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A question for the experts

Looking around in pubmed I have found an interesting article about lesion evolution. It seems to refer to MS lesion evolution, but they never say it explicitly. What do you think? If true, this would be against the vascular hypothesis, isn't it?


Abstract
BACKGROUND AND PURPOSE:
It is unknown whether white matter lesions (WML) develop abruptly in previously normal brain areas, or whether tissue changes are already present before WML become apparent on MRI. We therefore investigated whether development of WML is preceded by quantifiable changes in normal-appearing white matter (NAWM).

METHODS:
In 689 participants from the general population (mean age 67 years), we performed 2 MRI scans (including diffusion tensor imaging and Fluid Attenuation Inversion Recovery [FLAIR] sequences) 3.5 years apart using the same 1.5-T scanner. Using automated tissue segmentation, we identified NAWM at baseline. We assessed which NAWM regions converted into WML during follow-up and differentiated new WML into regions of WML growth and de novo WML. Fractional anisotropy, mean diffusivity, and FLAIR intensity of regions converting to WML and regions of persistent NAWM were compared using 3 approaches: a whole-brain analysis, a regionally matched approach, and a voxel-wise approach.

RESULTS:
All 3 approaches showed that low fractional anisotropy, high mean diffusivity, and relatively high FLAIR intensity at baseline were associated with WML development during follow-up. Compared with persistent NAWM regions, NAWM regions converting to WML had significantly lower fractional anisotropy (0.337 vs 0.387; P<0.001), higher mean diffusivity (0.910 × 10(-3) mm(2)/s vs 0.729 × 10(-3) mm(2)/s; P<0.001), and relatively higher normalized FLAIR intensity (1.233 vs -0.340; P<0.001). This applied to both NAWM developing into growing and de novo WML.

CONCLUSIONS:
White matter changes in NAWM are present and can be quantified on diffusion tensor imaging and FLAIR before WML develop. This suggests that WML develop gradually, and that visually appreciable WML are only the tip of the iceberg of white matter pathology.

EDIT: This article is not related to MS but to the condition known as "Leukoaraiosis", maybe the same than the "Small Vessel Disease"

http://www.thisisms.com/forum/post167470.html#p167470

They're looking at general population, not MS patients. Average age is 67. This is about white matter lesions of old age but still interesting.

Thanks. That's what I was thinking, but on the other hand, I had never heard about WM lesions just for ageing, and things like NAWM also sounds very MS-like. It is interesting that the same proceses of MS appear in old people (assuming that NAWM has the same meaning in both cases).

I think this it is not a very known fact. At least it was not known for me.

Doing more research, it seems that this article speaks about a condition named Leukoaraiosis, and, guess what, it is VASCULAR.

http://en.wikipedia.org/wiki/Leukoaraiosis

I have been looking for differences between MS lesions and this lesions and I have found nothing. Probably the only reason why some people is labeled MS and others like this is just for their clinical course.

The clinical definition implied by McDonalds has been probably the worst negative development in the history of medicine.

frodo wrote:Thanks. That's what I was thinking, but on the other hand, I had never heard about WM lesions just for ageing, and things like NAWM also sounds very MS-like. It is interesting that the same proceses of MS appear in old people (assuming that NAWM has the same meaning in both cases).

I've heard of leukoriasis but not of NAWM in leukoriasis. When I was first diagosed, it said on my MRI that the lesion was atypical for someone of my age, so I delved into reading about white matter lesions of old age. A percentage of older people have these and it's considered ok.

NAWM was an upsetting concept to read about back then too, because it shifted my thinking that I had one lesion in an otherwise healthy brain to the idea that I had one lesion and patches of normal-appearing brain that wasn't normal at all.

Cheer has posted on this topic before, let me google, if I'm spelling leukoriasis correctly (lol) it should come up:
http://www.thisisms.com/forum/chronic-c ... 14138.html

a list of studies on white matter lesions:
http://scholar.google.ca/scholar?q=whit ... CDIQgQMwAA

interesting related discussion topic from earlier this year

New Paper: Low vit and carotenoid lvls are related to lesions
http://www.thisisms.com/forum/chronic-c ... ml#p202979

study link: Low vitamin and carotenoid levels are related to cerebral white matter lesions
http://link.springer.com/article/10.100 ... 012-0419-z
"Lower gamma-tocopherol levels were significantly associated with DWLs in all subjects."

interesting connections to ms: interferon beta raises vit e levels.
also, vit e is strongly featured in the klenner protocol for ms. although the research on vit e forms was much more scarce when the klenner protocol was developed

I'm going to add this here because it's also about white matter lesions that are not MS in origin:
http://www.medpagetoday.com/Neurology/G ... id=5517461

The researchers estimated that each 1% increase in pulse wave velocity at baseline was associated with a 0.3% increase in the volume of white matter hyperintensities 7 years later.

They hypothesized that the difference in stiffness between the highly elastic aortic arch and the blood vessels leading to the brain might have a protective effect on the cerebral microvasculature, by causing some of the pressure to be reflected.

That notion would imply that higher pulse wave velocity (a result of greater stiffness) would reduce the protective effect.

This is looking at pulse wave velocity in the aortic arch, and a related increase in white matter hyperintensities in the brain.
Pressure leads to white matter hyperintensities.
To me, this meshes with the theory that increased pressure in the sinuses in MS as a result of CCSVI could contribute to the development of white matter lesions.

Cece - I think 'Dawson's fingers' are key . I believe this is a common discovery on MRI.

My theory is this : Due to a reduced or stopped bloodflow that connects the brain blood pathways back to the heart , MICRO bleeds happen. This is caused by the force of blood flow INTO your brain , produced by your heart. PULSATING Pressure.

This activates your immune system. The I S does exactly as it should , and patch's and heals the miniscule opening. A scar then forms . Now you have Multiple Scars.

By repairing the blood flow stoppage ..... this removes the possibility of micro bleeds.

Pressure is defined as ..... resistance to flow. You have one or the other. Never both.

Remove the resistance to flow ..... and there will be no more micro bleeds.


MrSuccess

Thanks for all the information Cece. Now I will have something to read during the weekend ..

Read it outside if you can, it's finally sunny out. (Depending on where you live.)

Cece wrote:Read it outside if you can, it's finally sunny out. (Depending on where you live.)

I'm living in Spain and it was sunny. Thanks.