Assessment Of Multiple Sclerosis Research Articles

French consensus procedure for neuropsychological assessment in multiple sclerosis

Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.

Evaluation of the quality and the productivity of neuroradiological reading of multiple sclerosis follow-up MRI scans using an intelligent automation software

PurposeThe assessment of multiple sclerosis (MS) lesions on follow-up magnetic resonance imaging (MRI) is tedious, time-consuming, and error-prone. Automation of low-level tasks could enhance the radiologist in this work. We evaluate the intelligent automation software Jazz in a blinded three centers study, for the assessment of new, slowly expanding, and contrast-enhancing MS lesions.MethodsIn three separate centers, 117 MS follow-up MRIs were blindly analyzed on fluid attenuated inversion recovery (FLAIR), pre- and post-gadolinium T1-weighted images using Jazz by 2 neuroradiologists in each center. The reading time was recorded. The ground truth was defined in a second reading by side-by-side comparison of both reports from Jazz and the standard clinical report. The number of described new, slowly expanding, and contrast-enhancing lesions described with Jazz was compared to the lesions described in the standard clinical report.ResultsA total of 96 new lesions from 41 patients and 162 slowly expanding lesions (SELs) from 61 patients were described in the ground truth reading. A significantly larger number of new lesions were described using Jazz compared to the standard clinical report (63 versus 24). No SELs were reported in the standard clinical report, while 95 SELs were reported on average using Jazz. A total of 4 new contrast-enhancing lesions were found in all reports. The reading with Jazz was very time efficient, taking on average 2min33s ± 1min0s per case. Overall inter-reader agreement for new lesions between the readers using Jazz was moderate for new lesions (Cohen kappa = 0.5) and slight for SELs (0.08).ConclusionThe quality and the productivity of neuroradiological reading of MS follow-up MRI scans can be significantly improved using the dedicated software Jazz.

Mini-Review: Gait and balance assessment in multiple sclerosis

BACKGROUND: Gait and balance deficiencies are significant concerns for people with multiple sclerosis, resulting in reduced walking capacity, falls and poor quality of life. Issues caused by sensory loss and the inability to properly reweight sensory information are often reported. Even at the early stages of the disease, subclinical gait and balance impairments can be found. AIM: In this article, we review objective measures used to assess gait and postural balance impairment in multiple sclerosis patients. INTERPRETATION: Although scales and clinical tests are important tools for assessing postural instability and walking performance, they can be insensitive to minor disabilities in multiple sclerosis. Instrumented measurements, such as kinematics, kinetics, spatiotemporal gait parameters and center of pressure, play an important role in detecting impairment and evaluating the effects of interventions in people with mild to moderate multiple sclerosis. Thus, objective measurements may be more suitable for tracking deficits in gait and postural balance in multiple sclerosis, contributing to the early detection of disease symptoms, and therefore allowing for the planning of effective interventions to control the speed of disease progression.

Premorbid cognitive functioning influences differences between self-reported cognitive difficulties and cognitive assessment in multiple sclerosis.

Cognitive difficulties are reported in up to 60% of people with MS (pwMS). There is often a discrepancy between self-reported cognitive difficulties and performance on cognitive assessments. Some of this discrepancy can be explained by depression and fatigue. Pre-MS cognitive abilities may be another important variable in explaining differences between self-reported and assessed cognitive abilities. PwMS with high estimated premorbid cognitive functioning (ePCF) may notice cognitive difficulties in daily life whilst performing within the average range on cognitive assessments. We hypothesised that, taking into account depression and fatigue, ePCF would predict (1) differences between self-reported and assessed cognitive abilities and (2) performance on cognitive assessments. We explored whether ePCF predicted (3) self-reported cognitive difficulties. Eighty-seven pwMS completed the Test of Premorbid Functioning (TOPF), the Brief International Cognitive Assessment for MS (BICAMS), self-report measures of cognitive difficulty (MS Neuropsychological Questionnaire; MSNQ), fatigue (MS Fatigue Impact Scale; MFIS) and depression (Hospital Anxiety and Depression Scale; HADS). Results revealed that, taking into account covariates, ePCF predicted (1) differences between self-reported and assessed cognitive abilities, p < .001 (model explained 29.35% of variance), and (2) performance on cognitive assessments, p < .001 (model explained 46.00% of variance), but not (3) self-reported cognitive difficulties, p = .545 (model explained 35.10% of variance). These results provide new and unique insights into predictors of the frequently observed discrepancy between self-reported and assessed cognitive abilities for pwMS. These findings have important implications for clinical practice, including the importance of exploring premorbid factors in self-reported experience of cognitive difficulties.

