Monitoring Of Multiple Sclerosis Research Articles

The Value of Using Quantitative MRI based on Synthetic Acquisition and Apparent Diffusion Coefficient to Monitor Multiple Sclerosis Lesion Activity.

Multiple sclerosis (MS) is one of the most common disabling central nervous system diseases affecting young adults. Magnetic resonance imaging (MRI) is an essential tool for diagnosing and following up multiple sclerosis. Over the years, many MRI techniques have been developed to improve the sensitivity of MS disease detection. In recent years synthetic MRI (sMRI) and quantitative MRI (qMRI) have gained traction in neuroimaging applications, providing more detailed information than traditional acquisition methods. These techniques enable the detection of microstructural changes in the brain with high sensitivity and robustness to inter-scanner and inter-observer variability. This study aims to evaluate the feasibility of using these techniques to avoid administering intravenous gadolinium-based contrast agents (GBCAs) for assessing MS disease activity and monitoring. Forty-two known MS patients, aged 20 to 45, were scanned as part of their routine follow-up. MAGnetic resonance image Compilation (MAGiC) sequence, an implementation of synthetic MRI, was added to our institute's routine MS protocol to automatically generate quantitative maps of T1, T2, and PD. T1, T2, PD, and apparent diffusion coefficient (ADC) data were collected from regions of interest (ROIs) representing normalappearing white matter (NAWM), enhancing, and non-enhancing MS lesions. The extracted information was compared, and statistically analyzed, and the sensitivity and specificity were calculated. The mean R1 (the reciprocal of T1) value of the non-enhancing MS lesions was 0.694 s-1 (T1=1440 ms), for enhancing lesions 1.015 s-1 (T1=985ms), and for NAWM 1.514 s-1 (T1=660ms). For R2 (the reciprocal of T2) values, the mean value was 6.816 s-1 (T2=146ms) for nonenhancing lesions, 8.944 s-1 (T2=112 ms) for enhancing lesions, and 1.916 s-1 (T2=522 ms) for NAWM. PD values averaged 93.069% for nonenhancing lesions, 82.260% for enhancing lesions, and 67.191% for NAWM. For ADC, the mean value for non-enhancing lesions was 1216.60×10-6 mm2/s, for enhancing lesions 1016.66×10-6 mm2/s, and for NAWM 770.51×10-6 mm2/s. Our results indicate that enhancing and non-enhancing MS lesions significantly decrease R1 and R2 values. Non-enhancing lesions have significantly lower R1 and R2 values compared to enhancing lesions. Conversely, PD values are significantly higher in non-enhancing lesions than in enhancing lesions. For ADC, while NAWM has lower values, there was minimal difference between the mean ADC values of enhancing and non-enhancing lesions.

Anti-JCV antibody index seroconversion in Turkish multiple sclerosis patients treated with natalizumab.

The anti-JCV antibody index is widely used to monitor multiple sclerosis (MS) patients receiving natalizumab, as seroconversion is linked to an increased risk of progressive multifocal leukoencephalopathy. This study aimed to evaluate the prevalence and risk factors of anti-JCV antibody seroconversion in patients treated with natalizumab. We included MS patients exposed to natalizumab treatment for at least one year, with a negative anti-JCV antibody index at baseline, and a minimum of two anti-JCV antibody assessments more than six months apart. We employed Kaplan-Meier survival analysis to assess the median time to seroconversion and the annual seroconversion rate, and univariate and multivariate Cox regression models to evaluate the covariates. Among 96 patients followed for a median of 99months, 29 (30.2%) patients had seroconversion. The median time to seroconversion was 8.3years, with an annual rate of 6.1%. Seroconversion rates were higher in smokers (p = 0.02) and patients with a body mass index (BMI) over 25kg/m2 (p = 0.006). Patients who started natalizumab at age 35 or older had a shorter median time to seroconversion (p = 0.003), and most seroconversions occurred within the first three years. No significant associations were found with gender, prior immunosuppressive treatment, MS subtype, or MS age of onset. Anti-JCV seroconversion is more likely in patients who smoke, have a higher BMI, start natalizumab therapy after age 35, and within the first three years of treatment. For these high-risk patients, vigilant monitoring of anti-JCV antibodies is required.

