Cortical Grey Matter Hypoxia in MS

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frodo
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Cortical Grey Matter Hypoxia in MS

Post by frodo » Tue Jun 30, 2020 12:05 am

Investigating the Relationship Between Cortical Grey Matter Hypoxia and Disability in Multiple Sclerosis

https://prism.ucalgary.ca/handle/1880/112222

Abstract

Multiple sclerosis (MS) is a progressive neurological disease characterized by inflammation and neurodegeneration. These pathological processes may be mediated by hypoxia, or reduced oxygenation. Thus, hypoxia may contribute to disability and therapeutic outcomes in MS.

Near-infrared spectroscopy (NIRS) non-invasively measures absolute cortical oxygenation and can be used to quantify hypoxia. The goal of this thesis was to characterize the prevalence of grey matter (GM) hypoxia in people with MS (PwMS) using NIRS and to relate hypoxia to disability and treatment with disease-modifying therapies (DMTs). Results indicate that 30% of PwMS exhibit hypoxia, which is unexpectedly more common in patients treated with DMTs than untreated subjects. However, no clear association between hypoxia and physical or cognitive disability was observed. Therefore, GM hypoxia may reflect subclinical disease activity, although this needs to be explored.

Overall, this thesis validates that NIRS bears potential for clinical use as an adjunctive imaging modality in MS.

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Re: Cortical Grey Matter Hypoxia in MS

Post by ThisIsMA » Mon Aug 17, 2020 9:43 am

Wow, THAT's an interesting study, isn't it? I have had only one brain MRI that measured my brain perfusion. The results of the MRI said I had reduced brain perfusion, but the comments did not quantify HOW reduced, what percentage less than normal was I?

I found that frustrating and also to me at the time I thought: "Well this is something that could totally explain my fuzzy thinking and why I sometimes feel like I'm struggling to wake up my brain to think!" But the doctor just said something like: "Oh yes, that's a common finding in MS."

To me that could be the whole reason neurons are dying and lesions form. Lack of oxygen is what causes strokes and strokes cause brain lesions. Reduced oxygen should be an emergency that needs treatment!

I didn't know that there is a non-invasive way to measure brain hypoxia. People like Terry Wahls and the people who advocate for the Best Bet Diet and other MS diets should conduct studies to compare brain hypoxia in people with MS who have been on their diet for at least 1 year, with people on the standard American diet (or standard diet of the country where the researchers live). It could be a way to clinically show the benefit of that diet!

Also tucked into that study is the fact that people on DMT's were MORE LIKELY to have hypoxia than those not taking DMTs. This reminds me of the findings of the government health service in England that did a retrospective study and found that those who used a particular DMT that was commonly used by people with RRMS at time (some type of Interferon?), needed a walking aid sooner (in fewer years time) than those who did not take the DMT.

That kind of a finding almost guarantees that no more studies about THAT topic will be funded, because drug companies hold the purse strings of major funding for studies so they have the power.

Even though its possible that people with more disability are more likely to try DMT's instead of that the DMT's are worsening the hypoxia. Without more and bigger studies, there's no way to know.

I wonder how commonly available the "Near-infrared spectroscopy (NIRS)" machine is that can non invasively measure brain hypoxia, and how expensive to use the machines are. I'd love to get tested again. After that first MRI that measured my brain perfusion as being low, all subsequent MRI's have not commented on my brain perfusion at all. And I'm hoping to no longer have brain MRI's anyway, because of the expense and because I'm not all that found of injecting dye into my brain.
DX 6-09 RRMS, now SPMS

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Re: Cortical Grey Matter Hypoxia in MS

Post by ThisIsMA » Mon Aug 17, 2020 10:23 am

Open Access
Published: 13 November 2015
Reduced cortical microvascular oxygenation in multiple sclerosis: a blinded, case-controlled study using a novel quantitative near-infrared spectroscopy method

Runze Yang & Jeff F. Dunn
Scientific Reports volume 5, Article number: 16477 (2015) Cite this article

Abstract
Hypoxia (low oxygen) is associated with many brain disorders as well as inflammation, but the lack of widely available technology has limited our ability to study hypoxia in human brain. Multiple sclerosis (MS) is a poorly understood neurological disease with a significant inflammatory component which may cause hypoxia. We hypothesized that if hypoxia were to occur, there should be reduced microvascular hemoglobin saturation (StO2). In this study, we aimed to determine if reduced StO2 can be detected in MS using frequency domain near-infrared spectroscopy (fdNIRS). We measured fdNIRS data in cortex and assessed disability of 3 clinical isolated syndrome (CIS), 72 MS patients and 12 controls. Control StO2 was 63.5 ± 3% (mean ± SD). In MS patients, 42% of StO2 values were more than 2 × SD lower than the control mean. There was a significant relationship between StO2 and clinical disability. A reduced microvascular StO2 is supportive (although not conclusive) that there may be hypoxic regions in MS brain. This is the first study showing how quantitative NIRS can be used to detect reduced StO2 in patients with MS, opening the door to understanding how microvascular oxygenation impacts neurological conditions.

Full study text is available at:

https://www.nature.com/articles/srep16477
DX 6-09 RRMS, now SPMS

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Re: Cortical Grey Matter Hypoxia in MS

Post by ThisIsMA » Mon Aug 17, 2020 11:05 am

https://journals.sagepub.com/doi/full/1 ... 8518791683


Multiple sclerosis disease progression: Contributions from a hypoxia–inflammation cycle
Runze Yang, Jeff F Dunn
First Published July 27, 2018

Abstract
Hypoxia has been associated with multiple sclerosis (MS) and is an important area of research. Hypoxia can exacerbate inflammation via the prolylhydroxylase pathway. Inflammation can also trigger hypoxia by damaging mitochondria and endothelial cells to impair blood flow regulation. We hypothesize that there is a “hypoxia–inflammation cycle” in MS which plays an important role in MS disease progression. Therapies that break this cycle may be an interesting area of exploration for treatment of MS.

Excerpt:
We found that relapse–remitting patients with higher levels of impairment, as well as secondary progressive patients, had significantly lower StO2 in their brains compared to controls.9 These evidence suggests that hypoxia is present in MS, and that it is relatively common phenomenon.
This study also used "Near-infrared spectroscopy (NIRS)" as a non-invasive measuring tool of hypoxia in MS.
DX 6-09 RRMS, now SPMS

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