Poor Responses to Interferon-Beta Treatment in Patients with Neuromyelitis Optica and Multiple Sclerosis with Long Spinal Cord Lesions

Background: Multiple sclerosis (MS) and neuromyelitis optica (NMO) both affect spinal cord with notable differences in pathology. Objective: Determine the utility of diffusion tensor imaging (DTI) to differentiate the spinal cord lesions of NMO from MS within and outside T2 lesions. Methods: Subjects greater than or equal to 12 months from a clinical episode of transverse myelitis underwent a novel transaxial cervical spinal cord DTI sequence. Ten subjects with NMO, 10 with MS and 10 healthy controls were included. Results: Within T2 affected white matter regions, radial diffusivity was increased in both NMO and MS compared with healthy controls ( p<0.001, respectively), and to a greater extent in NMO than MS ( p<0.001). Axial diffusivity was decreased in T2 lesions in both NMO and MS compared with controls ( p<0.001, p=0.001), but did not differ between the two diseases. Radial diffusivity and fractional anisotropy within white matter regions upstream and downstream of T2 lesions were different from controls in each disease. Conclusions: Higher radial diffusivity within spinal cord white matter tracts derived from diffusion tensor imaging were appreciated in NMO compared with MS, consistent with the known greater tissue destruction seen in NMO. DTI also detected tissue alterations outside T2 lesions and may be a surrogate of anterograde and retrograde degeneration.

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Faculty Opinions recommendation of Spinal cord involvement in multiple sclerosis and neuromyelitis optica spectrum disorders.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734959278.793556675 ◽

2019 ◽

Author(s):

Mario Manto ◽

Lionel Paternoster

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Neuromyelitis Optica ◽

Neuromyelitis Optica Spectrum Disorders ◽

Spinal Cord Involvement ◽

Spectrum Disorders

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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Holocord involvement with sparing of the peripheral white matter rim in longitudinally extensive spinal cord lesions of neuromyelitis optica

Clinical and Experimental Neuroimmunology ◽

10.1111/cen3.12274 ◽

2015 ◽

Vol 6 (S1) ◽

pp. 78-79

Author(s):

Shotaro Hayashida ◽

Katsuhisa Masaki ◽

Takuya Matsushita ◽

Mitsuru Watanabe ◽

Ryo Yamasaki ◽

...

Keyword(s):

Spinal Cord ◽

White Matter ◽

Neuromyelitis Optica ◽

Spinal Cord Lesions

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The Prevalence of Long Spinal Cord Lesions and Anti-Aquaporin 4 Antibodies in Neuromyelitis Optica Patients in Taiwan

European Neurology ◽

10.1159/000322740 ◽

2011 ◽

Vol 65 (2) ◽

pp. 99-104 ◽

Cited By ~ 9

Author(s):

Kai-Chen Wang ◽

Ching-Piao Tsai ◽

Chao-Lin Lee ◽

Shao-Yuan Chen ◽

Shyi-Jou Chen

Keyword(s):

Spinal Cord ◽

Neuromyelitis Optica ◽

Aquaporin 4 ◽

Spinal Cord Lesions

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Spinal cord involvement in multiple sclerosis and neuromyelitis optica spectrum disorders

The Lancet Neurology ◽

10.1016/s1474-4422(18)30460-5 ◽

2019 ◽

Vol 18 (2) ◽

pp. 185-197 ◽

Cited By ~ 47

Author(s):

Olga Ciccarelli ◽

Jeffrey A Cohen ◽

Stephen C Reingold ◽

Brian G Weinshenker ◽

Maria Pia Amato ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Neuromyelitis Optica ◽

Neuromyelitis Optica Spectrum Disorders ◽

Spinal Cord Involvement ◽

Spectrum Disorders

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Multiple Sclerosis Of The Spinal Cord: Is Gadolinium Irreplaceable In Assessing Lesion Activity?

Acta Medica Marisiensis ◽

10.2478/amma-2013-0037 ◽

2013 ◽

Vol 59 (3) ◽

pp. 158-161

Author(s):

Constantina Andrada Treabă ◽

M Buruian ◽

Rodica Bălașa ◽

Maria Daniela Podeanu ◽

I P Simu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Contrast Enhancement ◽

Signs And Symptoms ◽

Magnetic Resonance Images ◽

Type I ◽

Focal Lesions ◽

Spinal Cord Lesions ◽

Active Lesion

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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3D PSIR MRI at 3 Tesla improves detection of spinal cord lesions in multiple sclerosis

Journal of Neurology ◽

10.1007/s00415-019-09591-8 ◽

2019 ◽

Vol 267 (2) ◽

pp. 406-414 ◽

Cited By ~ 5

Author(s):

S. Mirafzal ◽

A. Goujon ◽

R. Deschamps ◽

K. Zuber ◽

J. C. Sadik ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

3 Tesla ◽

Spinal Cord Lesions

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Spinal cord syndromes in patients with systemic lupus erythematosus: differentiating lupus myelitis, neuromyelitis optica, and multiple sclerosis

Lupus ◽

10.1177/0961203319886103 ◽

2019 ◽

Vol 28 (14) ◽

pp. 1656-1662

Author(s):

J N Williams ◽

C B Speyer ◽

D J Kreps ◽

D J Kimbrough ◽

K Costenbader ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systemic Lupus Erythematosus ◽

Spinal Cord ◽

Disease Activity ◽

Neuromyelitis Optica ◽

Lupus Erythematosus ◽

Clinical Laboratory ◽

Activity Index ◽

Disease Activity Index ◽

Systemic Lupus

Objective Non-infectious myelitis in systemic lupus erythematosus (SLE) may be due to SLE myelitis, comorbid multiple sclerosis (MS), or neuromyelitis optica (NMO). We compared characteristics of these three conditions in SLE patients at a large academic institution. Methods We searched for neurologic diagnoses of SLE myelitis, NMO myelitis, and MS myelitis among 2297 patients with at least four 1997 American College of Rheumatology revised criteria for SLE between 2000 and 2015. Each subject was reviewed by a neurologist to confirm the underlying neurologic diagnosis. Demographic, clinical, laboratory, and radiographic data were extracted and compared using Fisher's exact test, analysis of variance, and Wilcoxon rank-sum test. Results Fifteen of the 2297 subjects with SLE (0.7%) met criteria for a spinal cord syndrome: seven had SLE myelitis, three had AQP4 seropositive NMO, and five had MS. The median SLE Disease Activity Index 2000 score at time of neurologic syndrome presentation was higher in SLE myelitis subjects (8, interquartile range (IQR) 7–16) compared with subjects with NMO (6, IQR 0–14) or MS (2, IQR 0–4), p = 0.02. Subjects with SLE myelitis were also more likely to have elevated anti-dsDNA antibodies at presentation (86%) compared with subjects with NMO (33%) or MS (0%), p = 0.03. Conclusion Myelitis occurs rarely among patients with SLE. Compared with subjects with SLE + NMO and subjects with SLE + MS, subjects with SLE myelitis had higher SLE disease activity at presentation.

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