Cortical involvement determines impairment 30 years after a clinically isolated syndrome
Many studies report an overlap of MRI and clinical findings between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), which in part is reflective of inclusion of subjects with variable disease duration and short periods of follow-up. To...
| Autores: | , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2021 |
| País: | España |
| Institución: | Universitat Oberta de Catalunya (UOC) |
| Repositorio: | O2, repositorio institucional de la UOC |
| OAI Identifier: | oai:openaccess.uoc.edu:10609/147533 |
| Acceso en línea: | https://hdl.handle.net/10609/147533 http://hdl.handle.net/10609/147533 |
| Access Level: | acceso abierto |
| Palabra clave: | multiple sclerosis clinically isolated syndrome atrophy magnetic resonance imaging cortex esclerosis múltiple síndrome clínicament aïllada atrofia imatge de ressonància magnètica escorça síndrome clínicamente aislado imagen de resonancia magnética corteza esclerosi múltiple |
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Cortical involvement determines impairment 30 years after a clinically isolated syndromeHaider, LukasPrados Carrasco, FerranChung, KarenGoodkin, OliviaKanber, BarisSudre, CaroleYiannakas, MariosSamson, RebeccaMangesius, StephanieThompson, AlanGandini Wheeler-Kingshott, Claudia A.M.Ciccarelli, OlgaChard, DeclanBarkhof, Frederikmultiple sclerosisclinically isolated syndromeatrophymagnetic resonance imagingcortexesclerosis múltiplesíndrome clínicament aïlladaatrofiaimatge de ressonància magnèticaescorçaesclerosis múltiplesíndrome clínicamente aisladoatrofiaimagen de resonancia magnéticacortezamultiple sclerosisesclerosi múltipleesclerosis múltipleMany studies report an overlap of MRI and clinical findings between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), which in part is reflective of inclusion of subjects with variable disease duration and short periods of follow-up. To overcome these limitations, we examined the differences between RRMS and SPMS and the relationship between MRI measures and clinical outcomes 30 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis. Sixty-three patients were studied 30 years after their initial presentation with a clinically isolated syndrome; only 14% received a disease modifying treatment at any time point. Twenty-seven patients developed RRMS, 15 SPMS and 21 experienced no further neurological events; these groups were comparable in terms of age and disease duration. Clinical assessment included the Expanded Disability Status Scale, 9-Hole Peg Test and Timed 25-Foot Walk and the Brief International Cognitive Assessment For Multiple Sclerosis. All subjects underwent a comprehensive MRI protocol at 3 T measuring brain white and grey matter (lesions, volumes and magnetization transfer ratio) and cervical cord involvement. Linear regression models were used to estimate age- and gender-adjusted group differences between clinical phenotypes after 30 years, and stepwise selection to determine associations between a large sets of MRI predictor variables and physical and cognitive outcome measures. At the 30-year follow-up, the greatest differences in MRI measures between SPMS and RRMS were the number of cortical lesions, which were higher in SPMS (the presence of cortical lesions had 100% sensitivity and 88% specificity), and grey matter volume, which was lower in SPMS. Across all subjects, cortical lesions, grey matter volume and cervical cord volume explained 60% of the variance of the Expanded Disability Status Scale; cortical lesions alone explained 43%. Grey matter volume, cortical lesions and gender explained 43% of the variance of Timed 25-Foot Walk. Reduced cortical magnetization transfer ratios emerged as the only significant explanatory variable for the symbol digit modality test and explained 52% of its variance. Cortical involvement, both in terms of lesions and atrophy, appears to be the main correlate of progressive disease and disability in a cohort of individuals with very long follow-up and homogeneous disease duration, indicating that this should be the target of therapeutic interventions.Oxford University Press (OUP)University College London (UCL)Medical University of ViennaUniversitat Oberta de Catalunya (UOC)King’s College LondonMedical University of InnsbruckUniversity of PaviaIRCCS Mondino FoundationVU University Medical Centre202320232021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/10609/147533http://hdl.handle.net/10609/147533reponame:O2, repositorio institucional de la UOCinstname:Universitat Oberta de Catalunya (UOC)InglésBrain, 2021, 144(5)Brain;144https://doi.org/10.1093/brain/awab033info:eu-repo/grantAgreement/MSSociety//CC BY 4.0https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:openaccess.uoc.edu:10609/1475332026-05-28T12:42:01Z |
| dc.title.none.fl_str_mv |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| title |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| spellingShingle |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome Haider, Lukas multiple sclerosis clinically isolated syndrome atrophy magnetic resonance imaging cortex esclerosis múltiple síndrome clínicament aïllada atrofia imatge de ressonància magnètica escorça esclerosis múltiple síndrome clínicamente aislado atrofia imagen de resonancia magnética corteza multiple sclerosis esclerosi múltiple esclerosis múltiple |
| title_short |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| title_full |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| title_fullStr |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| title_full_unstemmed |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| title_sort |
