Pathology and MRI: exploring cognitive impairment in MS

Paul, Friedemann

doi:10.1111/ane.12649

Cited by 72 publications

(43 citation statements)

References 161 publications

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“…Among subcortical structures, the thalamic volume is the best predictor of cognitive impairment in adult [16] and juvenile [19] onset MS. Moreover, thalamic atrophy was correlated with accumulation of disability [20,21], and cognitive impairment [17,20,[22][23][24]. It was also found that thalamic atrophy predicts the cognitive decline in MS patients [25], and is associated with the development of clinically definite MS in CIS [26].…”

Section: Discussionmentioning

confidence: 99%

Central Slab versus Whole Brain to Measure Brain Atrophy in Multiple Sclerosis

Ruberte¹,

Sinnecker

Amann

et al. 2018

Eur Neurol

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Background: Structural Image Evaluation using Normalization of Atrophy (SIENA) is used to measure brain atrophy in multiple sclerosis (MS). However, brain extraction is prone to artefacts in the upper and lower parts of the brain. To overcome these shortcomings, some pivotal MS trials used a central slab instead of the whole brain as input for SIENA. The aim of this study was to compare the internal consistency and statistical dispersion of atrophy measures, associations with clinical outcomes and required sample sizes in clinical trials between these two approaches. Methods: Brain volume change was assessed using SIENA in 119 MS patients with 5-years follow-up on 3D T1-weighted Magnetization Prepared Rapid Gradient Echo datasets using the whole brain or a central slab ranging from –10 to +60 mm Montreal Neurological Institute atlas coordinates. The statistical analysis included the quartile coefficient of dispersion, partial correlations with clinical outcomes and sample size calculations. Clinical outcome measures comprised the Expanded Disability Status Scale, MS Functional Composite and Symbol Digit Modalities Test. Results: Annualized brain atrophy rates were higher using central slab than whole brain as input for SIENA (–0.51 ± 0.49 vs. –0.37 ± 0.39% per year, p < 0.001). Central and whole brain volume change showed comparable statistical dispersion and similarly correlated with clinical outcomes at 5-years follow-up. Sample size calculations estimated 14% fewer patients required to detect a given treatment effect when using the central slab instead of the whole brain option in SIENA. Conclusion: Central slab and whole brain SIENA produced comparable statistical dispersion with similar associations to clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Central Slab versus Whole Brain to Measure Brain Atrophy in Multiple Sclerosis

Ruberte¹,

Sinnecker

Amann

et al. 2018

Eur Neurol

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“…Проявлениями активного воспалительного процесса яв-ляются клинические обострения РС, а также появление новых очагов и накопле-ние в них контраста, отражающее нару-шение ГЭБ, что определяется при прове-дении магнитно-резонансной томографии (МРТ) [24][25][26]. Постепенное неуклонное нарастание инвалидизации более типично для диффузного поражения аксонов (де-генеративного процесса) [9,10].…”

Section: Abstract: Multiple Sclerosis Demyelination Neurodegeneratiunclassified

“…Тревожные расстройства встречаются реже, чем депрессии, но зна-чительно дезадаптируют больного, за-трудняют социальные контакты [32,33]. Эйфория наблюдается чаще в развернутой стадии заболевания, ее выраженность коррелирует со степенью когнитивных нарушений, расширением желудочков мозга, определяемых при МРТ [25,34]. Когнитивные нарушения коррелируют с тяжестью неврологических расстройств и более выражены при прогрессирующих типах течения заболевания [35,36].…”

Section: нарушение функции мочевого пузы-ря и кишечника (фс 6)unclassified

“…Особое внимание уделяется дегене-ративно-атрофическим процессам в го-ловном мозге при РС, так как с ними свя-зано формирование стойких неврологиче-ских расстройств и когнитивных наруше-ний [25,34]. Показано, что тотальная ат-рофия головного мозга при РС является более адекватным показателем тяжести состояния пациентов, чем объем и лока-лизация очагов демиелинизации.…”

