Selective vulnerability of brainstem and cervical spinal cord regions in people with non-progressive multiple sclerosis of Black or African American and European ancestry

Abstract

Background: We evaluated imaging features suggestive of neurodegeneration within the brainstem and upper cervical spinal cord (UCSC) in non-progressive multiple sclerosis (MS). Methods: Standardized 3-Tesla three-dimensional brain magnetic resonance imaging (MRI) studies were prospectively acquired. Rates of change in volume, surface texture, curvature were quantified at the pons and medulla-UCSC. Whole and regional brain volumes and T2-weighted lesion volumes were also quantified. Independent regression models were constructed to evaluate differences between those of Black or African ancestry (B/AA) and European ancestry (EA) with non-progressive MS. Results: 209 people with MS (pwMS) having at least two MRI studies, 29% possessing 3–6 timepoints, resulted in 487 scans for analysis. Median follow-up time between MRI timepoints was 1.33 (25th–75th percentile: 0.51–1.98) years. Of 183 non-progressive pwMS, 88 and 95 self-reported being B/AA and EA, respectively. Non-progressive pwMS demonstrated greater rates of decline in pontine volume ( p < 0.0001) in B/AA and in medulla-UCSC volume ( p < 0.0001) for EA pwMS. Longitudinal surface texture and curvature changes suggesting reduced tissue integrity were observed at the ventral medulla-UCSC ( p < 0.001), dorsal pons ( p < 0.0001) and dorsal medulla ( p < 0.0001) but not the ventral pons ( p = 0.92) between groups. Conclusions: Selectively vulnerable regions within the brainstem-UCSC may allow for more personalized approaches to disease surveillance and management.

Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities?

“…One of these studies found that African American pwMS had greater total spinal cord atrophy, and more specifically, also within the ventral and dorsal regions, compared to White pwMS (39). The other study demonstrated that Europeans with MS had greater volume loss at the medulla-upper cervical spinal cord region than African Americans, but that African Americans had greater baseline pontine volume loss, which continued to worsen at one-year follow-up (41).…”

Eine Übersicht über neuro-ophthalmologische Erkrankungen bei Afroamerikanern und Hispanics mit multipler Sklerose

“…Auch die okuläre Dysmotilität, einschließlich der internukleären Ophthalmoplegie (INO) und der bilateralen INO mit dem Schielauge, ist bei MS weit verbreitet [77]. Es gibt nur wenige Artikel in der Literatur, die sich mit den ethnischen und rassischen Unterschieden bei diesen Befunden befassen, was erwähnenswert ist, zumal es Literaturstellen gibt, die darauf hindeuten, dass die Hirnstammregionen, die diese Funktionen steuern, bei Menschen mit afroamerikanischer Abstammung strukturell besonders anfällig sind [78]. Zu diesem Thema sind weitere Studien erforderlich.…”

A narrative review of neuro-ophthalmologic disease in African Americans and Hispanics with multiple sclerosis

“…Similarly, ocular dysmotility, including internuclear ophthalmoplegia (INO) and wall-eyed bilateral INO, are highly prevalent in MS. 77 There is a dearth of literature examining ethnic and racial disparities in these findings, which is worth mentioning, particularly as there is literature suggesting that structurally the brainstem regions controlling these functions are selectively vulnerable in those with African-American ancestry. 78 Further study is needed on this topic.…”