scholarly journals A voxel-based morphometry study of disease severity correlates in relapsing— remitting multiple sclerosis

2009 ◽  
Vol 16 (1) ◽  
pp. 45-54 ◽  
Author(s):  
A. Prinster ◽  
M. Quarantelli ◽  
R. Lanzillo ◽  
G. Orefice ◽  
G. Vacca ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Grey Matter ◽  
Disease Duration ◽  
Expanded Disability Status Scale ◽  
Lesion Load ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Previous studies have shown a preferential loss of grey matter in fronto-temporal regions in patients with multiple sclerosis. Studies of correlates of disease severity are more controversial, because some studies have suggested an association between sensorimotor cortex atrophy and Expanded Disability Status Scale score, while others did not find such a correlation. The objective of this study was to assess the correlation of regional loss of grey matter and white matter with indexes of clinical and radiological severity in relapsing—remitting multiple sclerosis, including the Expanded Disability Status Scale and lesion load. Correlations between Expanded Disability Status Scale, lesion load and disease duration were assessed in 128 patients with relapsing—remitting multiple sclerosis (Expanded Disability Status Scale range 1.0—6.0) using optimized voxel-based morphometry. Bilateral loss of grey matter in sensorimotor cortices was correlated with Expanded Disability Status Scale, and tissue loss also involved adjacent white matter, extending along pyramidal tracts to the brainstem. Increasing lesion load was correlated with loss of deep grey matter and white matter. No specific region of grey matter or white matter showed a significant correlation with disease duration. These findings support the hypothesis that motor neuron involvement plays a major role in the progression of physical disability. Lesion load accrual affects mainly highly interconnected subcortical structures, while disease duration has a less significant impact on brain atrophy, probably owing to the inter-subject heterogeneity of the clinical course of the disease.

scholarly journals Magnetization transfer ratio abnormalities reflect clinically relevant grey matter damage in multiple sclerosis

2009 ◽  
Vol 15 (6) ◽  
pp. 668-677 ◽  
Author(s):  
LK Fisniku ◽  
DR Altmann ◽  
M Cercignani ◽  
DJ Tozer ◽  
DT Chard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Grey Matter ◽  
Magnetization Transfer ◽  
Magnetization Transfer Ratio ◽  
Expanded Disability Status Scale ◽  
Transfer Ratio ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background In multiple sclerosis, grey matter (GM) damage appears more clinically relevant than either white matter damage or lesion load. Objective We investigated if normal-appearing white matter (NAWM) and grey matter tissue changes assessed by magnetization transfer ratio were associated with long-term disability. Methods Sixty-nine people were assessed 20 years after presentation with a clinically isolated syndrome (CIS) [28 still CIS, 31 relapsing-remitting multiple sclerosis, 10 secondary progressive multiple sclerosis], along with 19 healthy subjects. Mean magnetization transfer ratio, peak height (PH) and peak location of the normalized magnetization transfer ratio histograms were determined in NAWM and grey matter, as well as, white matter and GM Fraction (GMF) and T2-weighted lesion load. Results Median expanded disability status scale for multiple sclerosis patients was 2.5 (range 1–8). GM-PH, and less so, NAWM mean and peak location, were lower in multiple sclerosis patients ( P = 0.009) versus controls, relapsing-remitting multiple sclerosis versus CIS ( P = 0.008) and secondary progressive multiple sclerosis versus relapsing-remitting multiple sclerosis ( P = 0.002). GM-PH (as well as GMF) correlated with expanded disability status scale ( rs = −0.49; P = 0.001) and multiple sclerosis functional score ( rs = 0.51; P = 0.001). GM-PH independently predicted disability with similar strength to the associations of GMF with clinical measures. Conclusion Grey matter damage was related to long-term disability in multiple sclerosis cohort with a relatively low median expanded disability status scale. Markers of intrinsic grey matter damage (magnetization transfer ratio) and tissue loss offer clinically relevant information in multiple sclerosis.

scholarly journals Patients with neuromyelitis optica have a more severe disease than patients with relapsingremitting multiple sclerosis, including higher risk of dying of a demyelinating disease