Q‐Space Myelin Map: A new myelin‐specific imaging technique for treatment monitoring of multiple sclerosis

AbstractObjectivesIn multiple sclerosis (MS) patients, hyperintense signals on T2‐weighted images by magnetic resonance imaging are signs of demyelination; however, T2 signals lack specificity and fail to detect remyelination. For more precise monitoring of MS, a new magnetic resonance imaging technique, q‐space Myelin Map (qMM), which specifically identifies myelin, has been developed. This study aimed to explore clinical factors associated with remyelination for different disease‐modifying drugs, and to examine the utility and feasibility of qMM in clinical practice.MethodsData from sequential patients with relapsing–remitting MS initiating disease‐modifying drugs at our center were collected. After treatment initiation, qMM was carried out at 6‐month intervals and the resulting images analyzed for evidence of remyelination.ResultsA total of 48 patients with relapsing–remitting MS were included: 22 with dimethyl fumarate, 14 with fingolimod, four with glatiramer acetate and eight with natalizumab. qMM showed qMM‐remyelination in 22 patients (45.8%). In natalizumab patients, baseline ages were 33.6 ± 6.9 years (n = 5) and 47.3 ± 5.8 years (n = 3) in patients with or without qMM remyelination, respectively. In dimethyl fumarate patients, the proportion of women was 100% (n = 10) and 50% (n = 12) in patients with or without qMM myelination, respectively.ConclusionsThis exploratory study suggested the potential clinical utility of qMM for visualizing remyelination in MS patients and fine‐tuning their pharmacotherapy. Two potential clinical factors promoting qMM‐remyelination were identified: female sex with dimethyl fumarate and younger baseline age with natalizumab; a larger prospective study is warranted to confirm these results.

Spinal cord MRI activity in multiple sclerosis: Predictive value for relapses and impact on treatment decisions

IntroductionEmerging evidence suggests the prognostic value of spinal cord (SC) pathology in multiple sclerosis (MS). However, the 2021 MAGNIMS-CMSC-NAIMS guidelines don't recommend routine SC MRI for disease monitoring. This study investigates the frequency of new asymptomatic and isolated SC lesions, exploring their potential to predict clinical activity and guide treatment decisions. MethodsWe enrolled relapsing-remitting MS (RRMS) patients who underwent brain and SC MRI at baseline and after 12 months. New, enlarged, or gadolinium-enhanced (Gd+) lesions on MRI were considered disease activity markers. Clinical relapses and treatment changes observed 3 months after the 12-month MRI were analyzed using regression analysis, evaluating their association with worsening SC findings. ResultsA total of 201 RRMS patients (56 males, 27.9%, mean age 42.5 ± 12.1 years, mean EDSS 2.7 ± 1.9) were included. Isolated worsening of T2 lesion burden in the SC occurred in 16 patients (8%), and 12 (6%) had Gd + lesions. Among patients without brain MRI activity (n = 138), regression analysis revealed a significant association between new Gd + SC lesions and clinical relapses within 3 months of the 12-month MRI (p = 0.024). Worsening SC findings (p = 0.021) and SC lesion enhancement (p = 0.046) emerged as key factors influencing disease-modifying therapy changes within 3 months in these patients. Notably, even without clinical symptoms, worsening SC findings significantly predicted treatment changes (p = 0.003). ConclusionOur findings highlight the independent value of SC MRI findings in MS monitoring. Importantly, isolated and asymptomatic SC worsening significantly impacted treatment decisions.

