Abstract
BackgroundThe present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease. Some patients underwent hyperbaric oxygen therapy (HBOT) and brain perfusion between before and after that was compared.MethodsWe retrospectively reviewed 25 secondary progressive (SP)-MS patients from the hospital database. Neurological disability evaluated by Expanded Disability Status Scale Score (EDSS). Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM). In total, 16 patients underwent HBOT. Before HBOT and at the end of 20 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed again then the results were evaluated and compared. Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM).ResultsA total of 25 SP-MS patients, 14 females (56 %) and 11 males (44 %) with a mean age of 38.92 ± 11.28 years included in the study. The mean disease duration was 8.70 ± 5.30 years. Of the 25 patients, 2 (8 %) had a normal SPECT and 23 (92 %) had abnormal brain perfusion SPECT studies. The study showed a significant association between severity of perfusion impairment with disease duration and also with EDSS (P <0.05). There was a significant improvement in pre- and post-treatment perfusion scans (P <0.05), but this did not demonstrate a significant improvement in the clinical subjective and objective evaluation of patients (P >0.05).ConclusionsThis study depicted decreased cerebral perfusion in SP-MS patients with a moderate to severe disability score and its association with clinical parameters. Because of its accessibility, rather low price, practical ease, and being objective quantitative information, brain perfusion SPECT can be complementing to other diagnostic modalities such as MRI and clinical examinations in disease surveillance and monitoring. The literature on this important issue is extremely scarce, and follow up studies are required to assess these preliminary results.
Highlights
The present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease
Wakefield et al later reported similar findings and showed fibrin deposition and vessel thrombosis without obvious cellular infiltration, which suggested that the presentation of thrombosis in small veins and capillaries supported the possible role of ischemic process in Multiple sclerosis (MS) disease [5]
A total of 25 secondary progressive (SP)-MS patients, including 14 females (56 %) and 11 males (44 %) with a mean age of 38.92 ± 11.28 years participated in the study
Summary
The present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease. Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) that affects myelin, oligodendrocytes, and axons, and eventually results in neuronal loss and progressive neurologic disability [1]. In the 1930s, Putnam explained the evidence of vascular occlusion in MS histopathology for the first time, and believed that vascular occlusion and inflammation were involved as antecedent processes in demyelinating disease evolution [4]. Wakefield et al later reported similar findings and showed fibrin deposition and vessel thrombosis without obvious cellular infiltration, which suggested that the presentation of thrombosis in small veins and capillaries supported the possible role of ischemic process in MS disease [5]
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