly clear we need to work out a way of incorporating brain volume measurements into clinical practice. At present the methods for measuring brain volume are not good enough at the individual MSer level over short time periods (<12-18 months). I view this as a technological issue that will be overcome by innovation; it is only a matter of time before we have reliable methods for measuring brain volume changes in clinical practice."

Epub: Weier et al. Impaired growth of the cerebellum in pediatric-onset acquired CNS demyelinating disease. Mult Scler. 2015 Nov 9. pii: 1352458515615224.

BACKGROUND: Acquired demyelinating syndromes (ADS) have the potential to negatively impact cerebellar growth, given the proclivity for infratentorial lesions in pediatric-onset multiple sclerosis (MS) and ADS.

OBJECTIVE: To investigate cerebellar growth longitudinally in pediatric ADS.

METHODS: Cerebellar volumes from 472 magnetic resonance imaging (MRI) scans of 98 patients with monophasic ADS (monoADS), monophasic acute disseminated encephalomyelitis (ADEM), and MS (49 girls; mean age: 11.4 years at first scan, mean follow-up: 3.1 years) imaged sertially from onset and 897 MRI scans of 418 healthy children (223 girls, mean age: 11.3 years, mean follow-up: 2.9 years) were segmented automatically, analyzed with mixed-effect models, and compared with cerebral volume.

RESULTS: Cerebellar developmental trajectories followed a U-shaped curve, showing larger volumes in boys (p < 0.001). Cerebellar volumes in all three patient groups failed to reach age-expected trajectories, leading to significantly smaller volumes, notably in the posterior lobes. Cerebellar volume reductions were of a similar magnitude to cerebral volume reductions. Cerebellar white matter volume declined in MS and ADEM patients over time, while in monoADS patients it remained similar to controls. Cerebellar volumes did not correlate either with lesion volumes at onset or with physical disability.

CONCLUSION: MonoADS, ADEM, and MS in childhood lead to impaired age-expected growth of the cerebellum.

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