Modeling multiple sclerosis using mobile and wearable sensor data

Multiple sclerosis (MS) is a neurological disease of the central nervous system that is the leading cause of non-traumatic disability in young adults. Clinical laboratory tests and neuroimaging studies are the standard methods to diagnose and monitor MS. However, due to infrequent clinic visits, it is fundamental to identify remote and frequent approaches for monitoring MS, which enable timely diagnosis, early access to treatment, and slowing down disease progression. In this work, we investigate the most reliable, clinically useful, and available features derived from mobile and wearable devices as well as their ability to distinguish people with MS (PwMS) from healthy controls, recognize MS disability and fatigue levels. To this end, we formalize clinical knowledge and derive behavioral markers to characterize MS. We evaluate our approach on a dataset we collected from 55 PwMS and 24 healthy controls for a total of 489 days conducted in free-living conditions. The dataset contains wearable sensor data – e.g., heart rate – collected using an arm-worn device, smartphone data – e.g., phone locks – collected through a mobile application, patient health records – e.g., MS type – obtained from the hospital, and self-reports – e.g., fatigue level – collected using validated questionnaires administered via the mobile application. Our results demonstrate the feasibility of using features derived from mobile and wearable sensors to monitor MS. Our findings open up opportunities for continuous monitoring of MS in free-living conditions and can be used to evaluate and guide the effectiveness of treatments, manage the disease, and identify participants for clinical trials.

Complete Blood Count in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic disease that affects the central nervous system in primarily young adults. Although the exact etiology of MS is unknown, autoimmune mechanisms are thought to play a crucial role, especially with CD4+ T cells involved in the immune response. Inflammatory reactions involving T cells and macrophages are commonly observed in MS lesions. B lymphocytes, plasma cells, and antibodies also contribute to MS pathogenesis. Neutrophils, lymphocytes, monocytes, and platelets, key immune system components, play roles in inflammatory processes, but their association with MS prognosis remains inconclusive. Due to its heterogeneous nature, clinical manifestations of MS vary depending on the location of the affected central nervous system. While several potential biomarkers have been identified for MS diagnosis and monitoring, none have been universally accepted. Studies have examined complete blood count parameters in MS patients, including erythrocyte, platelet, and leukocyte populations. Changes in these parameters have been observed in MS patients compared to healthy controls and may be related to disease prognosis. For example, increased erythrocyte fragility and altered hemoglobin levels have been reported in MS patients. Leukocyte counts and ratios, such as the neutrophil/lymphocyte ratio, have shown associations with disease severity. Platelet activation and interaction with immune cells have also been implicated in MS pathophysiology. Nevertheless, further research is needed to fully understand the role of complete blood count parameters in MS. Identifying reliable biomarkers for early diagnosis and prognosis prediction would greatly enhance MS management. Moreover, these benefits could lead to substantial improvements in achieving complete recovery of patients, surpassing the focus on current symptomatic treatments.

Cortical matrix remodeling as a hallmark of relapsing–remitting neuroinflammation in MR elastography and quantitative MRI

Multiple sclerosis (MS) is a chronic neuroinflammatory disease that involves both white and gray matter. Although gray matter damage is a major contributor to disability in MS patients, conventional clinical magnetic resonance imaging (MRI) fails to accurately detect gray matter pathology and establish a clear correlation with clinical symptoms. Using magnetic resonance elastography (MRE), we previously reported global brain softening in MS and experimental autoimmune encephalomyelitis (EAE). However, it needs to be established if changes of the spatiotemporal patterns of brain tissue mechanics constitute a marker of neuroinflammation. Here, we use advanced multifrequency MRE with tomoelastography postprocessing to investigate longitudinal and regional inflammation-induced tissue changes in EAE and in a small group of MS patients. Surprisingly, we found reversible softening in synchrony with the EAE disease course predominantly in the cortex of the mouse brain. This cortical softening was associated neither with a shift of tissue water compartments as quantified by T2-mapping and diffusion-weighted MRI, nor with leukocyte infiltration as seen by histopathology. Instead, cortical softening correlated with transient structural remodeling of perineuronal nets (PNNs), which involved abnormal chondroitin sulfate expression and microgliosis. These mechanisms also appear to be critical in humans with MS, where tomoelastography for the first time demonstrated marked cortical softening. Taken together, our study shows that neuroinflammation (i) critically affects the integrity of PNNs in cortical brain tissue, in a reversible process that correlates with disease disability in EAE, (ii) reduces the mechanical integrity of brain tissue rather than leading to water accumulation, and (iii) shows similar spatial patterns in humans and mice. These results raise the prospect of leveraging MRE and quantitative MRI for MS staging and monitoring treatment in affected patients.

