#3
Primary And Transitional/Progressive MS:
A Clinical And MRI Cross-Sectional Study
Stevenson VL, Miller DH, Rovaris M, Barkhof F, Brochet B, Dousset V, Dousset V, Filippi M, Montalban X, Polman CH, Rovira A, de Sa J, Thompson AJ
Neurology 1999 Mar 10;52(4):839-45
Institute of Neurology, NMR Research Unit, London, UK
PMID# 10078736; UI# 99176622
Abstract
Background
Ten percent of patients with MS have a Progressive course from onset with no history of relapses or remissions.
A smaller subgroup follow a similar Progressive course but have a single relapse at some point (Transitional/Progressive [TP] MS). To date these patients have been excluded from receiving licensed treatments for MS and from most therapeutic trials.
Objective
To document the clinical and MRI characteristics of a large cohort of Progressive patients, including 158 with Primary/Progressive (PP) MS and 33 with TPMS.
Data from a small reference group of 20 patients with Secondary/Progressive (SP) MS are also presented for reference.
Methods
Patients were recruited from six European centers. All underwent a clinical assessment including scoring on the Expanded Disability Status Scale (EDSS) and MRI of the Brain and Spinal Cord.
Results
The men-to-women ratio was 81:77 (51% men) in the PP group, 14:19 (42% men) in the TP group, and 5:15 (25% men) in the SP group.
The mean age at disease onset was significantly higher in the PP group than it was in the other two groups (PP 40.2 years, TP 34.9 years, SP 28.7 years).
On MRI the PP group had lower mean Brain T2 and T1 HypoIntensity lesion loads than the SP group (T2 12.02 versus 27.74 cm3, p = 0.001; T1 4.34 versus 7.04 cm3, p = 0.015).
The SP and TP cohorts had significantly more T2-weighted lesions in the Spinal Cord than the PP patients, and the SP cohort had the greatest degree of Atrophy.
There was a correlation in the PP and TP patients between EDSS score and Brain and Spinal Cord Atrophy (r = 0.3, 0.2, p < or = 0.006) but not with Brain lesion load.
The PP and TP patients who presented with Spinal Cord pathology had significantly lower Brain T2 and T1 lesion loads than those with Non-Spinal Cord presentations (p = 0.002).
Conclusions
The monitoring of disease progression in PPMS is difficult, although measures of Atrophy correlate with the EDSS and appear most promising.
This study increases our understanding of this unique patient group, which will be further expanded with the acquisition of serial data.
#4
Serial NeuroPsychological Assessment And MRI Analysis In Multiple Sclerosis
Hohol MJ, Guttmann CR, Orav J, Mackin GA, Kikinis R, Khoury SJ, Jolesz FA, Weiner HL
Arch Neurol 1997 Aug;54(8):1018-25
Brigham and Women's Hospital, Center for Neurologic Diseases, Boston, MA 02115, USA
PMID# 9267977; UI# 97411864
Abstract
Objective
To assess the correlation between Cognitive dysfunction and disease burden in Multiple Sclerosis (MS) during a 1-year period.
Design
The Brief, Repeatable Battery of NeuroPsychological Tests in Multiple Sclerosis was performed at entrance and 1 year.
Patients underwent at least 20 Proton Density (range, 20-24) and T2-weighted axial Magnetic Resonance Imaging (MRI) Brain scans except for stable patients who were scanned monthly.
Magnetic Resonance Imaging was evaluated using computer-automated, 3-dimensional volumetric analysis.
Setting
A research clinic of a university hospital.
Patients
Forty-four patients with MS of the following disease categories: Relapsing/Remitting (14), Relapsing/Remitting Progressive (12), Chronic/Progressive (13), and stable (5).
Main Outcome Measures
The relationships between scores on the Brief, Repeatable Battery of NeuroPsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and Brain to IntraCranial cavity volume ratio) were assessed using linear regression.
These MRI measures were also compared with Cognitive status at 1 year using analysis of variance.
Results
Overall, there was no decline in mean Cognitive test performance during 1 year.
Significant correlations were found between baseline NeuroPsychological test scores of NonVerbal Memory, Information-Processing Speed, and Attention and both MRI measures.
Patients with Chronic/Progressive MS demonstrated the strongest correlations. At 1 year, change in Information-Processing Speed and Attention correlated with change in total lesion volume.
The mean increase in total lesion volume was 5.7 mL for 4 patients whose Cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable.
Conclusions
During a 1-year period mean Cognitive performance did not worsen.
Automated volumetric MRI measures of total lesion volume and Brain to IntraCranial cavity volume ratio correlated with NeuroPsychological performance, especially in patients with Chronic/Progressive MS.
Worsening MRI lesion burden correlated with Cognitive decline.
#5
Executive Function In Multiple Sclerosis:
The Role Of Frontal Lobe Pathology
Foong J, Rozewicz L, Quaghebeur G, Davie CA, Kartsounis LD, Thompson AJ, Miller DH, Ron MA
Brain 1997 Jan;120 ( Pt 1):15-26
Institute of Neurology, London, UK
PMID# 9055794; UI# 97208852
Abstract
Deficits in executive function and the relationship to Frontal lesion load as detected on MRI were investigated in 42 Multiple Sclerosis patients.
A battery of NeuroPsychological test examining executive skills including computerized tests of Planning and Spatial Working Memory was administered to all subjects.
Performance on these tests was impaired in the patient group when compared with a group of matched controls, but not all executive skills were affected to the same extent.
Although a number of executive test scores correlated with the severity of Frontal lesion load, it was difficult to disentangle the specific contribution of Frontal Lobe pathology to the impairment on Executive Tasks.
This study highlights the difficulties in attempting to attribute specific Cognitive abnormalities to focal Brain pathology in the presence of widespread disease such as in Multiple Sclerosis. |
