Microstructural Damage and Repair in the Spinal Cord of Patients With Early Multiple Sclerosis and Association With Disability at 5 Years.

IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY
Malo Gaubert, Benoit Combès, Elise Bannier, Arthur Masson, Vivien Caron, Gaëlle Baudron, Jean-Christophe Ferré, Laure Michel, Emmanuelle Le Page, Bruno Stankoff, Gilles Edan, Benedetta Bodini, Anne Kerbrat
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引用次数: 0

Abstract

Background and objectives: The dynamics of microstructural spinal cord (SC) damage and repair in people with multiple sclerosis (pwMS) and their clinical relevance have yet to be explored. We set out to describe patient-specific profiles of microstructural SC damage and change during the first year after MS diagnosis and to investigate their associations with disability and SC atrophy at 5 years.

Methods: We performed a longitudinal monocentric cohort study among patients with relapsing-remitting MS: first relapse <1 year, no relapse <1 month, and high initial severity on MRI (>9 T2 lesions on brain MRI and/or initial myelitis). pwMS and age-matched healthy controls (HCs) underwent cervical SC magnetization transfer (MT) imaging at baseline and at 1 year for pwMS. Based on HC data, SC MT ratio z-score maps were computed for each person with MS. An index of microstructural damage was calculated as the proportion of voxels classified as normal at baseline and identified as damaged after 1 year. Similarly, an index of repair was also calculated (voxels classified as damaged at baseline and as normal after 1 year). Linear models including these indices and disability or SC cross-sectional area (CSA) change between baseline and 5 years were implemented.

Results: Thirty-seven patients and 19 HCs were included. We observed considerable variability in the extent of microstructural SC damage at baseline (0%-58% of SC voxels). We also observed considerable variability in damage and repair indices over 1 year (0%-31% and 0%-20%), with 18 patients showing predominance of damage and 18 predominance of repair. The index of microstructural damage was associated positively with the Expanded Disability Status Scale score (r = 0.504, p = 0.002) and negatively with CSA change (r = -0.416, p = 0.02) at 5 years, independent of baseline SC lesion volume.

Discussion: People with early relapsing-remitting MS exhibited heterogeneous profiles of microstructural SC damage and repair. Progression of microstructural damage was associated with disability progression and SC atrophy 5 years later. These results indicate a potential for microstructural repair in the SC to prevent disability progression in pwMS.

早期多发性硬化症患者脊髓的微结构损伤和修复以及与 5 年后残疾的关系。
背景和目的:多发性硬化症患者脊髓(SC)微结构损伤和修复的动态变化及其临床意义尚待探索。我们的目的是描述多发性硬化症确诊后第一年内患者脊髓微结构损伤和变化的特异性特征,并研究它们与5年后残疾和脊髓萎缩的关系:我们对复发缓解型多发性硬化症患者进行了一项纵向单中心队列研究:首次复发9例脑MRI上的T2病变和/或最初的脊髓炎。根据健康对照组的数据,计算出每位多发性硬化症患者的颈椎 SC MT 比值 z-score 图。微结构损伤指数的计算方法是:在基线时被归类为正常的体素在 1 年后被确定为损伤的体素所占的比例。同样,还计算了修复指数(基线时归类为受损的体素和 1 年后归类为正常的体素)。建立的线性模型包括这些指数和基线与 5 年之间残疾或 SC 横截面面积(CSA)的变化:结果:共纳入 37 名患者和 19 名 HC。我们观察到基线时 SC 微结构损伤程度存在很大差异(0%-58% 的 SC 体素)。我们还观察到一年内损伤和修复指数存在相当大的差异(0%-31% 和 0%-20%),其中 18 名患者以损伤为主,18 名患者以修复为主。微结构损伤指数与5年后的残疾状况扩展量表评分呈正相关(r = 0.504,p = 0.002),与CSA变化呈负相关(r = -0.416,p = 0.02),与基线SC病变体积无关:讨论:早期复发缓解型多发性硬化症患者的SC微结构损伤和修复情况各不相同。微结构损伤的进展与5年后的残疾进展和SC萎缩有关。这些结果表明,SC微结构修复有可能预防多发性硬化症患者的残疾进展。
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来源期刊
CiteScore
15.60
自引率
2.30%
发文量
219
审稿时长
8 weeks
期刊介绍: Neurology Neuroimmunology & Neuroinflammation is an official journal of the American Academy of Neurology. Neurology: Neuroimmunology & Neuroinflammation will be the premier peer-reviewed journal in neuroimmunology and neuroinflammation. This journal publishes rigorously peer-reviewed open-access reports of original research and in-depth reviews of topics in neuroimmunology & neuroinflammation, affecting the full range of neurologic diseases including (but not limited to) Alzheimer's disease, Parkinson's disease, ALS, tauopathy, and stroke; multiple sclerosis and NMO; inflammatory peripheral nerve and muscle disease, Guillain-Barré and myasthenia gravis; nervous system infection; paraneoplastic syndromes, noninfectious encephalitides and other antibody-mediated disorders; and psychiatric and neurodevelopmental disorders. Clinical trials, instructive case reports, and small case series will also be featured.
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