Segmenting Multi-Sclerosis Lesions: An Enhanced Approach using an Optimized U-Net

Based on MRI images and a U-Net architecture, this study presents an optimized Convolutional Neural Network for segmenting Multiple Sclerosis (MS) lesions. The approach entails a two-step procedure designed to maximize accuracy in lesion detection. First, it identifies the most informative modality from the MRI images at hand. Then, it systematically assesses the critical hyper-parameters of the U-Net architecture to improve the learning process. By selecting the optimal modality and fine-tuning hyper-parameters, significant improvements in MS lesion detection and monitoring accuracy are achieved. This advancement facilitates a deeper understanding of the disease’s progression and its sub-types. The proposed approach holds promise for improving clinical decision-making and patient management in MS diagnosis and treatment.

Plasma IgG aggregates as biomarkers for multiple sclerosis

We recently reported that multiple sclerosis (MS) plasma contains IgG aggregates and induces complement-dependent neuronal cytotoxicity (Zhou et al., 2023). Using ELISA, we report herein that plasma IgG levels in the aggregates can be used as biomarkers for MS. We enriched the IgG aggregates from samples of two cohorts (190 MS and 160 controls) by collecting flow-through after plasma binding to Protein A followed by detection of IgG subclass. We show that there are significantly higher levels of IgG1, IgG3, and total IgG antibodies in MS IgG aggregates, with an AUC >90%; higher levels of IgG1 distinguish secondary progressive MS from relapsing-remitting MS (AUC = 91%). Significantly, we provided the biological rationale for MS plasma IgG biomarkers by demonstrating the strong correlation between IgG antibodies and IgG aggregate-induced neuronal cytotoxicity. These non-invasive, simple IgG-based blood ELISA assays can be adapted into clinical practice for diagnosing MS and SPMS and monitoring treatment responses.

PET imaging of TREM1 identifies CNS-infiltrating myeloid cells in a mouse model of multiple sclerosis.

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system (CNS) that causes substantial morbidity and diminished quality of life. Evidence highlights the central role of myeloid lineage cells in the initiation and progression of MS. However, existing imaging strategies for detecting myeloid cells in the CNS cannot distinguish between beneficial and harmful immune responses. Thus, imaging strategies that specifically identify myeloid cells and their activation states are critical for MS disease staging and monitoring of therapeutic responses. We hypothesized that positron emission tomography (PET) imaging of triggering receptor expressed on myeloid cells 1 (TREM1) could be used to monitor deleterious innate immune responses and disease progression in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS. We first validated TREM1 as a specific marker of proinflammatory, CNS-infiltrating, peripheral myeloid cells in mice with EAE. We show that the 64Cu-radiolabeled TREM1 antibody-based PET tracer monitored active disease with 14- to 17-fold higher sensitivity than translocator protein 18 kDa (TSPO)-PET imaging, the established approach for detecting neuroinflammation in vivo. We illustrate the therapeutic potential of attenuating TREM1 signaling both genetically and pharmacologically in the EAE mice and show that TREM1-PET imaging detected responses to an FDA-approved MS therapy with siponimod (BAF312) in these animals. Last, we observed TREM1+ cells in clinical brain biopsy samples from two treatment-naïve patients with MS but not in healthy control brain tissue. Thus, TREM1-PET imaging has potential for aiding in the diagnosis of MS and monitoring of therapeutic responses to drug treatment.