The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support

ObjectiveThe present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stress-related psychosocial factors such as anxiety, coping and social support. MethodsA one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted. ResultsThe bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels. ConclusionPeople with multiple sclerosis may benefit from different types of psychological therapies, from gold-standard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model.

Preliminary validity of the Draw a Shape Test for upper extremity assessment in multiple sclerosis.

To validate the smartphone sensor-based Draw a Shape Test - a part of the Floodlight Proof-of-Concept app for remotely assessing multiple sclerosis-related upper extremity impairment by tracing six different shapes. People with multiple sclerosis, classified functionally normal/abnormal via their Nine-Hole Peg Test time, and healthy controls participated in a 24-week, nonrandomized study. Spatial (trace accuracy), temporal (mean and variability in linear, angular, and radial drawing velocities, and dwell time ratio), and spatiotemporal features (trace celerity) were cross-sectionally analyzed for correlation with standard clinical and brain magnetic resonance imaging (normalized brain volume and total lesion volume) disease burden measures, and for capacity to differentiate people with multiple sclerosis from healthy controls. Data from 69 people with multiple sclerosis and 18 healthy controls were analyzed. Trace accuracy (all shapes), linear velocity variability (circle, figure-of-8, spiral shapes), and radial velocity variability (spiral shape) had a mostly fair/moderate-to-good correlation (|r|=0.14-0.66) with all disease burden measures. Trace celerity also had mostly fair/moderate-to-good correlation (|r|=0.18-0.41) with Nine-Hole Peg Test performance, cerebellar functional system score, and brain magnetic resonance imaging. Furthermore, partial correlation analysis related these results to motor impairment. People with multiple sclerosis showed greater drawing velocity variability, though slower mean velocity, than healthy controls. Linear velocity (spiral shape) and angular velocity (circle shape) potentially differentiate functionally normal people with multiple sclerosis from healthy controls. The Draw a Shape Test objectively assesses upper extremity impairment and correlates with all disease burden measures, thus aiding multiple sclerosis-related upper extremity impairment characterization.

Sexual Dysfunction in Women With Multiple Sclerosis: Expectations Regarding Treatment and Information, and Utility of the SEA-MS-F Questionnaire.

IntroductionSexual dysfunction is a common complaint in female with multiple sclerosis (MS), however this problem is not often considered in the medical and psychological care.AimTo evaluate expectations regarding treatment and information for sexual dysfunction in women with multiple sclerosis using the SEA-MS-F (Sexual Dysfunction Management and Expectations Assessment in Multiple sclerosis - Female) questionnaire, and to gain an understanding of the relationship between their expectations, demographic factors and medical factors known to promote sexual dysfunction.MethodsA prospective epidemiological, descriptive, analytical, multicentre study was carried out over 15 months on adult women suffering from MS. The SEA-MS-F was used to evaluate expectations regarding their sexuality and sexual activity.Main OutcomeMeasure 87 women were included. Mean age was 47 years and the mean time since MS diagnosis was 14 years.Results59.8% reported sexual dysfunction, but only 22.4% of the participants had raised the subject with a professional. With regards to expectations, 68% of the women wanted information about sexual dysfunction and 80% of women with sexual difficulties wanted treatment. High expectations correlated with the presence of sexual dysfunction, a regular sexual partner and with milder ambulatory handicap. There were no correlations between expectations and age, time since MS diagnosis, fatigue or being postmenopausal. The SEA-MS-F questionnaire was perceived as useful by 63.4% of the women and 90% felt that it could help doctors to treat sexual dysfunction.ConclusionTo date, the SEA-MS-F is the only questionnaire validated in women with MS for the evaluation of sexual expectations and in the present study the women felt strongly that it represented a useful way for them to introduce and then discuss the subject of their sexual dysfunction with their doctor.Audrey S-B, Marion R, Béatrice M, et al. Sexual Dysfunction in Women With Multiple Sclerosis: Expectations Regarding Treatment and Information, and Utility of the SEA-MS-F Questionnaire. Sex Med 2022;10:100502.

