MS also affects the peripheral nervous system

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MS also affects the peripheral nervous system

Postby frodo » Tue Jun 05, 2018 7:09 am

This is a report from a German team using some kind of MRI named "magnetic resonance neurography":

https://journals.lww.com/neurotodayonli ... hic.6.aspx

Neurographic MRI Reveals Peripheral Nerve Lesions in MS Patients

Using a highly sensitive magnetic resonance imaging technique, researchers were able to see more peripheral nerve lesions in patients with multiple sclerosis, suggesting that demyelination may be occurring in the peripheral nerve system.

German researchers using magnetic resonance neurography (MRN) — an imaging method that provides high-resolution sequences that visualize peripheral nerves — have detected and quantified lesions suggestive of peripheral nerve demyelination in multiple sclerosis (MS) patients, a team of German investigators reported in the October 10 online publication of Annals of Neurology.

It remains unclear, however, whether or not these are the result of an inflammatory process or related to spinal cord lesions.

Significantly more peripheral nerve lesions were found in a group of MS patients compared to a matched group of healthy controls, according to the study.

Current opinion is that pathological changes in MS are restricted to the central nervous system (CNS) and cranial nerves, but the new proof-of-concept study may offer new insights into the pathophysiology of the disease and help guide new treatment options, said lead author Jennifer Kollmer, MD, a neuroradiologist at Heidelberg University Hospital.

The results might also help explain why CNS MRI scans in some patients show only a few lesions or older, non-enhancing ones, despite severe or new clinical symptoms, she told Neurology Today.

“Although a few studies have suggested that the peripheral nervous system [PNS] might be affected in MS, ours is the first to prove frequent involvement of peripheral nerves in MS patients by high-resolution MRN, regardless of disease duration or medical treatment,” Dr. Kollmer said.
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Re: MS also affects the peripheral nervous system

Postby NHE » Wed Jun 06, 2018 3:05 am

Here's the article's abstract from PubMed.


Peripheral nerve involvement in multiple sclerosis: Demonstration by magnetic resonance neurography.
Ann Neurol. 2017 Nov;82(5):676-685.

    OBJECTIVE: To detect and quantify peripheral nerve lesions in multiple sclerosis (MS) by magnetic resonance neurography (MRN).

    METHODS: Thirty-six patients diagnosed with MS based on the 2010 McDonald criteria (34 with the relapsing-remitting form, 2 with clinically isolated syndrome) with and without disease-modifying treatment were compared to 35 healthy age-/sex-matched volunteers. All patients underwent detailed neurological and electrophysiological examinations. Three Tesla MRN with large anatomical coverage of both legs and the lumbosacral plexus was performed by using 2-dimensional (2D) fat-saturated, T2-weighted (T2w) and dual echo turbo spin echo sequences as well as a 3D T2-weighted, fat-saturated SPACE sequence. Besides qualitative visual nerve assessment, a T2w signal quantification was performed by calculation of proton spin density and T2 relaxation time. Nerve diameter was measured as a morphometric criterion.

    RESULTS: T2w hyperintense nerve lesions were detectable in all MS patients, with a mean lesion number at thigh level of 151.5 ± 5.7 versus 19.1 ± 2.4 in controls (p < 0.0001). Nerve proton spin density was higher in MS (tibial/peroneal: 371.8 ± 7.7/368.9 ± 8.2) versus controls (tibial/peroneal: 266.0 ± 11.0/276.8 ± 9.7, p < 0.0001). In contrast, T2 relaxation time was significantly higher in controls (tibial/peroneal: 82.0 ± 2.1/78.3 ± 1.7) versus MS (tibial/peroneal: 64.3 ± 1.0/61.2 ± 0.9, p < 0.0001). Proximal tibial and peroneal nerve caliber was higher in MS (tibial: 52.4 ± 2.1mm2 , peroneal: 25.4 ± 1.3mm2 ) versus controls (tibial: 45.2 ± 1.4mm2 , p < 0.0015; peroneal: 21.3 ± 0.7mm2 , p = 0.0049).

    INTERPRETATION: Peripheral nerve lesions could be visualized and quantified in MS in vivo by high-resolution MRN. Lesions are defined by an increase of proton spin density and a decrease of T2 relaxation time, indicating changes in the microstructural organization of the extracellular matrix in peripheral nerve tissue in MS. By showing involvement of the peripheral nervous system in MS, this proof-of-concept study may offer new insights into the pathophysiology and treatment of MS. Ann Neurol 2017;82:676-685.
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