Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a progressive condition characterized by degeneration of osseocartilaginous structures within the cervical spine resulting in compression of the spinal cord and presentation of clinical symptoms. Compared to healthy controls (HCs), studies have shown DCM patients experience structural and functional reorganization in the brain; however, sex-dependent cortical differences in DCM patients remains largely unexplored. In the present study, we investigate the role of sex differences on the structure of the cerebral cortex in DCM and determine how structural differences may relate to clinical measures of neurological function. T1-weighted structural MRI scans were acquired in 85 symptomatic and asymptomatic patients with DCM and 90 age-matched HCs. Modified Japanese Orthopedic Association (mJOA) scores were obtained for patients. A general linear model was used to determine vertex-level significant differences in gray matter volume (GMV) between the following groups (1) male HCs and female HCs, (2) male patients and female patients, (3) male patients and male HCs, and (4) female patients and female HCs. Within patients, males exhibited larger GMV in motor, language, and vision related brain regions compared to female DCM patients. Males demonstrated a significant positive correlation between GMV and mJOA score, in which patients with worsening neurological symptoms exhibited decreasing GMV primarily across somatosensory and motor related cortical regions. Females exhibited a similar association, albeit across a broader range of cortical areas including those involved in pain processing. In sensorimotor regions, female patients consistently showed smaller GMV compared with male patients, independent of mJOA score. Results from the current study suggest strong sex-related differences in cortical volume in patients with DCM, which may reflect hormonal influence or differing compensation mechanisms.

Download Full-text

Is microdiffusion imaging able to improve the detection of cervical myelopathy? Study protocol of a prospective observational trial (MIDICAM-Trial)

BMJ Open ◽

10.1136/bmjopen-2019-029153 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029153

Author(s):

Marc Hohenhaus ◽

Karl Egger ◽

Jan-Helge Klingler ◽

Ulrich Hubbe ◽

Marco Reisert ◽

...

Keyword(s):

Study Protocol ◽

Cervical Myelopathy ◽

Clinical Symptoms ◽

Negative Control ◽

Observational Trial ◽

Conventional Mri ◽

Diffusion Parameters ◽

Registration Number ◽

Degenerative Cervical Myelopathy ◽

Tissue Alterations

IntroductionThe diagnosis of degenerative cervical myelopathy (DCM) is difficult in numerous patients due to the limited correlation of clinical symptoms, electrophysiology and MRI. This applies especially for early disease stages with mild symptoms or in uncertainty due to comorbidities. Conventional MRI myelopathy signs show a restricted sensitivity to clinical symptoms of at most 60%. It is desirable to select patients for surgical treatment as early as possible before irreversible neurological damage occurs. To improve treatment, a more reliable imaging is necessary. Microdiffusion imaging (MIDI) is an innovative MRI modality to depict tissue alterations within one voxel based on diffusion-weighted imaging (DWI) postprocessing. By separating the affected area into several mesoscopic compartments, pathological changes might be detected more sensitive through this subtle tissue resolution. We hypothesise, that MIDI shows myelopathic alterations more sensitive than conventional MRI and improves the correlation to functional impairment.Methods and analysisIn this prospective, observational trial, 130 patients with a relevant degenerative cervical spinal stenosis receive MRI including MIDI and a standard clinical and electrophysiological assessment. Special subvoxel diffusion parameters are calculated. Clinical follow-ups are conducted after 3, 6 and with additional MRI and electrophysiology after 12 months. The primary endpoint is the sensitivity of MIDI to detect functional myelopathy defined by clinical and electrophysiological features correlated to conventional MRI myelopathy signs. Twenty healthy subjects will be included as negative control. The results will provide new insights into the development of mesoscopic spinal cord alterations in DCM associated to the clinical course. Aim is to improve the diagnostics of incipient myelopathy through this new modality.Ethics and disseminationThe study protocol is approved by the Ethics Committee of the University of Freiburg (reference 261/17). The results will be published in a peer-reviewed journal.Trial registration numberDRKS00012962.

Download Full-text

Association Between Paraspinal Muscle Morphology, Clinical Symptoms, and Functional Status in Patients With Degenerative Cervical Myelopathy

Spine ◽

10.1097/brs.0000000000001704 ◽

2017 ◽

Vol 42 (4) ◽

pp. 232-239 ◽

Cited By ~ 18

Author(s):

Maryse Fortin ◽

Octavian Dobrescu ◽

Matthew Courtemanche ◽

Carolyn J. Sparrey ◽

Carlo Santaguida ◽

...