Multiple sclerosis cortical lesion detection with deep learning at ultra-high-field MRI.

Manually segmenting multiple sclerosis (MS) cortical lesions (CLs) is extremely time consuming, and past studies have shown only moderate inter‐rater reliability. To accelerate this task, we developed a deep‐learning‐based framework (CLAIMS: Cortical Lesion AI‐Based Assessment in Multiple Sclerosis) for the automated detection and classification of MS CLs with 7 T MRI. Two 7 T datasets, acquired at different sites, were considered. The first consisted of 60 scans that include 0.5 mm isotropic MP2RAGE acquired four times (MP2RAGE×4), 0.7 mm MP2RAGE, 0.5 mm T 2*‐weighted GRE, and 0.5 mm T 2*‐weighted EPI. The second dataset consisted of 20 scans including only 0.75 × 0.75 × 0.9 mm3 MP2RAGE. CLAIMS was first evaluated using sixfold cross‐validation with single and multi‐contrast 0.5 mm MRI input. Second, the performance of the model was tested on 0.7 mm MP2RAGE images after training with either 0.5 mm MP2RAGE×4, 0.7 mm MP2RAGE, or alternating the two. Third, its generalizability was evaluated on the second external dataset and compared with a state‐of‐the‐art technique based on partial volume estimation and topological constraints (MSLAST). CLAIMS trained only with MP2RAGE×4 achieved results comparable to those of the multi‐contrast model, reaching a CL true positive rate of 74% with a false positive rate of 30%. Detection rate was excellent for leukocortical and subpial lesions (83%, and 70%, respectively), whereas it reached 53% for intracortical lesions. The correlation between disability measures and CL count was similar for manual and CLAIMS lesion counts. Applying a domain‐scanner adaptation approach and testing CLAIMS on the second dataset, the performance was superior to MSLAST when considering a minimum lesion volume of 6 μL (lesion‐wise detection rate of 71% versus 48%). The proposed framework outperforms previous state‐of‐the‐art methods for automated CL detection across scanners and protocols. In the future, CLAIMS may be useful to support clinical decisions at 7 T MRI, especially in the field of diagnosis and differential diagnosis of MS patients.

Predictors of unemployment status in people with relapsing multiple sclerosis: a single center experience

BackgroundMultiple sclerosis (MS) is the most common cause of nontraumatic chronic neurological disability affecting young adults during their crucial employment years.ObjectivesTo evaluate patients and disease related factors associated to unemployment in a cohort of relapsing–remitting (RR) MS patients.MethodsWe included RRMS patients with a follow-up of at least 1 year. We collected data about years of school education and employment status. Patients underwent a neuropsychological evaluation using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Demographic and clinical predictors of unemployment were assessed through a multivariable stepwise logistic regression model.ResultsWe evaluated 260 consecutive RRMS patients. Employed patients were less frequently female (68.4% vs 83.3%, p = 0.006), less disabled (median Expanded Disability Status Scale (EDSS) score: 2.0 (0–7.0) vs 2.5 (0–7.5), p < 0.001), with more years of school education (mean ± standard deviation (SD), years: 13.74 ± 0.30 vs 10.86 ± 3.47, p < 0.001). Female sex and a higher EDSS score resulted associated with a greater risk of unemployment (OR 3.510, 95% CI 1.654–7.448, p = 0.001; OR 1.366, 95% CI 1.074–1.737, p = 0.011, respectively), whereas a greater number of years of schooling and current disease-modifying therapy exposure resulted protective factors (OR 0.788, 95% CI 0.723–0.858, p < 0,001; OR 0.414, 95% CI 0.217–0.790, p = 0.008, respectively).ConclusionsUnderstanding work is pervasively influenced by consequences of MS, we confirmed the impact of demographic, physical, and cognitive factors on employment status in RRMS patients.