2013 ◽  
Vol 71 (5) ◽  
pp. 275-279 ◽  
Author(s):  
Denis Bernardi Bichuetti ◽  
Enedina Maria Lobato de Oliveira ◽  
Nilton Amorin de Souza ◽  
Mar Tintoré ◽  
Alberto Alain Gabbai
Keyword(s):  
Multiple Sclerosis ◽  
Neuromyelitis Optica ◽  
Disease Duration ◽  
Demyelinating Disease ◽  
Age Of Onset ◽  
Severe Disease ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Although neuromyelitis optica (NMO) is known to be a more severe disease than relapsing-remitting multiple sclerosis (RRMS), few studies comparing both conditions in a single center have been done.Methods:Comparison of our previously published cohort of 41 NMO patients with 177 RRMS patients followed in the same center, from 1994 to 2007.Results:Mean age of onset was 32.6 for NMO and 30.2 for RRMS (p=0.2062) with mean disease duration of 7.4 years for NMO and 10.3 years for RRMS. Patients with NMO had a higher annualized relapse rate (1.0 versus 0.8, p=0.0013) and progression index (0.9 versus 0.6, p≪0.0001), with more patients reaching expanded disability status scale (EDSS) 6.0 (39 versus 17%, p=0.0036). The odds ratio for reaching EDSS 6.0 and being deceased due to NMO in comparison to RRMS were, respectively, 3.14 and 12.15.Conclusion:Patients with NMO have a more severe disease than patients with RRMS, including higher risk of dying of a demyelinating disease.

No evidence for an effect on brain atrophy rate of atorvastatin add-on to interferon β1b therapy in relapsing–remitting multiple sclerosis (the ARIANNA study)

2016 ◽  
Vol 22 (9) ◽  
pp. 1163-1173 ◽  
Author(s):  
Roberta Lanzillo ◽  
Mario Quarantelli ◽  
Carlo Pozzilli ◽  
Maria Trojano ◽  
Maria Pia Amato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Atrophy ◽  
Composite Score ◽  
Expanded Disability Status Scale ◽  
Functional Composite ◽  
Multiple Sclerosis Functional Composite ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Background: A previous phase 2 trial has suggested that statins might delay brain atrophy in secondary progressive multiple sclerosis. Objectives: The objective of this study was to evaluate the effect of atorvastatin add-on therapy on cerebral atrophy in relapsing–remitting multiple sclerosis. Methods: This randomised, placebo-controlled study compared atorvastatin 40 mg or placebo add-on therapy to interferon β1b for 24 months. Brain magnetic resonance imaging, multiple sclerosis functional composite score, Rao neuropsychological battery and expanded disability status scale were evaluated over 24 months. Results: A total of 154 patients were randomly assigned, 75 in the atorvastatin and 79 in the placebo arms, with a comparable drop-out rate (overall 23.4%). Brain atrophy over 2 years was not different in the two arms (−0.38% and −0.32% for the atorvastatin and placebo groups, respectively). Relapse rate, expanded disability status scale, multiple sclerosis functional composite score or cognitive changes were not different in the two arms. Patients withdrawing from the study had a higher number of relapses in the previous 2 years ( P=0.04) and a greater probability of relapsing within 12 months. Conclusions: Our results suggest that the combination of atorvastatin and interferon β1b is not justified in early relapsing–remitting multiple sclerosis and adds to the body of evidence indicating an absence of significant radiological and clinical benefit of statins in relapsing–remitting multiple sclerosis.

Simvastatin treatment in patients with relapsing-remitting multiple sclerosis receiving interferon beta 1a: a double-blind randomized controlled trial

2010 ◽  
Vol 16 (7) ◽  
pp. 848-854 ◽  
Author(s):  
Mansoureh Togha ◽  
Sanaz Ahmadi Karvigh ◽  
Masoud Nabavi ◽  
Nahid Beladi Moghadam ◽  
Mohammad Hossein Harirchian ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Placebo Group ◽  
Scale Score ◽  
Expanded Disability Status Scale ◽  
T2 Lesions ◽  
Simvastatin Group ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Objectives: This study was conducted to evaluate the effect of simvastatin (40 mg/day) as an adjuvant therapy to interferon beta (IFNb 1a, 30 µg once weekly) in relapsing—remitting multiple sclerosis patients, compared with placebo. Methods: We enrolled 85 patients with relapsing—remitting multiple sclerosis (71% female) who were already receiving IFNb 1a (Avonex), with Expanded Disability Status Scale score of less than 5.0. The patients were assigned (in random and double-blinded fashion) into the two groups of simvastatin and placebo. All patients continued to receive their current IFNb treatment. The outcome measures were total relapse rate, Expanded Disability Status Scale score, and the number of gadolinium-enhanced (Gd+) and new T2 lesions in magnetic resonance imaging after a 1-year follow-up. We used Mann—Whitney and one-way multivariate analysis of variances to analyze the data. Results: Four patients in the placebo and two in the simvastatin group prematurely withdrew from the study due to experiencing two attacks. The total attack number in the simvastatin group was significantly lower than placebo group (moderate effect size r = 0.29) ( p = 0.01). The final Expanded Disability Status Scale scores were lower in the simvastatin group (1.01 ± 1.40, mean ± SD) than in the placebo group (1.73 ± 1.49, mean ± SD), but this difference was not significant after controlling the baseline Expanded Disability Status Scale score ( p = 0.07). In the simvastatin group, the mean ± SD of gadolinium-enhanced and new T2 lesions were 0.66 ± 1.18 and 3.39 ± 3.55, respectively, (compared with 0.74 ± 1.21 and 3.39 ± 3.55 in the placebo group). Although there was a decreasing trend in lesions on magnetic resonance imaging, this difference was not statistically significant ( p = 0.62). The combination therapy was safe and well tolerated, and no serious adverse effect was noted. Conclusion: Our study supports the safety and efficacy of simvastatin as an add-on therapy to INFb 1a in patients with relapsing—remitting multiple sclerosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT00668343. This interventional study provides Class I evidence stating that adding simvastatin 40 mg/day to IFNb 1a 30 µg a week in patients with relapsing—remitting multiple sclerosis may reduce the relapse rate (moderate effect size r = 0.29) ( p = 0.01) compared with treatment with IFNb 1a alone.