Keyword(s):

Functional Status ◽

Cervical Myelopathy ◽

Clinical Symptoms ◽

Paraspinal Muscle ◽

Muscle Morphology ◽

Degenerative Cervical Myelopathy

Download Full-text

Management of degenerative cervical myelopathy – An update

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.09.886 ◽

2016 ◽

Vol 62 (9) ◽

pp. 886-894 ◽

Cited By ~ 7

Author(s):

ANDREI F. JOAQUIM ◽

ENRICO GHIZONI ◽

HELDER TEDESCHI ◽

WELLINGTON K. HSU ◽

ALPESH A. PATEL

Keyword(s):

Spinal Cord ◽

Cervical Myelopathy ◽

Clinical Symptoms ◽

Surgical Techniques ◽

The Other ◽

Surgical Approaches ◽

Japanese Orthopedic Association ◽

Advantages And Disadvantages ◽

Clinical Magnetic Resonance Imaging ◽

Degenerative Cervical Myelopathy

SUMMARY Introduction Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adult patients. Patients generally present with a slow, progressive neurological decline or a stepwise deterioration pattern. In this paper, we discuss the most important factors involved in the management of DCM, including a discussion about the surgical approaches. Method The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Although the diagnosis is clinical, magnetic resonance imaging (MRI) is the study of choice to confirm stenosis and also to exclude the differential diagnosis. The severity the clinical symptoms of DCM are evaluated by different scales, but the modified Japanese Orthopedic Association (mJOA) and the Nürick scale are probably the most commonly used. Spontaneous clinical improvement is rare and surgery is the main treatment form in an attempt to prevent further neurological deterioration and, potentially, to provide some improvement in symptoms and function. Anterior, posterior or combined cervical approaches are used to decompress the spinal cord, with adjunctive fusion being commonly performed. The choice of one approach over the other depends on patient characteristics (such as number of involved levels, site of compression, cervical alignment, previous surgeries, bone quality, presence of instability, among others) as well as surgeon preference and experience. Conclusion Spine surgeons must understand the advantages and disadvantages of all surgical techniques to choose the best procedure for their patients. Further comparative studies are necessary to establish the superiority of one approach over the other when multiple options are available.

Download Full-text

Faculty Opinions recommendation of Sex-Dependent Cortical Volume Changes in Patients with Degenerative Cervical Myelopathy.

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

10.3410/f.740734089.793590291 ◽

2021 ◽

Author(s):

Mark Kotter ◽

Oliver Mowforth

Keyword(s):

Cervical Myelopathy ◽

Volume Changes ◽

Cortical Volume ◽

Degenerative Cervical Myelopathy

Download Full-text

Analysis of Relation Between Electroclinical Features and Cerebrospinal Fluid Antibody Titers in Patients With anti-NMDAR Encephalitis

Clinical EEG and Neuroscience ◽

10.1177/1550059418800867 ◽

2018 ◽

Vol 50 (1) ◽

pp. 56-62 ◽

Cited By ~ 2

Author(s):

Ailiang Miao ◽

Mingyang Du ◽

Lingling Wang ◽

Jianqing Ge ◽

Hengdong Lu ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Clinical Symptoms ◽

Behavioral Changes ◽

Female Patients ◽

Nmdar Encephalitis ◽

Initial Symptoms ◽

Scale Scores ◽

Antibody Titers ◽

Male Patients ◽

Eeg Recordings

Purpose. This study aimed to determine the relation between electroclinical features and cerebrospinal fluid (CSF) antibody titers in patients with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Method. Clinical symptoms and electroencephalography (EEG) at different stages were analyzed in 51 hospitalized patients with anti-NMDAR encephalitis. Results. Behavioral changes were the initial symptoms in 90.9% (20/22) of female patients with high (1:10 or 1:32) CSF antibody titers. A greater number of clinical symptoms were observed in the patients with high CSF antibody titers than in those with low (1:1 or 1:3.2) CSF antibody titers (mean 3.11 ± 1.06 vs 1.62 ± 0.65, P = .000). The number of clinical symptoms was greater in the female patients than in the male patients (mean 3.52 ± 0.98 vs 2.69 ± 1.09, P = .000). At the peak stage, worse background activity (BA) in EEG recordings was observed in patients with high CSF antibody titers than in those with low CSF antibody titers (Mann-Whitney U test, P = .001). The peak-stage BA in EEG was worse in female patients than in male patients (Mann-Whitney U test, P = .000). Modified Rankin scale scores were higher in patients with high CSF antibody titers than in those with low CSF antibody titers (mean 2.62 ± 1.42 vs 0.75 ± 0.97, P = .000). Brush patterns and constant chewing were observed primarily in female patients with high CSF antibody titers. Epileptic discharges were located predominately in the frontal regions and were noted to vary. Conclusion. The electroclinical features of patients with anti-NMDAR encephalitis were associated with gender and CSF antibody titers.

Download Full-text

Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia

Annals of General Psychiatry ◽

10.1186/s12991-021-00347-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Na Zhao ◽

Xiao Hong Wang ◽

Chuan Yi Kang ◽

Yue Zheng ◽

Li Ying Yang ◽

...

