Corticospinal Tract Abnormalities Are Associated with Weakness in Multiple Sclerosis

Reich, Daniel S.; Zackowski, Kathleen M.; Gordon-Lipkin, Eliza; Smith, Seth A.; Chodkowski, B.; Cutter, Gary; Calabresi, Peter A.

doi:10.3174/ajnr.a0788

Cited by 66 publications

(58 citation statements)

References 33 publications

(37 reference statements)

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“…There is additional evidence that lower aerobic fitness levels (VO 2peak ) were associated with less activation in the right inferior and middle frontal gyri (pr=0.46) and increased activation in the anterior cingulate cortex (pr=-.44) during performance of the Paced Visual Serial Addition Task (PVSAT) in 24 persons with relapsing-remitting MS who had minimal disability [35]. Other researchers have reported that muscle strength of the ankle dorsiflexors and hip flexors, assessed using a hand-held dynamometer, has been associated with brain imaging abnormalities along the intracranial corticospinal tract in 47 persons with moderate MS-related disability [36]. One study reported that larger postural sway amplitude (i.e., worse balance) was associated with reduced structural spinal cord integrity (i.e., cerebrospinal-fluidnormalized magnetization-transfer imaging) in 42 persons with MS who had moderate disability (mean EDSS=3.7) [37].…”

Section: Brian Structure and Function And Fitness Outcomesmentioning

confidence: 99%

The Importance of Physical Fitness in Multiple Sclerosis

Motl¹

2013

J Nov Physiother

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Multiple Sclerosis (MS) is a common and life-altering neurological disease among adults in the United States and worldwide. This disease has an estimated prevalence of 1 per 1,000 adults in the United States [1] with the majority of cases occurring in women of European descent. The MS pathophysiology initially involves episodic periods of immune-mediated demyelination and transection of axons within the Central Nervous System (CNS). This results in the disruption of saltatory conduction of action potentials along myelinated axonal pathways in the brain, spinal cord, and optic nerves. The MS pathophysiology later transitions into a neurodegenerative disease process, presumably associated with insufficient neurotrophic support, and results in the accumulation of irreversible neurologic disability. The degree and location of axonal and neuronal damage within the CNS result in the heterogeneous expression of symptomatic, functional, and participatory consequences among persons with MS [2]. Such manifestations might be initiated or worsened by physical inactivity and resulting physiological deconditioning.We have previously described a model of physical inactivity, deconditioning, and worsening MS [3,4], and this was based on a similar framework for persons with chronic disease conditions [5] including MS [6]. The model is displayed in figure 1 and indicates that MS onset results in physical inactivity [7,8] that initiates physiological deconditioning (i.e., compromised or reduced physical fitness). This physiological deconditioning, in turn, results in worsening of MS, as indicated by loss of brain structure and function as well as symptomatic (e.g., fatigue) and functional (e.g., walking impairment) manifestations. The worsening of MS results in further physical inactivity and subsequent physiological deconditioning thereby yields a cycle of associations among physical inactivity, deconditioning, and worsening MS that develops over time. This model is important as it conceptualizes the importance of maintaining and improving physical fitness levels in persons with MS. Physical fitness might provide a form of "physiological reserve" that is protective of disease consequences and worsening of MS and this is consistent with other literatures such as cancer [9].To that end, this paper provides a comprehensive review of research on physical fitness in persons with MS. We begin by defining physical fitness and its domains as well as differentiating it from physical activity. We then present research on physiological deconditioning (i.e., detraining that manifests as a reduction in domains of physical work capacity or fitness) in persons with MS as well as evidence on the association between markers of physical fitness and consequences of MS. We lastly review research regarding the effects of exercise training on physical fitness and consequences of MS, and conclude with recently developed exercise recommendations for improving physical fitness. Our goal is the provision of a paper that underscores the (a) importance of p...

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Section: Brian Structure and Function And Fitness Outcomesmentioning

confidence: 99%

The Importance of Physical Fitness in Multiple Sclerosis

Motl¹

2013

J Nov Physiother

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“…however, previous authors have failed to prove the relation between the spinal cord MR imaging abnormalities on the conventional sequences and the clinical disability 16,18,19 . Advanced MR imaging techniques, such as proton spectroscopy and diffusion tensor imaging, have also been studied with some success when aiming to demonstrate a correlation between the imaging findings and the clinical status 20 . Also, the DTI have demonstrated fractional anisotropy abnormalities in the brain white matter 7,8 and in the spinal cord 11,12 , even in regions with normal signal on T2-weighted images, defining the well-known terms called "normal appearing white matter" and "normal appearing spinal cord".…”

Section: Discussionmentioning

confidence: 99%

Diffusion tensor imaging of the cervical spinal cord of patients with relapsing-remising multiple sclerosis: a study of 41 cases

