Well, what a can of worms this has opened - but I doubt if the right people will look at the worms and go away for a rethink.
Measuring brain atrophy (whether en masse, or by specific lobes or areas) seems so easy, one has to wonder why no-one else has thought of it.
The answer is probably a matter of vested interests. I have in mind, the people who may pay for a treatment. It matters little whether these are an insurance company, or a state medical system. Each will have their own pet test, and the supplier of treatment, therapy, or medication, will seek to address precisely that test so that their product will continue to be paid for.
Any good test should meet a number of criteria, including that of repeatability, and consistency, and validity. Even the EDSS should give the same result if two different clinicians make an assessment (and there are times when it is fashionable to deride the EDSS).
Or, consider the "Timed 25 foot walk". I will be taking this in a few week to see if I continue to get funding for the Functional Electronic Stimulator (FES) that minimizes the effect of my Drop foot. I will be tested with my FES turned on, or turned off. Will I deliberately influence the test result? Since the tester is from the FES supplier, will he/she care?
So, a simple measurement that only requires a ruler has a lot to commend it.
Some years (about 20) back I was responsible for a study that tested the accuracy with which the computer models of armored vehicles scaled over distance on a simulator display, and compared these to judgements of their distance made by members of the military. The primary instrument used was a transparent ruler.
The results were not popular in some quarters (big money in simulators, and in the computer models that they used).
So, if a simple measurement of brain atrophy is a good measure of MS severity, and if repeated measurements are a good measure of disease progression, and if - as the Swiss study shows - this leads to a direct comparison of the effectiveness of the various DMTs, guess what will happen? Now guess the response from the company that produces the least effective DMT.
Of course, this could be used to compare other things, if used over several years. Diets for example, CCSVI treatment versus DMTs, and there are a lot more.
And the downside? Someone will need to pay for annual MRI scans!
cheer will likely resolve this, but I think yes. Delta rate of atrophy should also be measured.Just wondering if anyone knows whether brain atrophy and level of disability correspond to each other?
1eye wrote:The 3rd ventricle is enlarged, which could be caused by surrounding atrophy. It, the thalamus and corpus callosum, are all affected by atrophy, and are all quite centrally located. Could there be a drainage problem? I would hate to see one of these areas ignored in favour of others.
Thus, there is a huge need of a methodology suitable to be applied in daily clinical practice in order to estimate GM atrophy in a convenient and comprehensive way. Given the thalamus is the brain structure found to be more consistently implied in MS both in terms of extent of atrophy and in terms of prognostic value, we propose a solution based in this structure. In particular, we propose to compare the extent of thalamus atrophy with the extent of unspecific, global brain atrophy, represented by ventricular enlargement.
Thalamic pathology, similar to the cortical pathology, appears to be present in MS from very early on, including at the CIS stage and in pediatric MS. In the progressive phase of MS, which is poorly explained by focal inflammatory WM demyelination, cortical and subcortical GM pathology including neuronal and axonal degeneration are the likely substrates for accumulating cognitive and motor dysfunction that characterizes long-standing disease.
cortical and subcortical GM pathology including neuronal and axonal degeneration are the likely substrates for accumulating cognitive and motor dysfunction that characterizes long-standing disease
ElliotB wrote:"How To Stop Shrinking Your Brain And Improve Your Thought Process"
http://www.medicaldaily.com/knowledge-b ... ess-302450 Imagine, improved diet, exercise, supplements, and proper sleep can all help your brain - what a novel idea!
1. eat fish or take an omega 3 supplement
2. exercise. walk if you can, swim, practice seated yoga, dance, bike, move.
3. discover a new interest-- a foreign language, knitting, oil painting, floral arranging, cooking, juggling.
4. get vitamin D from sun and/or supplement
6. get plenty of good sleep, and take naps.
7. listen to music...even better, sing along or play an instrument.
8. read a book or join a book club
9. eat Indian food, or take a curcumin supplement. If curcumin is contraindicated for you, you can skip this one
10. hug often. A pet, a grandkid, a spouse, a tree, a friend--yourself
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