Evaluation of Rosuvastatin Therapy on SIRT1 Gene Expression in Patients with Multiple Sclerosis: An Uncontrolled Clinical Trial

Multiple sclerosis (MS) is a chronic autoimmune disease. Current medications have some limitations such as low efficacy and high side effects. In recent years, statins have been raised as potential therapeutics for MS treatment with minimal complications. In addition, patient monitoring using suitable molecular markers is necessary for treatment response evaluation. The aim of the present study was the evaluation of SIRT1 gene expression changes following rosuvastatin therapy in patients with MS. This before-after uncontrolled clinical trial study was performed on 25 patients with MS. Patients were treated with 20 mg rosuvastatin daily for 3 months. The Expanded Disability Status Scale (EDSS) was measured before and after statin therapy. Blood samples were taken from patients 2 times, before and after statin therapy, and centrifuged for white blood cell isolation. Total RNA was extracted using RNX-plus reagent, and complementary DNA was synthesized using Pars Tous cDNA Synthesis Kit. Real-time polymerase chain reaction was done using SYBR blue master mix and gene-specific primers in Roche light cycler. Patients' information was recorded using a checklist. Data analysis was performed using SPSS version 23 and Graph Pad version 9 software and P < 0.05 was considered a significant level. SIRT1 was significantly upregulated in MS patients after statin therapy. Subsequently, EDSS of patients was decreased along with the increase in SIRT1 gene expression, although EDSS changes were not significant (P > 0.05). Pearson correlation test showed no significant relationship between EDSS and SIRT1 gene expression (P > 0.05). No significant relationship was observed between SIRT1 expression or EDSS levels with patients' age, sex, weight, height, and body mass index and administrated drugs (P > 0.05). SIRT1 potentially is a sensitive and reliable biomarker for patients with MS monitoring during statin therapy.

004 Physical activity monitoring to assess disability progression in multiple sclerosis

To monitor multiple sclerosis (MS) disability, scales like the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) are commonly used. Both rely on a single clinical assess- ment in time which may not reflect the patient’s performance in their living environment. They also require training and are time consuming. The SenseWear armband incorporates a triaxial accelerometer sensitive to upper and lower limb motion. A proprietary algorithm computes several physical activity variables, such as total energy expenditure, physical activity duration, metabolic equivalents (METs) and average daily steps. Here we assess the SenseWear armband for its ability to monitor disease progression, alongside the EDSS and MSFC. Progressive MS patients (n=50) wore the device for one week, every 6 months for2.5 years. MSFC and EDSS were performed at the end of each week. The armband was agreeable and easy to use. Patients showed progression across all three disability measures (p&lt;0.01). Baseline physical activity, EDSS and MSFC values correlated well between each other. The change in the three measures with time correlated poorly, suggesting that they measure functional aspects which have different pro- gression trajectories. In summary, physical activity monitoring is a user-friendly and ecological method to measure MS disability progression.c.stuart@soton.ac.uk

039 Disease modifying treatments and cancer monitoring in MS; the need for a nation-wide disease registry

The immune system is inextricably linked to both cancer and Multiple Sclerosis (MS). National population- based cohort studies in Denmark and Norway have attempted to elucidate the relationship between cancer and MS, but results are conflicting. The advent of highly-efficacious disease modifying treatments (DMTs) in recent years revolutionised MS treatment, but the effect of their immunomodulating mechanism on cancer risk is unclear. Studies thus far have been limited by lack of cancer risk factor data and statistical power. In this pilot study, we identified the relevant data, including patient and cancer characteristics, DMT use, and important risk factors that may confound treatment effects. These data was collected for MS patients with cancer under the care of Salford Royal Foundation Trust. This highlighted the incomplete- ness of records, and the need for a framework for data collection. Moreover, data collection relied on multiple sources. Integration of the resultant question proforma into patient records will be a simple tool to enable reliable, homogeneous data collection. Deepening understanding of the effect of DMTs on cancer risk will improve risk-benefit treatment analysis in MS, thus improving care. Indeed, the institution of a nation-wide patient registry for such data in the UK will facilitate necessary future research.j.das@doctors.org.uk

