Neuroimaging as a method of «looking under the clinical threshold» of neurodegeneration

Abstract

Adaptive properties of the nervous system and the phenomenon of neuroplasticity form the concept of a clinical threshold, due to which existing damage to the nervous system does not clinically manifest until a certain point. Clinical threshold is a complex of adaptive mechanisms based on the plastic properties of nervous tissue. High-field modern magnetic resonance tomographs provide an opportunity to look under the clinical threshold and timely prescribe or optimize therapy. Thanks to the timely conduct of magnetic resonance imaging of the brain, it is possible to identify preclinical changes in the nervous system, as well as timely identify adverse trends during the course of the disease in order to minimize damage to the nervous system. Changes in the ventricular system and subarachnoid spaces of the brain in patients with multiple sclerosis and Wilson–Konovalov’s disease were described. Changes were revealed that indicate the presence of atrophic changes characteristic of both demyelinating and neurodegenerative pathologies. Progressive atrophic changes in the brain with a stable clinical picture may serve as a sign of the loss of a neurological reserve. The phenomena of rapidly increasing atrophy of the brain, increasing atrophy of the corpus callosum and cerebellum in the early stages of the pathological process are unfavorable prognostic signs of both multiple sclerosis and Wilson–Konovalov’s disease. Timely assessment of the severity of atrophy can help in deciding on a drug change, a complex of intensive neuroprotective measures, and to personify therapy.