| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Neurology (M.P.A., E.P., B.G., V.Z., G.S., S.S.), University of Florence; Department of Neurological and Behavioral Sciences (M.L.S., M.B., A.G., A.F., N.D.S.), University of Siena; and Neurology Unit (M.L.B., L.G.), Hospital of Empoli, Italy.
Address correspondence and reprint requests to Dr. Maria Pia Amato, Department of Neurology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy mariapia.amato{at}unifi.it
Background: The definition of benign multiple sclerosis (B-MS) is still controversial. This mainly takes into account the subject’s motor ability, with little or no relevance to other important features such as cognition. Moreover, no paraclinical markers are currently available to reliably identify patients who will remain benign in the long term.
Objectives: To assess, by using quantitative magnetic resonance (MR) metrics, differences in tissue damage between B-MS patients after dividing them into two groups on the basis of their cognitive performance.
Methods: Forty-seven B-MS patients (Expanded Disability Status Scale score 
3.0 and disease duration 
15 years) underwent neuropsychological assessment through the Rao Brief Repeatable Battery and the Stroop Test. At that time, B-MS patients underwent conventional brain MR and magnetization transfer (MT) imaging. White matter lesion load, global and regional brain volumes, and MT ratio (MTr) in lesions and normal-appearing brain were measured. Quantitative MR measures were compared in cognitively impaired (CI-MS) and cognitively preserved (CP-MS) patients and in 24 demographically matched healthy controls. Test performance was correlated with MR changes in specific cortical regions.
Results: Eleven patients were classified as CI-MS, and 36 were classified as CP-MS. Both T2-weighted and T1-weighted lesion loads were higher (p = 0.05 and 0.001) in CI-MS than in CP-MS patients. Furthermore, CI-MS patients were characterized by more pronounced decrease in neocortical volume (p = 0.005) and cortical MTr (p = 0.02) values than CP-MS patients. Finally, test performance correlated significantly with MR changes in relevant cortical regions.
Conclusions: Cognitive assessment and quantitative magnetic resonance can help to reliably identify benign multiple sclerosis patients.
Abbreviations: AC = anterior commissure; AISM = Associazione Italiana Sclerosi Multipla; ANOVA = analysis of variance; B-MS = benign multiple sclerosis; BRB = Brief Repeatable Neuropsychological Battery; CI-MS = cognitively impaired; CP-MS = cognitively preserved; EDSS = Expanded Disability Status Scale; GM = gray matter; HC = healthy control; LV = lesion volume; MADRS = Montgomery and Asberg Depression Rating Scale; MR = magnetic resonance; MS = multiple sclerosis; MT = magnetization transfer; MTr = magnetization transfer ratio; NAWM = normal-appearing white matter; NBV = normalized brain volume; NCV = normalized cortical volume; NFV = normalized frontal volume; NOV = normalized occipital volume; NS = not significant; NTV = normalized temporal volume; PC = posterior commissure; SDMT = Symbol Digit Modalities Test; SRT = Selective Reminding Test; SRT-CLTR = Selective Reminding Test–Consistent Long-Term Retrieval; SRT-LTS = Selective Reminding Test–Long-Term Storage; ST = Stroop Test; T1-W = T1-weighted; T2-W = T2-weighted; TE = echo time; TR = repetition time; WM = white matter.
Supplemental data at www.neurology.org
Disclosure: Supported in part by a grant of the Associazione Italiana Sclerosi Multipla (AISM). N.D.S. received support for MRI examinations from the AISM. All other authors report no disclosures.
Received December 19, 2007. Accepted in final form May 21, 2008.
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