Section: критерии диагностики рассеянно-го склерозаunclassified

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Current Issues of Etiopathogenesis, Clinical Picture, Diagnosis and Treatment of Multiple Sclerosis (Literature Review and Own Data)

Лорина

Burshinov

2017

I.P. Pavlov Russian Medical Biological Herald

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АКТУАЛЬНЫЕ ВОПРОСЫ ЭТИОПАТОГЕНЕЗА, КЛИНИКИ, ДИАГНОСТИКИ И ЛЕЧЕНИЯ РАССЕЯННОГО СКЛЕРОЗА(ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЕ ДАННЫЕ) Л.В. Лорина, А.О. БуршиновРязанский государственный медицинский университет им. акад. И.П. Павлова, ул. Высоковольтная, 9, 390026, г. Рязань, Российская Федерация В статье приводится обзор данных литературы по современным аспектам этиопатогенеза, клиники, диагностики и лечения рассеянного склероза (РС). РС яв-ляется одной из наиболее социально значимых проблем в современной неврологии. Доказано, что РС -это мультифакторное заболевание, в развитии которого участ-вуют как внутренние, так и внешние факторы. Уже на ранних этапах болезни име-ется повреждение аксонов, в связи с чем РС рассматривается не только как ауто-иммунное демиелинизирующее заболевание, но и как нейродегенеративное. РС характеризуется многообразием клинических проявлений, что обусловлено множест-венностью очагов демиелинизации и их разнообразной локализацией в головном и в спинном мозге. Методы нейровизуализации играют важную роль в современной диагностике РС. Ведение больных с установленным диагнозом РС предполагает обязательную и длительную базисную терапию иммуномодулирующими препара-тами, изменяющими течение заболевания. Ключевые слова: рассеянный склероз, демиелинизация, нейродегенерация, нейро-визуализация, иммуномодулирующие препараты. _____________________________________________________________________________ CURRENT ISSUES OF ETIOPATHOGENESIS, CLINICAL PICTURE, DIAGNOSIS AND TREATMENT OF MULTIPLE SCLEROSIS (LITERATURE REVIEW AND OWN DATA) L.V. Lorina, A.O. BurshinovRyazan State Medical University, Vysokovoltnaya str., 9, 390026, Ryazan, Russian FederationThe article provides a literature review on contemporary aspects of etiopathogenesis, clinical picture, diagnosis and treatment of multiple sclerosis (MS). MS is one of the most socially significant problems of modern neurology. MS has been proven to be a multifactorial disease, which develops as a result of both internal and external factors. In the early stages of this disease there is damage to the axons, therefore MS is not only considered an autoimmune demyelinating disease, but also neurodegenerative. The disease is characterized by a variety of clinical manifestations. The variety of neurological symptoms is due to

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“…As structural and diffuse brain damage are detectable from the earliest disease stages, multiple studies have attempted to relate fatigue severity assessed by different questionnaires and sometimes in conjunction with cognitive dysfunction to various neuroimaging findings acquired using structural, functional, and metabolic imaging modalities [83–88]. For example, a magnetic resonance spectroscopy study has indicated decreased N-acetylaspartate-creatine ratios (NAA/Cr) as a marker of axonal metabolic integrity with increasing fatigue scores, suggesting diffuse and widespread axonal dysfunction as a contributor to fatigue in MS [89].…”

Section: Clinical Correlates and Biological Mechanismsmentioning

confidence: 99%

The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue

et al. 2016

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More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.

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Pathology and MRI: exploring cognitive impairment in MS

Cited by 72 publications

References 161 publications

Central Slab versus Whole Brain to Measure Brain Atrophy in Multiple Sclerosis

Central Slab versus Whole Brain to Measure Brain Atrophy in Multiple Sclerosis

Current Issues of Etiopathogenesis, Clinical Picture, Diagnosis and Treatment of Multiple Sclerosis (Literature Review and Own Data)

The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue

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