Validation of a Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) and comparison with reference batteries

Background: The Brief Computerized Cognitive Assessment in Multiple Sclerosis (BCCAMS) is a short neuropsychological battery for persons with multiple sclerosis (PwMS). Objectives: The main objective of the study is to validate the BCCAMS. Methods: PwMS and healthy subjects (HS) were evaluated using the BCCAMS which include two computerized tests, the Computerized Speed Cognitive Test and the Computerized Episodic Visual Memory Test (CEVMT), a newly developed visuospatial memory test, and the French learning test. The Minimal Assessment of Cognitive Function in MS (MACFIMS), including the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tests, was also administered. Regression-based norms of the BCCAMS were calculated in 276 HS. BCCAMS was compared with BICAMS and MACFIMS for detection of cognitive impairment (CI). Results: Out of 120 PwMS, CI was detected using the BCCAMS, BICAMS (one impaired test), and MACFIMS (two impaired tests) in 59.1%, 50%, and 37.9%, respectively. The BCCAMS produced the same predictive value as that of the BICAMS battery for detecting CI in the MACFIMS. Conclusion: This study validated the BCCAMS as a validated computerized short assessment for information processing speed and learning in MS.

Developing a Digital Solution for Remote Assessment in Multiple Sclerosis: From Concept to Software as a Medical Device.

There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients’ home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers.

The Relationship between Third Ventricle Diameter, Motor Disability and Cognitive Decline in Patients with Multiple Sclerosis

Background: Multiple Sclerosis (MS) causes brain atrophy at the early stages of the disease which leads to progressive motor and cognitive dysfunction. Brain atrophy can be diagnosed indirectly by measuring the Third Ventricle Diameter (TVD) using Trans Cranial Sonography (TCS). The purpose of the current study was evaluation of TVD in MS patients using TCS to examine its possible correlation with cognitive dysfunction and Expanded Disability Status Scale (EDSS).&#x0D; Methods: Seventy-four patients with a definite diagnosis of MS were enrolled in this study. Transverse diameter of the third ventricle was measured using TCS. All patients were assessed by neurological examination and the level of disability was measured via EDSS. The cognitive performance was assessed by the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Pearson’s correlation was performed to evaluate possible correlations and p-value&lt;0.05 was considered statistically significant.&#x0D; Results: From the total 74 individuals, 58.1% were diagnosed with Relapse-Remitting MS (RRMS) (n=43) and 43.9% with Secondary-Progressive MS (SPMS) (n=31). The mean EDSS score was 1.81±1.38 (Range of 0-10). The mean TVD was 5.61±1.82 cm which had no statistical correlation with the EDSS score, but it was significantly wider in group with EDSS score&gt;3 when compared to the group with EDSS score≤3 (p-value=0.0001). The mean BICAMS score was 0.65±0.57 and there was no statistical correlation between BICAMS score and TVD.&#x0D; Conclusion: Measuring the diameter of the third ventricle using TCS appears to be an appropriate method to diagnose brain atrophy and is associated with cognitive dysfunction in the process of MS. Our data emphasized no association between the diameter of the third ventricle and cognitive dysfunction.

Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis.

