Third ventricular enlargement in early stages of multiple sclerosis is a predictor of motor and neuropsychological deficits: a cross-sectional study

Abstract

ObjectivesWhether transcranal sonography (TCS) depicted third ventricular enlargement as a sign of brain atrophy is predictive for neuropsychological deficits in mildly affected patients with multiple sclerosis (MS).DesignCross-sectional study of a cohort of mildly diseased patients with MS.SettingNeurological MS outpatient clinic at a large teaching hospital in central Europe.ParticipantsFifty-four patients with MS (16 men, 38 women, mean age 40±10 years, mean disease duration 6±5 years; mean Expanded Disability Status Scale 2±1.3) and 33 healthy controls (12 men, 21 women; 38±11 years) underwent clinical examination, an assessment of the third ventricle width by means of TCS and the Brief Repeatable Battery of Neuropsychological tests for MS, the 25-Feet Foot Walk test, the 9-Hole PEG test, the Beck Depression Inventory and a quantitative fatigue assessment. Statistical analysis was performed with univariate correlation and thereafter by stepwise regression analysis.ResultsPatients’ mean third ventricular width (3.9±1.6 mm) was significantly wider compared to controls (3.4±0.8 mm). Using stepwise regression analysis models with age, MS duration, third ventricle width and quantitative fatigue assessment as baseline variables, an increasing third ventricle width significantly correlated with the target variables worsening of motor deficits (p<0.002), worsening of verbal recall (p<0.04) and of visual spatial recall (p<0.005). Severity of depression and of fatigue was unrelated to third ventricular width.ConclusionsIn this cohort of patients with MS with mild disease, third ventricular enlargement was indicative for motor deficits and cognitive impairment, even after considering fatigue as a relevant comorbidity. Third ventricular enlargement by means of TCS seems to be a useful, clinically meaningful parameter to stage patients’ disease severity. Follow-up studies must show whether an intraindividual future third ventricular increase indeed signals larger cognitive impairment.

Central Atrophy Early in Multiple Sclerosis: Third Ventricle Volumetry versus Planimetry

“…By contrast, third ventricular enlargement might be closer related to cognitive dysfunction as indicated by previous findings . Cognitive dysfunction is known to be a disabling manifestation of MS that affects attention, information processing speed, and episodic memory .…”

“…Especially in mildly impaired patients, the association between alterations of the third ventricle to clinical measures such as the EDSS may be limited. Two earlier studies with comparable EDSS values did not find any significant correlations between central brain atrophy and EDSS scores, while in another study, such correlations were observed inconsistently in groups of clinical less affected patients (EDSS 2.0, mean disease duration 6 years) . The same holds true for the temporal changes in EDSS over 12 month .…”

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

“…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].…”

Width of The Third Ventricle as Assessed by Transcranial Sonography is Associated with Future Relapses in Mild Multiple Sclerosis

“…In several studies, the TCS findings demonstrated clinical relevance. Ventricular enlargement correlated with disease progression, with the clinical handicap as assessed by EDSS [6,[14][15][16], or with the severity of neuropsychological deficits [6,[14][15][16]. Similarly, hyperechogenicity of the substantia nigra corresponded to actual EDSS and to disease progression over 2 years [15].…”

“…TCS is examiner-dependent, which could explain the variability in 3rd ventricle reference values established by different working groups [6,[13][14][15][16]. For similar reasons, ventricle widths measured with TCS cannot simply be transferred to MRI measurements [6,17].…”