Spinal cord

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Petr75
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Spinal cord

Post by Petr75 »

2019 Sep
Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Italy
Spinal cord dysfunction contributes to balance impairment in multiple sclerosis patients
https://www.ncbi.nlm.nih.gov/pubmed/31336360

Abstract
OBJECTIVES:

Balance impairment is very common in multiple sclerosis (MS) but its causes are still unclear. Some studies suggest that balance deficit originates mainly from damage in specific locations of the central nervous system such as cerebellum and spinal cord, that are involved in transmission and integration of sensory inputs and motor outputs. The aim of this study is to investigate the contribution of spinal cord to MS-related imbalance, by combining neurophysiologic and neuroimaging techniques.
PATIENTS AND METHODS:
Balance performance was correlated with clinical, neurophysiological and MRI findings. The functionality of spinal cord was tested by somatosensory (SEP) and motor (MEP) evoked potentials. MRI was used to identify spinal and cerebellar lesions. Balance performance was assessed by Tinetti Scale (TS). Clinical disability was measured by EDSS.
RESULTS:
38 patients were included. Linear regression model revealed significant negative correlations between TS and EDSS scores, between TS and cervical lesions, and between TS and SEP findings.
CONCLUSION:
Our study, by combining neurophysiologic and neuroimaging techniques, confirms that spinal cord plays an important role for balance control and that its dysfunction, especially in lower limbs somatosensory ascending pathways conveying proprioceptive information, contributes to balance impairment in MS patients.
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zen2010
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Re: Spinal cord

Post by zen2010 »

I've met MSers with spinal cord lesions and without spinal lesions. All of them had severe gait issues.

This study is showing that gait issues are related to lesions located at the spinal cord.
So I am confused...
Are MSers with gait issues and without spinal cord lesions can't walk cause of poor balance (also due to brain lesions)?
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Petr75
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Re: Spinal cord

Post by Petr75 »

2020 Jun 23
From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience ..
Clinical Relevance of Multiparametric MRI Assessment of Cervical Cord Damage in Multiple Sclerosis
https://pubmed.ncbi.nlm.nih.gov/32573387/


Abstract

Background In multiple sclerosis (MS), knowledge about how spinal cord abnormalities translate into clinical manifestations is incomplete. Comprehensive, multiparametric MRI studies are useful in this perspective, but studies for the spinal cord are lacking. Purpose To identify MRI features of cervical spinal cord damage that could help predict disability and disease course in MS by using a comprehensive, multiparametric MRI approach. Materials and Methods In this retrospective hypothesis-driven analysis of longitudinally acquired data between June 2017 and April 2019, 120 patients with MS (58 with relapsing-remitting MS [RRMS] and 62 with progressive MS [PMS]) and 30 age- and sex-matched healthy control participants underwent 3.0-T MRI of the brain and cervical spinal cord. Cervical spinal cord MRI was performed with three-dimensional (3D) T1-weighted, T2-weighted, and diffusion-weighted imaging; sagittal two-dimensional (2D) short inversion time inversion-recovery imaging; and axial 2D phase-sensitive inversion-recovery imaging at the C2-C3 level. Brain MRI was performed with 3D T1-weighted, fluid-attenuated inversion-recovery and T2-weighted sequences. Associations between MRI variables and disability were explored with age-, sex- and phenotype-adjusted linear models. Results In patients with MS, multivariable analysis identified phenotype, cervical spinal cord gray matter (GM) cross-sectional area (CSA), lateral funiculi fractional anisotropy (FA), and brain GM volume as independent predictors of Expanded Disability Status Scale (EDSS) score (R2 = 0.86). The independent predictors of EDSS score in RRMS were lateral funiculi FA, normalized brain volume, and cervical spinal cord GM T2 lesion volume (R2 = 0.51). The independent predictors of EDSS score in PMS were cervical spinal cord GM CSA and brain GM volume (R2 = 0.44). Logistic regression analysis identified cervical spinal cord GM CSA and T2 lesion volume as independent predictors of phenotype (area under the receiver operating characteristic curve = 0.95). An optimal cervical spinal cord GM CSA cut-off value of 11.1 mm2 was found to enable accurate differentiation of patients with PMS, having values below the threshold, from those with RRMS (sensitivity = 90% [56 of 62], specificity = 91% [53 of 58]). Conclusion Cervical spinal cord MRI involvement has a central role in explaining disability in multiple sclerosis (MS): Lesion-induced damage in the lateral funiculi and gray matter (GM) in relapsing-remitting MS and GM atrophy in patients with progressive MS are the most relevant variables. Cervical spinal cord GM atrophy is an accurate predictor of progressive phenotype. Cervical spinal cord GM lesions may subsequently cause GM atrophy, which may contribute to evolution to PMS. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zivadinov and Bergsland in this issue.
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Petr75
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Re: Spinal cord