Sleep problems are a common consequence of multiple sclerosis; however, there is limited evidence regarding the agreement between device-measured and self-reported sleep parameters in adults with multiple sclerosis. The present study examined the agreement between self-reported and device-measured parameters of sleep quality in a sample of adults with multiple sclerosis. Participants (n = 49) completed a 7-day sleep diary and wore a wrist-worn ActiGraph GT3×+ (ActiGraph Corp., Pensecola, FL) for seven consecutive nights to quantify self-reported and device-measured sleep parameters, respectively. There was a significant discrepancy between self-reported and device-measured parameters of total time in bed (mean difference = 19.8 [51.3] min), sleep onset latency (mean difference = 22.2 [19.5] min), and frequency of awakenings during the night (mean difference = 12.8 [6.8]). Intraclass correlation estimates indicated poor agreement between methods on most parameters, except for total time in bed (intraclass correlation = 0.80). Bland-Altman plots suggested that total time in bed and total sleep time had acceptable levels of agreement and linear regression analyses indicated that sleep onset latency (F = 113.91, B = -1.34, P < .001), number of awakenings (F = 543.34, B = 1.85, P < .001), and sleep efficiency (F = 18.39, B = -0.77, P < .001) had significant proportional bias. Our results draw attention to the discrepancies between sleep parameter measurements and highlight the importance of including both self-report and device-measured outcomes for a complete and accurate representation of sleep in adults with multiple sclerosis. Cederberg KLJ, Mathison BG, Schuetz ML, Motl RW. Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis. J Clin Sleep Med. 2022;18(2):415-421.

Validity and reliability of the Georgian-language brief international cognitive assessment for multiple sclerosis (BICAMS)

BackgroundCognitive impairment is one of the common features of multiple sclerosis (MS). Despite high prevalence, cognitive decline is often overlooked by neurologists. The Brief International Cognitive Assessment for MS (BICAMS) was therefore introduced by the international expert committee as a brief and effective tool for the assessment and monitoring of cognitive functions in patients with MS. The validity and reliability of BICAMS have been demonstrated in many countries. Our aim was to validate the BICAMS in Georgian patients with MS.MethodsA total of 68 patients with MS and 68 matched controls were assessed by the Georgian-language BICAMS. All healthy controls and seven patients were re-evaluated with identical tests to assess retest reliability.ResultsIn comparison to healthy controls, patients with MS performed significantly worse on all tests in the assessment battery. Test–retest reliability measures were good for all tests. The prevalence of cognitive impairment in patients with MS was 43%.ConclusionThe Georgian-language BICAMS is a reliable and valid battery for the assessment of cognitive function in patients with MS.

The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): Validation in Arabic and Lebanese Normative Values.

Multiple sclerosis (MS) is often associated with cognitive deficits. Accurate evaluation of the MS patients' cognitive performance is essential for diagnosis and treatment recommendation. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS), widely used cognitive testing battery, examines processing speed, verbal and visuospatial learning, and memory. Our study aims to examine the psychometric properties of an Arabic version of the BICAMS and to provide normative values in a Lebanese sample. The BICAMS, comprised of the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and a newly developed verbal learning/memory test, the Verbal Memory Arabic Test (VMAT), were administered on healthy subjects and MS patients. The sample consisted of 180 healthy individuals, of whom 63 were retested after 2-3 weeks. Forty-three MS patients matched with 43 healthy subjects based on age, sex, and years of education were assessed. A sample of 10 MS patients was also examined on two occasions. Test-retest reliability and criterion-related validity were examined, and regression-based norms were derived. The test-retest correlations showed good evidence of reliability with coefficients ranging between 0.64 and 0.73 in the healthy sample, and between 0.43 and 0.92 in the MS sample. The BICAMS was able to discriminate between MS patients and matched healthy participants on the SDMT and BVMT-R. Normative data were comparable to other studies. This new Arabic version of the BICAMS shows initial good psychometric properties. While good evidence of VMAT's reliability was shown in the healthy participants, less test-retest reliability in this tool was seen in the MS group, and partial criterion-related validity was evident. This renders further examination of the VMAT. We provide regression-based norms for a Lebanese sample and encourage the use of this battery in both research and clinical settings.

Role Of Magnetic Resonance Imaging With Diffusion Sequences In Assessment Of Multiple Sclerosis In Brain Versus Normally-Appearing White Matter

Role Of Magnetic Resonance Imaging With Diffusion Sequences In Assessment Of Multiple Sclerosis In Brain Versus Normally-Appearing White Matter

Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study.

BackgroundCognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers.ObjectiveTo enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis.MethodsA total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated.ResultsParticipants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03).ConclusionsThese findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis.Trial RegistrationClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618

Cognitive impairment and its assessment in multiple sclerosis

Cognitive impairment and its assessment in multiple sclerosis

FLAIR-only joint volumetric analysis of brain lesions and atrophy in clinically isolated syndrome (CIS) suggestive of multiple sclerosis

BackgroundMRI assessment in multiple sclerosis (MS) focuses on the presence of typical white matter (WM) lesions. Neurodegeneration characterised by brain atrophy is recognised in the research field as an important prognostic factor. It is not routinely reported clinically, in part due to difficulty in achieving reproducible measurements. Automated MRI quantification of WM lesions and brain volume could provide important clinical monitoring data. In general, lesion quantification relies on both T1 and FLAIR input images, while tissue volumetry relies on T1. However, T1-weighted scans are not routinely included in the clinical MS protocol, limiting the utility of automated quantification. ObjectivesWe address an aspect of this important translational challenge by assessing the performance of FLAIR-only lesion and brain segmentation, against a conventional approach requiring multi-contrast acquisition. We explore whether FLAIR-only grey matter (GM) segmentation yields more variability in performance compared with two-channel segmentation; whether this is related to field strength; and whether the results meet a level of clinical acceptability demonstrated by the ability to reproduce established biological associations. MethodsWe used a multicentre dataset of subjects with a CIS suggestive of MS scanned at 1.5T and 3T in the same week. WM lesions were manually segmented by two raters, ‘manual 1′ guided by consensus reading of CIS-specific lesions and ‘manual 2′ by any WM hyperintensity. An existing brain segmentation method was adapted for FLAIR-only input. Automated segmentation of WM hyperintensity and brain volumes were performed with conventional (T1/T1 + FLAIR) and FLAIR-only methods. ResultsWM lesion volumes were comparable at 1.5T between ‘manual 2′ and FLAIR-only methods and at 3T between ‘manual 2′, T1 + FLAIR and FLAIR-only methods. For cortical GM volume, linear regression measures between conventional and FLAIR-only segmentation were high (1.5T: α = 1.029, R2 = 0.997, standard error (SE) = 0.007; 3T: α = 1.019, R2 = 0.998, SE = 0.006). Age-associated change in cortical GM volume was a significant covariate in both T1 (p = 0.001) and FLAIR-only (p = 0.005) methods, confirming the expected relationship between age and GM volume for FLAIR-only segmentations. ConclusionsFLAIR-only automated segmentation of WM lesions and brain volumes were consistent with results obtained through conventional methods and had the ability to demonstrate biological effects in our study population. Imaging protocol harmonisation and validation with other MS phenotypes could facilitate the integration of automated WM lesion volume and brain atrophy analysis as clinical tools in radiological MS reporting.

Role of Magnetic Resonance Imaging with Diffusion Sequences in Assessment of Multiple Sclerosis in Brain Versus Normally Appearing White Matter

Background:Magnetic resonance imaging (MRI) is a very vital tool to diagnose and monitor multiple sclerosis (MS). Standard MRI measures lack of pathological specificity and are weakly correlated with MS clinical manifestations. Advanced MRI techniques together with diffusion studies square measure up the understanding of the mechanisms underlying tissue injury, repair and functional adaptation in MS but, they need careful standardization. It doesn’t only enhance the understanding of the pathophysiology and evolution of disease, but also to generate research hypotheses, monitor treatment, increase cost-effectiveness and power of clinical trials. Aim of the Work: The aim of this study is to evaluate the role of DTI in assessment of MS versus the normally-appearing white matter (NAWM). Patients and Methods:The study included 50 patients, 42 females and 8 males having MS (between 20 and 40 years of age) referred from Neurologists to Radio-diagnosis Department at Benha University hospitals with 5 age-matched control subjects (during the period between Aug. 2018 and Jan. 2020). Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Tensor imaging. Technique was performed using a standard 1.5 Tesla unit. Results:The study showed that DTI can reveal changes in NAWM in MS cases before visible sizable plaques can be detected by conventional MRI.