Keyword(s):

Sex Differences ◽

Cognitive Impairment ◽

Clinical Symptoms ◽

Verbal Learning ◽

Chinese Patients ◽

First Episode ◽

Hamilton Depression Scale ◽

Female Patients ◽

Drug Naïve ◽

Male Patients

Abstract Background Schizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia. Methods 93 FEDN patients (male/female = 45/48) and 160 controls (male/female = 74/86) were enrolled to compare the sex differences in cognitive functions measured by the MATRICS Consensus Cognitive Battery (MCCB). Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Scale (HAMD) were used to evaluate patients' clinical symptoms. We compared cognitive impairment with sociodemographic characteristics and measures of different genders, as well as group-by-sex interactions. Results Our results showed that male patients had significantly lower scores for symbol coding, digital sequence, and verbal learning than female patients, while the healthy controls showed similar sex differences. In female patients, multiple linear regression analysis confirmed that PANSS negative symptoms and general psychopathology scores, HAMD total score, and education level were independent contributors to MCCB total score. In male patients, only education was an independent contributor to MCCB total score. Conclusions These findings revealed significant sex differences in cognitive impairments and clinical symptoms in FEDN, which will be worthy of a follow-up study of schizophrenia in the future.

Download Full-text

Association between Paraspinal Muscle Morphology, Clinical Symptoms and Functional Status in Patients with Degenerative Cervical Myelopathy

The Spine Journal ◽

10.1016/j.spinee.2016.07.110 ◽

2016 ◽

Vol 16 (10) ◽

pp. S200 ◽

Cited By ~ 2

Author(s):

Maryse Fortin ◽

Octavian Dobrescu ◽

Matthew Courtemanche ◽

Carolyn Sparrey ◽

Carlo Santaguida ◽

...

Keyword(s):

Functional Status ◽

Cervical Myelopathy ◽

Clinical Symptoms ◽

Paraspinal Muscle ◽

Muscle Morphology ◽

Degenerative Cervical Myelopathy

Download Full-text

Cortical volume reductions as a sign of secondary cerebral and cerebellar impairment in patients with degenerative cervical myelopathy

Brain and Spine ◽

10.1016/j.bas.2021.100388 ◽

2021 ◽

Vol 1 ◽

pp. 100388

Author(s):

K. Jütten ◽

V. Mainz ◽

G.A. Schubert ◽

R. Gohmann ◽

T. Schmidt ◽

...

Keyword(s):

Cervical Myelopathy ◽

Cortical Volume ◽

Degenerative Cervical Myelopathy

Download Full-text

Sex differences in association between cognitive impairment and clinical correlates in Chinese patients with first-episode drug-naïve schizophrenia

10.21203/rs.3.rs-143729/v1 ◽

2021 ◽

Author(s):

Na Zhao ◽

Xiao Hong Wang ◽

Chuan Yi Kang ◽

Yue Zheng ◽

Li Ying Yang ◽

...

Keyword(s):

Sex Differences ◽

Cognitive Impairment ◽

Clinical Symptoms ◽

Verbal Learning ◽

First Episode ◽

Control Group ◽

Hamilton Depression Scale ◽

Female Patients ◽

Drug Naïve ◽

Male Patients

Abstract Background Schizophrenia is a complex mental illness with significant sex differences. Cognitive impairment is common in patients with schizophrenia, even in remission. This study was designed to examine the sex differences in the relationship between cognitive impairment and clinical correlations with first-episode drug-naïve (FEDN) schizophrenia. Methods 93 FEDN patients (male/female = 45/48) and 160 controls (male/female = 74/86) were enrolled to compare the sex differences in cognitive functions measure by the MATRICS Consensus Cognitive Battery (MCCB). Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Scale (HAMD) were used to evaluated patients' clinical symptoms. We compared cognitive impairment with sociodemographic characteristics and measures of different genders, as well as group-by-sex interactions. Results Our results showed that the MCCB total and index score in FEDN were lower than in the control group, except for category fluency and social cognition. Male patients had significantly lower symbol coding, digital sequence, and verbal learning scores than female patients, and the controls showed a similar sex difference. Interestingly, we also found six indexes and MCCB total score that showed diagnosis-by-sex interactions, belonging to the speed of processing, attention, working memory, and verbal learning. The MCCB total score showed correlations with PANSS total score and education for both genders. In female patients, education showed significant positive correlations with MCCB total and all ten index scores. Multiple linear regression analysis confirmed that negative symptoms and general psychopathology of PANSS, HAMD total score, and education were independent contributors to MCCB total score. In male patients, only education was an independent contributor to MCCB total score. Conclusions These findings revealed significant sex differences in cognitive impairments and clinical symptoms in FEDN. These results should be considered, which will be worthy of a follow-up study of schizophrenia in the future.

Download Full-text