Post by Petr75 »

zen2010 wrote: Mon Oct 07, 2019 6:13 pm I've met MSers with spinal cord lesions and without spinal lesions. All of them had severe gait issues.

This study is showing that gait issues are related to lesions located at the spinal cord.
So I am confused...
Are MSers with gait issues and without spinal cord lesions can't walk cause of poor balance (also due to brain lesions)?
2020 Jun 23
NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Canada
Multiple Sclerosis Lesions in Motor Tracts From Brain to Cervical Cord: Spatial Distribution and Correlation With Disability
https://pubmed.ncbi.nlm.nih.gov/32572488/

Abstract

Despite important efforts to solve the clinico-radiological paradox, correlation between lesion load and physical disability in patients with multiple sclerosis remains modest. One hypothesis could be that lesion location in corticospinal tracts plays a key role in explaining motor impairment. In this study, we describe the distribution of lesions along the corticospinal tracts from the cortex to the cervical spinal cord in patients with various disease phenotypes and disability status. We also assess the link between lesion load and location within corticospinal tracts, and disability at baseline and 2-year follow-up. We retrospectively included 290 patients (22 clinically isolated syndrome, 198 relapsing remitting, 39 secondary progressive, 31 primary progressive multiple sclerosis) from eight sites. Lesions were segmented on both brain (T2-FLAIR or T2-weighted) and cervical (axial T2- or T2*-weighted) MRI scans. Data were processed using an automated and publicly available pipeline. Brain, brainstem and spinal cord portions of the corticospinal tracts were identified using probabilistic atlases to measure the lesion volume fraction. Lesion frequency maps were produced for each phenotype and disability scores assessed with Expanded Disability Status Scale score and pyramidal functional system score. Results show that lesions were not homogeneously distributed along the corticospinal tracts, with the highest lesion frequency in the corona radiata and between C2 and C4 vertebral levels. The lesion volume fraction in the corticospinal tracts was higher in secondary and primary progressive patients (mean = 3.6 ± 2.7% and 2.9 ± 2.4%), compared to relapsing-remitting patients (1.6 ± 2.1%, both P < 0.0001). Voxel-wise analyses confirmed that lesion frequency was higher in progressive compared to relapsing-remitting patients, with significant bilateral clusters in the spinal cord corticospinal tracts (P < 0.01). The baseline Expanded Disability Status Scale score was associated with lesion volume fraction within the brain (r = 0.31, P < 0.0001), brainstem (r = 0.45, P < 0.0001) and spinal cord (r = 0.57, P < 0.0001) corticospinal tracts. The spinal cord corticospinal tracts lesion volume fraction remained the strongest factor in the multiple linear regression model, independently from cord atrophy. Baseline spinal cord corticospinal tracts lesion volume fraction was also associated with disability progression at 2-year follow-up (P = 0.003). Our results suggest a cumulative effect of lesions within the corticospinal tracts along the brain, brainstem and spinal cord portions to explain physical disability in multiple sclerosis patients, with a predominant impact of intramedullary lesions.
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