scholarly journals Serum Anjiogenesis Factors of Neuropilin-1 and Neuropilin-2 Levels in Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis Patients

2020 ◽  
Author(s):  
Ahmet Dönder ◽  
Hasan Hüseyin ÖZDEMİR ◽  
Hamza ASLANHAN
Keyword(s):  
Multiple Sclerosis ◽  
Clinically Isolated Syndrome ◽  
Control Group ◽  
Expanded Disability Status Scale ◽  
Angiogenesis Factors ◽  
Neuropilin 1 ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Abstract Background: Several of the molecular constituent factors in the pathophysiology of Multiple Sclerosis (MS). Neuropilins are transmembrane glycoproteins which have to be receptors for the vascular endothelial growth factor (VEGF) family of angiogenesis factors. The role of angiogenesis factors of Neuropilin-1 and 2 in the pathology of MS is unknown. Methods: We aimed to investigate levels of serum Neuropilin-1 and 2 in Relapsing-Remitting Multiple Sclerosis (RRMS), and Clinically Isolated Syndrome Patients (CIS) and to investigate a correlation with, age, sex, Expanded Disability Status Scale (EDSS) and relationship with immunomodulatory therapy. Serum Neuropilin-1 and 2 concentrations of 46 RRMS patients and 28 CIS patients and 45 healthy control group were analyzed. Clinical status was evaulated using the Expanded Disability Status Scale (EDSS). Results: Neuropilin-1 and 2 concentrations matched for immumodulatuar treatment, age and sex at a group level.Neuropilin levels were found to be significantly higher in the CIS and RRMS patient’s groups compared with the control group (p˂0,001). No statistically significant difference was found between groups; age, immunmodulatuar treatment, EDSS and gender. Conclusions: Neuropilin-1 and 2 levels have been shown to increase in RRMS and CIS patients. Neuropilins, one of the factors of angiogenesis, may be effective in pathophysiology since the first period of the disease.

scholarly journals Differential disease phenotypes and progression in relapsing–remitting multiple sclerosis: comparative analyses of single Canadian and Saudi Arabian clinics

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Alluqmani ◽  
W. Roda ◽  
M. Qqrmli ◽  
G. Blevins ◽  
F. Giuliani ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Saudi Arabia ◽  
Severe Disease ◽  
Geographic Location ◽  
Expanded Disability Status Scale ◽  
Disease Phenotypes ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Abstract Objective Relapsing–remitting multiple sclerosis (RR-MS) phenotypes differ widely although the variables contributing to this heterogeneity remain uncertain. To assess geographic and ethnic effects on RR-MS phenotypes, we investigated RR-MS patients in Canada and Saudi Arabia. Methods A retrospective analysis of patients followed in two MS Clinics was performed in Medina, Saudi Arabia and Edmonton, Canada. Demographic and clinical data were collected for each patient and analyzed using univariable and multivariable statistics. Univariable and multivariable linear regression were used to distinguish the significant clinical and demographic features and neurological systems associated with the change in expanded disability status scale (EDSS) between clinical assessments. Results Patients with treated RR-MS were recruited (n = 51, Saudi; n = 47, Canada) although the disease duration was longer in the Canadian cohort (5.6 ± 2.2 yr.) compared to the Saudi cohort (4.4 ± 1.4 yr.) (P < 0.05), annual relapse rate and EDSS change were higher in the Saudi cohort (P < 0.05). Infratentorial lesion-associated presentation differed (Canada, n = 23; Saudi, n = 13) among groups (P < 0.05). Spinal cord lesions on MRI were more frequently detected in Canadian (n = 23) compared to Saudi (n = 1) patients (P < 0.05). Patients within the Saudi cohort displayed a significantly greater change in Expanded Disability Status Scale (EDSS) between first and second assessments. Conclusions Despite differences in geographic location, ethnicity, and predominance of infratentorial lesions in the Canadian group, the RR-MS phenotypes were similar although the Saudi cohort displayed a more severe disease course.

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