Morphostructural MRI Abnormalities Related to Neuropsychiatric Disorders Associated to Multiple Sclerosis

Abstract

Multiple Sclerosis associated neuropsychiatric disorders include major depression (MD), obsessive-compulsive disorder (OCD), bipolar affective disorder, euphoria, pseudobulbar affect, psychosis, and personality change. Magnetic Resonance Imaging (MRI) studies focused mainly on identifying morphostructural correlates of MD; only a few anecdotal cases on OCD associated to MS (OCD-MS), euphoria, pseudobulbar affect, psychosis, personality change, and one research article on MRI abnormalities in OCD-MS have been published. Therefore, in the present review we will report mainly on neuroimaging abnormalities found in MS patients with MD and OCD. All together, the studies on MD associated to MS suggest that, in this disease, depression is linked to a damage involving mainly frontotemporal regions either with discrete lesions (with those visible in T1 weighted images playing a more significant role) or subtle normal appearing white matter abnormalities. Hippocampal atrophy, as well, seems to be involved in MS related depression. It is conceivable that grey matter pathology (i.e., global and regional atrophy, cortical lesions), which occurs early in the course of disease, may involve several areas including the dorsolateral prefrontal cortex, the orbitofrontal cortex, and the anterior cingulate cortex whose disruption is currently thought to explain late-life depression. Further MRI studies are necessary to better elucidate OCD pathogenesis in MS.

Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis

“…Depression is the most common psychiatric disorder in multiple sclerosis (MS) with annual prevalence rates of 20% . Including adjustment disorders, depressive disorders due to the medical condition and major depressive disorder, depression is 3–10 times more common in MS than in the general population, showing an elevated lifetime prevalence rate .…”

Affective Temperament Profiles in Patients with Multiple Sclerosis: Association with Mood Disorders

“…The prevalence of depression for MS varies between 27% and 50% (5). In addition, several neuropsychiatric syndromes, such as anxiety disorders, bipolar disorder (BD), euphoria, pathological laughing and crying, psychosis, and personality disorders (PD), are also reported among patients with MS (6,7,8,9). Hence, an early diagnosis and treatment of these psychiatric symptoms could play an important role in the prognosis and quality of life in MS patients, considering that psychiatric symptoms are more common than other neurological disorders (10,11).…”

Safety and preliminary efficacy of deep transcranial magnetic stimulation in MS-related fatigue

“… 13 , 14 It has also been widely proven as safe and well tolerated, including in a study of healthy volunteers 15 and, in the form of high-frequency stimulation of the left PFC, as effective and safe treatment of MDD. 16 – 18 PFC and MC stimulation directly targets circuits for which alterations in fatigue were reported, 5 – 9 and PFC stimulation is supported by the high overlap between fatigue and depressive symptoms. 19 MC stimulation, on the other hand, may also lead to an additional improvement of fatigue via reduction of spasticity.…”

“… 2 Although MS fatigue contributes to poor health-related quality of life 3 and is a major factor in disease-related unemployment, 4 its etiology has not yet been fully elucidated, and efficacious treatment options are scarce. Neuroimaging studies suggest that structural and functional connectivity alterations, particularly to interconnections between the basal ganglia and the prefrontal cortex (PFC), the posterior cingulate cortex and cortical motor areas, may contribute to fatigue in MS. 5 – 9 …”