Abstract
BackgroundThe cerebellum is an important site for cortical demyelination in multiple sclerosis, but the functional significance of this finding is not fully understood.ObjectiveTo evaluate the clinical and cognitive impact of cerebellar grey-matter pathology in multiple sclerosis patients.MethodsForty-two relapsing-remitting multiple sclerosis patients and 30 controls underwent clinical assessment including the Multiple Sclerosis Functional Composite, Expanded Disability Status Scale (EDSS) and cerebellar functional system (FS) score, and cognitive evaluation, including the Paced Auditory Serial Addition Test (PASAT) and the Symbol-Digit Modalities Test (SDMT). Magnetic resonance imaging was performed with a 3T scanner and variables of interest were: brain white-matter and cortical lesion load, cerebellar intracortical and leukocortical lesion volumes, and brain cortical and cerebellar white-matter and grey-matter volumes.ResultsAfter multivariate analysis high burden of cerebellar intracortical lesions was the only predictor for the EDSS (p<0.001), cerebellar FS (p = 0.002), arm function (p = 0.049), and for leg function (p<0.001). Patients with high burden of cerebellar leukocortical lesions had lower PASAT scores (p = 0.013), while patients with greater volumes of cerebellar intracortical lesions had worse SDMT scores (p = 0.015).ConclusionsCerebellar grey-matter pathology is widely present and contributes to clinical dysfunction in relapsing-remitting multiple sclerosis patients, independently of brain grey-matter damage.
Highlights
In recent years, several neuroimaging studies have shown diffuse grey matter (GM) damage in multiple sclerosis (MS) patients, involving both cortical and subcortical structures, such as the spinal cord and cerebellum
In this study, we evaluated the influence of cerebellar GM pathology, as measured by MRI, in clinical and cognitive functions in a group of patients with relapsing remitting MS, addressing relative contributions of cerebellar cortical and white-matter (WM) atrophy, and cerebellar leukocortical and intracortical lesions
Cerebellar intracortical and/or leukocortical lesions were observed in 53.8% of the patients
Summary
Several neuroimaging studies have shown diffuse grey matter (GM) damage in multiple sclerosis (MS) patients, involving both cortical and subcortical structures, such as the spinal cord and cerebellum. Modern neuropathological research confirmed these findings and proposed the cerebellum as an important location for cortical demyelination in MS, in those with primary or secondary progressive disease.[1,2,3] Similar types of cortical lesions, as described in the forebrain, are seen in the cerebellum, such as intracortical and leukocortical. These lesions are characterized by complete demyelination with relative preservation of neurons and axons.[1,3] the functional significance of these lesions is not completely clear. The cerebellum is an important site for cortical demyelination in multiple sclerosis, but the functional significance of this finding is not fully understood
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