Cognitive changes in patients with relapse-free MS treated with high efficacy therapies: the predictive value of paramagnetic rim lesions
Journal of Neurology Neurosurgery & Psychiatry,
Journal Year:
2025,
Volume and Issue:
unknown, P. jnnp - 335144
Published: Jan. 31, 2025
Background
High-efficacy
disease-modifying
therapies
(HETs)
have
substantially
improved
multiple
sclerosis
(MS)
management,
yet
ongoing
cognitive
decline
remains
a
concern.
This
study
aims
to
assess
Symbol
Digit
Modalities
Test
(SDMT)
changes
in
patients
with
stable
relapsing-remitting
MS
(RRMS)
treated
HETs
and
evaluate
the
role
of
baseline
MRI
biomarkers
as
predictors
SDMT
changes.
Methods
Consecutive
RRMS
underwent
clinical,
assessment
at
clinical
re-evaluation
after
24
months.
Patients
presenting
relapses
or
activity
(new
T2
and/or
gadolinium-enhancing
lesions)
during
follow-up
were
excluded.
Cognitive
defined
using
90%
CI
regression-based
reliable
change
index
methodology
accounting
for
sex,
age,
education
score.
Baseline
examination
included
three-dimensional-sagittal
Fluid
Attenuated
Inversion
Recovery
(FLAIR),
T1-Magnetization
Prepared
-
RApid
Gradient
Echo
(T1-MPRAGE)
quantitative
susceptibility
mapping
(QSM)
paramagnetic
rim
lesions
(PRLs)
QSM-isointense
(ISO)
assessment.
Univariate
multivariable
regression
analyses
performed
predict
Results
90
(mean
age:
40.3
years,
median
Expanded
Disability
Status
Scale:
2.0)
included.
PRLs
present
46
(51.1%)
patients.
After
months,
13
(14.4%)
showed
8
(8.9%)
improvement.
At
analyses,
associated
higher
risk
(β:
2.70,
p:
0.02,
OR:
14.82)
while
ISO
lesion
volumes
weakly
improvement
0.07,
0.01,
1.07).
Conclusions
are
detectable
without
over
2
years.
seem
MS,
underscoring
critical
compartmentalised
chronic
inflammation
disease
progression.
Language: Английский
Biomarkers of Progression Independent of Relapse Activity—Can We Actually Measure It Yet?
International Journal of Molecular Sciences,
Journal Year:
2025,
Volume and Issue:
26(10), P. 4704 - 4704
Published: May 14, 2025
Progression
independent
of
relapse
activity
(PIRA)
is
increasingly
recognized
as
a
key
driver
disability
in
multiple
sclerosis
(MS).
However,
the
concept
PIRA
remains
elusive,
with
uncertainty
surrounding
its
definition,
underlying
mechanisms,
and
methods
quantification.
This
review
examines
current
landscape
biomarkers
used
to
predict
measure
PIRA,
focusing
on
clinical,
imaging,
body
fluid
biomarkers.
Clinical
scores
such
Expanded
Disability
Status
Scale
(EDSS)
are
widely
used,
but
may
lack
sensitivity
capturing
subtle
relapse-independent
progression.
Imaging
biomarkers,
including
MRI-derived
metrics
(brain
spinal
cord
volume
loss,
chronic
active
lesions)
optical
coherence
tomography
(OCT)
parameters
(retinal
nerve
fiber
layer
ganglion
cell-inner
plexiform
thinning),
offer
valuable
insights,
often
reflect
both
inflammatory
neurodegenerative
processes.
Body
neurofilament
light
chain
(NfL)
glial
fibrillary
acidic
protein
(GFAP),
promising
indicators
axonal
damage
activation,
their
specificity
for
limited.
emphasizes
distinction
between
predicting
PIRA—identifying
individuals
at
risk
future
progression—and
measuring
ongoing
PIRA-related
real
time.
We
highlight
limitations
differentiating
from
relapse-associated
call
clearer
conceptual
framework
guide
research.
Advancing
precision
utility
will
require
multimodal
approaches,
longitudinal
studies,
standardized
protocols
enable
clinical
integration
improve
personalized
MS
management.
Language: Английский
Lesion phenotyping based on magnetic susceptibility in pediatric multiple sclerosis
Journal of Neuroimaging,
Journal Year:
2024,
Volume and Issue:
34(5), P. 567 - 571
Published: July 14, 2024
Abstract
Background
and
purpose
Pediatric
multiple
sclerosis
(MS)
displays
different
pathological
features
compared
to
adult
MS,
which
can
be
studied
in
vivo
by
assessing
tissue
magnetic
susceptibility
with
3T‐MRI.
We
aimed
assess
white
matter
lesions
(WMLs)
phenotypes
pediatric
MS
patients
using
quantitative
mapping
(QSM)
weighted
imaging
(SMWI)
over
12
months.
Methods
Eleven
[female:
63.6%;
mean
±
standard
deviation
(SD)
age
disease
duration:
16.3
2.2
2.4
1.5;
median
(range)
Expanded
Disability
Status
Scale
(EDSS)
1
(0‐2)]
underwent
3
Tesla‐MRI
exams
EDSS
assessments
at
baseline
after
year.
QSM
SMWI
were
obtained
3‐dimensional
(3D)‐segmented
echo‐planar‐imaging
submillimetric
spatial
resolution.
WMLs
classified
according
their
appearance
was
used
identify
hyperintensities
ascribable
veins.
Total
brain
volumes
follow‐up
computed
high‐resolution
3D
T1‐weighted
images.
Results
Mean
SD
paramagnetic
rim
(PRLs)
prevalence
7.0%
9.0.
Fifty‐four
percent
(6/11)
of
exhibited
least
one
PRL,
patient
exhibiting
≥
4
PRLs.
All
showed
QSM‐iso‐/hypo‐intense
lesions,
represented
a
65.8%
22.7
total
WMLs.
QSM‐hyperintense
positive
correlation
volume
reduction
(
r
=
0.705;
p
.02).
No
lesion
as
between
follow‐up.
Conclusion
Chronic
compartmentalized
inflammation
seems
occur
early
short
duration.
A
high
iso‐/hypo‐intense
found,
could
account
for
the
higher
remyelination
potential
MS.
Language: Английский