Cross-sectional and longitudinal correlations between the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and other outcome measures in multiple sclerosis

BackgroundThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) is the first validated disease specific patient-reported outcome measure (PROM) designed to assess upper extremity function in patients with multiple sclerosis (MS). ObjectiveTo determine correlations between the AMSQ and established physician- and performance based outcome measures. MethodsIn a cross-sectional cohort of 533 patients correlations between the AMSQ and the Expanded Disability Status Scale (EDSS), its functional systems, the 9-Hole Peg Test (9-HPT) and the Timed-25 Foot Walk (T25FW) were determined. Subgroup analyses were performed as well. Also, correlations were determined in 110 of 533 patients with available longitudinal data. ResultsStrongest correlations were found in the cross-sectional cohort between the AMSQ and the EDSS (β 0.60, p<.001), the 9-HPT dominant hand (β 0.52, p<.001) and 9-HPT non-dominant hand (β 0.46, p<.001), the Pyramidal (β 0.57 p<.001) and the Cerebellar functional system (β 0.54, p<.001) of the EDSS. ConclusionThe moderate correlations between the AMSQ and several established physician- and performance based outcome measures underline that the AMSQ, an easily at long-distance administrable PROM, could be considered as a reliable outcome measure for the monitoring of MS in daily practice. Additional research is needed to support these findings.

Evaluation of remote assessments for multiple sclerosis in an in-home setting

BackgroundThere is an urgent clinical need for reliable remote monitoring methods in Multiple Sclerosis (MS). We evaluated the use of remotely patient-recorded timed 25-foot walk (rT25FW) and nine-hole peg test (r9HPT). MethodsSeventy-one people with MS completed a previously-validated online EDSS (webEDSS) and r9HPT, and 108 completed the webEDSS and rT25FW. ResultsThere was a mild-moderate positive correlation between webEDSS and rT25FW, and no significant correlation between webEDSS and r9HPT. Distributions of rT25FW and r9HPT times were positively skewed. ConclusionsOur results provide pilot evidence that remote monitoring of MS is potentially valid but requires refinement before wide-scale implementation. With a median EDSS of 4.5 and EDSS range of 0 – 8.0, at least some patients with ambulatory difficulty are able to complete the assessments.

Exploring Self-management Needs of Persons With Multiple Sclerosis: A Qualitative Study for Mobile Application Development.

Multiple sclerosis (MS) is a common cause of neurologic disability in young adults. Individuals with MS deal with the day-to-day effects of the disease on their lives. Self-management can help with these challenges. This study aimed to explore MS self-management needs according to experiences of persons with MS and was conducted as part of a research project to develop an MS self-management mobile application. We used a qualitative method to elicit self-management needs among 12 individuals with MS and conducted semistructured interviews with them. The participants were chosen based on snowball sampling. The interviews were recorded and transcribed verbatim. Finally, qualitative data were analyzed using a content analysis method (inductive way) to identify the underlying themes and subthemes. The analysis resulted in the emergence of 7 themes: the source of information, basic needs, understanding MS, physical exercises in MS, useful nutrition in MS, MS monitoring, and communication. Within these 7 themes we identified 23 subthemes. The themes that emerged in this study show what needs are essential to help persons with MS improve their self-management capacity. These findings can help in the development of self-management mobile applications for supporting individuals in managing MS.

