Relationship between Physical Disability and Black Holes in Multiple Sclerosis: Upper Extremity Functions - an Important Parameter

Abstract

Objective: Typical lesion locations in multiple sclerosis (MS) and hypointense lesions that persist >6 months on T1-weighted magnetic resonance imaging (MRI) are known as black holes. This study aimed to investigate the potential relationship between brain MRI lesion localization and the presence of black holes and upper extremity function in patients with MS in remission. Materials and Methods:The nine-hole peg test (NHPT), timed 25-foot walk test (T25FWT), and expanded disability status scale (EDSS) scores were calculated with neurological examinations in the period when MRI was performed (±1 week).Results: This study included 47 patients diagnosed with MS. The mean patient age was 34.24±8.38 (19-54) years. The mean EDSS score of the study group was 1.7±0.85 (0-3). The mean NHPT time was 17.27±2.70 s (13.74-27.23 s). The mean T25FWT time of the study group was 4.35±0.62 s (3.30-6.05 s). Juxtacortical lesions were present in 46 (97.0%) patients, cortical lesions in 2 (4.3%), brain stem lesions in 38 (80.9%), and cerebellar lesions in 16 (34%). Permanent black holes were found in 37 (78.7%) patients, with more than one black holes being detected in 33 of these patients. The mean NHPT time was significantly longer in patients with permanent black holes detected by MRI of the brain than in those without black holes (p=0.034). A weak correlation was found between the EDSS score and NHPT time (r=0.192, p=0.046). Conclusion:The presence and number of permanent black holes can be used as a marker of disability. Upper extremity functions may well represent disability, especially in patients with low EDSS scores.