Cruz

Domingues

Gasparetto

2009

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the fractional anisotropy (FA) values of the multiple sclerosis (MS) plaques and normal-appearing cervical spinal cord (NASC) by diffusion tensor MRI imaging (DTI). Method: Forty-one patients with relapsing-remising MS and 37 controls were evaluated. All MRI exams were performed using a conventional protocol, as well as diffusion tensor MR imaging. Regions of interest were placed within the spinal cord lesions and in the normal appearing spinal cord adjacent to the plaque. Results: The FA values were statistically reduced in the plaques compared to the surrounding NASC and to equivalent location in controls. A reduction in FA values was also observed in the spinal cord of MS patients without visible lesions on T2WI. Conclusion: We observed reduced fractional anisotropy in the demyelinating plaques and in the NASC of MS patients, corroborating the hypothesis that the histological extension of the MS lesions is more severe than the abnormalities seen in the conventional MRI sequences.Key WoRDS: multiple sclerosis, magnetic resonance imaging, diffusion tensor imaging. imagens por tensor de difusão da medula cervical de pacientes com esclerose múltipla remitenterecorrente: estudo de 41 casos resumo -Objetivo: Avaliar os valores da anisotropia fracionada (FA) em pacientes com esclerose múltipla (eM) nas placas e na medula espinhal aparentemente normal (MeAN). Método: Quarenta e um pacientes com eM remitente-recorrente e 37 controles foram examinados. Todos os exames foram realizados com protocolo convencional, assim como imagens por tensor de difusão. Regiões de interesse foram definidas nas placas da medula espinhal e na MeAN ao redor das placas. Resultados: os valores de FA estavam significativamente reduzidos nas placas, comparados à MeAN ao redor e às regiões equivalentes dos controles. Redução dos valores de FA também foi demonstrada na medula espinhal de pacientes com eM sem lesões visíveis nas imagens de RM pesadas em T2. Conclusão: observamos redução dos valores de anisotropia fracionada nas placas de desmielinização e na MeAN, corroborando a hipótese de que a extensão histológica das lesões na eM é maior que as alterações de sinal vistas nas seqüências convencionais de ressonância magnética.PAlAvRAS-ChAve: esclerose múltipla, ressonância magnética, imagens por tensor de difusão.

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“…Despite the obvious advantages of DTI at 3 T in comparison to lower field strengths, the number of published applications in MS is rather limited so far [86][87][88][89]. The results of studies performed at 3 T are not likely to differ substantially from those obtained at lower field strengths, 3 T DTI might offer a greater perspective of (multiparametric) MRI research involving certain anatomic regions which are more difficult to investigate at lower fields such as gray matter structures [86,87].…”

Section: Quantitative Mri Methodsmentioning

confidence: 99%

High field MRI in the diagnosis of multiple sclerosis: high field–high yield?

Wattjes

Barkhof

2009

Neuroradiology

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Following the approval of the U.S. Food and Drug Administration (FDA), high field magnetic resonance imaging (MRI) has been increasingly incorporated into the clinical setting. Especially in the field of neuroimaging, the number of high field MRI applications has been increased dramatically. Taking advantage on increased signal-to-noise ratio (SNR) and chemical shift, higher magnetic field strengths offer new perspectives particularly in brain imaging and also challenges in terms of several technical and physical consequences. Over the past few years, many applications of high field MRI in patients with suspected and definite multiple sclerosis (MS) have been reported including conventional and quantitative MRI methods. Conventional pulse sequences at 3 T offers higher lesion detection rates when compared to 1.5 T, particularly in anatomic regions which are important for the diagnosis of patients with MS. MR spectroscopy at 3 T is characterized by an improved spectral resolution due to increased chemical shift allowing a better quantification of metabolites. It detects significant axonal damage already in patients presenting with clinically isolated syndromes and can quantify metabolites of special interest such as glutamate which is technically difficult to quantify at lower field strengths. Furthermore, the higher susceptibility and SNR offer advantages in the field of functional MRI and diffusion tensor imaging. The recently introduced new generation of ultra-high field systems beyond 3 T allows scanning in submillimeter resolution and gives new insights into in vivo MS pathology on MRI. The objectives of this article are to review the current knowledge and level of evidence concerning the application of high field MRI in MS and to give some ideas of research perspectives in the future.

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Corticospinal Tract Abnormalities Are Associated with Weakness in Multiple Sclerosis

Cited by 66 publications

References 33 publications

The Importance of Physical Fitness in Multiple Sclerosis

The Importance of Physical Fitness in Multiple Sclerosis

Diffusion tensor imaging of the cervical spinal cord of patients with relapsing-remising multiple sclerosis: a study of 41 cases

High field MRI in the diagnosis of multiple sclerosis: high field–high yield?

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