A New Generation of Translational Tools designed to Monitor Multiple Sclerosis (MS) at Clinical and Subclinical Stages

According to tremendous translational researchers, biomarkers as a part of the ligand-receptor tandems have induced an impulse to prompt the development of an upgraded concept of the targeted therapy. It is health indicators that justifying the necessity to create targeted drug of the next-step generation to be implemented at the clinical and sub-clinical key stages of the disease pathogenesis and to be involved into a multi-stage process to get the shifts appeared modified. Catalytic antibodies (CatAbs) have emerged as powerful tools for the efficient and specific catalysis of a wide range of chemical transformations. Generating antibody catalysts that achieve enzymatic efficiency remains a challenging task to be implemented in the designed translational applications. We also comment on recent developments in the screening CatAbs-related process that allow for a more efficient identification of Ab-based catalysts to be used further as native ones or engineered and/or designed bioproducts in clinical practice. The generation of an edited Abs, Eezyme or artificial ABZYME through transition state stabilization by Abs has been thus demonstrated. So, we may consider Ab-proteases as unique translational probes to diagnose, to monitor, to control and to treat and rehabilitate MS patients at clinical stages and to prevent the disorder at subclinical stages in personsat-risks to secure the efficacy of regenerative manipulations. There is an evident-based outcome of the latest studies in multiple sclerosis (MS) related fields that illustrates the proved targeted activity of Ab-proteases. High impact of Ab-proteases can be used to monitor both clinical and subclinical courses of chronic autoimmune inflammation (MS) to predict stepwise transformations of the course and to prognosticate the clinical illness finally. In this sense, Ab-proteases can be programmed and reprogrammed to suit the requests and standards of regenerative medicine and re-myelination, in particular. This information can allow to design the algorithms for combinatorial (preventive, prophylactic, therapeutic and rehabilitative) treatment, whilst developing unique tools for individually therapy for a number of diseases, such as a group of autoimmune diseases which holds a particular position.

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.

Data Collection in Multiple Sclerosis: The MSDS Approach.

Multiple sclerosis (MS) is a frequent chronic inflammatory disease of the central nervous system that affects patients over decades. As the monitoring and treatment of MS become more personalized and complex, the individual assessment and collection of different parameters ranging from clinical assessments via laboratory and imaging data to patient-reported data become increasingly important for innovative patient management in MS. These aspects predestine electronic data processing for use in MS documentation. Such technologies enable the rapid exchange of health information between patients, practitioners, and caregivers, regardless of time and location. In this perspective paper, we present our digital strategy from Dresden, where we are developing the Multiple Sclerosis Documentation System (MSDS) into an eHealth platform that can be used for multiple purposes. Various use cases are presented that implement this software platform and offer an important perspective for the innovative digital patient management in the future. A holistic patient management of the MS, electronically supported by clinical pathways, will have an important impact on other areas of patient care, such as neurorehabilitation.

Multiple sclerosis and bilingualism

Abstract It has been suggested that bilingualism is beneficial for executive control and could have positive long-term effects by delaying the onset of symptoms of degenerative diseases. This research investigates, for the first time, the impact of bilingualism on executive control (monitoring and inhibitory control) in individuals with Multiple Sclerosis (MS), a neurodegenerative disease which commonly causes deficiencies in the cognitive system. Bilingual and monolingual adults, with and without an MS diagnosis, performed a flanker task with two degrees of monitoring demands (high monitoring vs. low monitoring). Results showed that bilingual MS patients had inhibitory control and monitoring abilities that were similar to healthy bilingual controls. In contrast, monolingual MS patients showed similar inhibitory control but significantly worse monitoring abilities compared to monolingual healthy controls. We propose that the similar behaviour between bilingual groups suggests that bilingualism might counteract cognitive deficits related to MS, especially with respect to monitoring. The high monitoring cost observed in monolingual patients seems related to underlying deficits in monitoring and possibly switching, executive control abilities commonly impaired in MS patients from early stages. Our findings provide some preliminary evidence for the cognitive reserve hypothesis in bilingual MS patients.