Cortical involvement determines impairment 30 years after a clinically isolated syndrome |
| dc.creator.none.fl_str_mv |
Haider, Lukas Prados Carrasco, Ferran Chung, Karen Goodkin, Olivia Kanber, Baris Sudre, Carole Yiannakas, Marios Samson, Rebecca Mangesius, Stephanie Thompson, Alan Gandini Wheeler-Kingshott, Claudia A.M. Ciccarelli, Olga Chard, Declan Barkhof, Frederik |
| author |
Haider, Lukas |
| author_facet |
Haider, Lukas Prados Carrasco, Ferran Chung, Karen Goodkin, Olivia Kanber, Baris Sudre, Carole Yiannakas, Marios Samson, Rebecca Mangesius, Stephanie Thompson, Alan Gandini Wheeler-Kingshott, Claudia A.M. Ciccarelli, Olga Chard, Declan Barkhof, Frederik |
| author_role |
author |
| author2 |
Prados Carrasco, Ferran Chung, Karen Goodkin, Olivia Kanber, Baris Sudre, Carole Yiannakas, Marios Samson, Rebecca Mangesius, Stephanie Thompson, Alan Gandini Wheeler-Kingshott, Claudia A.M. Ciccarelli, Olga Chard, Declan Barkhof, Frederik |
| author2_role |
author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
University College London (UCL) Medical University of Vienna Universitat Oberta de Catalunya (UOC) King’s College London Medical University of Innsbruck University of Pavia IRCCS Mondino Foundation VU University Medical Centre |
| dc.subject.none.fl_str_mv |
multiple sclerosis clinically isolated syndrome atrophy magnetic resonance imaging cortex esclerosis múltiple síndrome clínicament aïllada atrofia imatge de ressonància magnètica escorça esclerosis múltiple síndrome clínicamente aislado atrofia imagen de resonancia magnética corteza multiple sclerosis esclerosi múltiple esclerosis múltiple |
| topic |
multiple sclerosis clinically isolated syndrome atrophy magnetic resonance imaging cortex esclerosis múltiple síndrome clínicament aïllada atrofia imatge de ressonància magnètica escorça esclerosis múltiple síndrome clínicamente aislado atrofia imagen de resonancia magnética corteza multiple sclerosis esclerosi múltiple esclerosis múltiple |
| description |
Many studies report an overlap of MRI and clinical findings between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), which in part is reflective of inclusion of subjects with variable disease duration and short periods of follow-up. To overcome these limitations, we examined the differences between RRMS and SPMS and the relationship between MRI measures and clinical outcomes 30 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis. Sixty-three patients were studied 30 years after their initial presentation with a clinically isolated syndrome; only 14% received a disease modifying treatment at any time point. Twenty-seven patients developed RRMS, 15 SPMS and 21 experienced no further neurological events; these groups were comparable in terms of age and disease duration. Clinical assessment included the Expanded Disability Status Scale, 9-Hole Peg Test and Timed 25-Foot Walk and the Brief International Cognitive Assessment For Multiple Sclerosis. All subjects underwent a comprehensive MRI protocol at 3 T measuring brain white and grey matter (lesions, volumes and magnetization transfer ratio) and cervical cord involvement. Linear regression models were used to estimate age- and gender-adjusted group differences between clinical phenotypes after 30 years, and stepwise selection to determine associations between a large sets of MRI predictor variables and physical and cognitive outcome measures. At the 30-year follow-up, the greatest differences in MRI measures between SPMS and RRMS were the number of cortical lesions, which were higher in SPMS (the presence of cortical lesions had 100% sensitivity and 88% specificity), and grey matter volume, which was lower in SPMS. Across all subjects, cortical lesions, grey matter volume and cervical cord volume explained 60% of the variance of the Expanded Disability Status Scale; cortical lesions alone explained 43%. Grey matter volume, cortical lesions and gender explained 43% of the variance of Timed 25-Foot Walk. Reduced cortical magnetization transfer ratios emerged as the only significant explanatory variable for the symbol digit modality test and explained 52% of its variance. Cortical involvement, both in terms of lesions and atrophy, appears to be the main correlate of progressive disease and disability in a cohort of individuals with very long follow-up and homogeneous disease duration, indicating that this should be the target of therapeutic interventions. |
| publishDate |
2021 |
| dc.date.none.fl_str_mv |
2021 2023 2023 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10609/147533 http://hdl.handle.net/10609/147533 |
| url |
https://hdl.handle.net/10609/147533 http://hdl.handle.net/10609/147533 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Brain, 2021, 144(5) Brain;144 https://doi.org/10.1093/brain/awab033 info:eu-repo/grantAgreement/MSSociety// |
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CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
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CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf application/pdf |
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Oxford University Press (OUP) |
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Oxford University Press (OUP) |
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reponame:O2, repositorio institucional de la UOC instname:Universitat Oberta de Catalunya (UOC) |
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Universitat Oberta de Catalunya (UOC) |
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