A Fundamentally New View of Multiple Sclerosis

2000 ◽  
Vol 2 (2) ◽  
pp. 2-8
Author(s):  
Richard Ransohoff
Keyword(s):  
Multiple Sclerosis ◽  
Imaging Techniques ◽  
Clinical State ◽  
Spinal Cord Atrophy ◽  
Axonal Pathology ◽  
Appropriate Treatment ◽  
The Us ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Abstract The last decade has been an era of unprecedented progress in our understanding of multiple sclerosis (MS). MS is now considered a destructive process of the central nervous system, initiated by inflammatory demyelination but including prominent axonal pathology. This new knowledge has been acquired from new imaging techniques and traditional histopathologic study. New mechanisms of myelin destruction have been uncovered, and hypothetical new therapies for MS include neuroprotectants. Serial gadolinium-enhanced magnetic resonance imaging (MRI) scans reveal MS as a continuously active process. Brain and spinal cord atrophy, defined by MRI, correlate closely with clinical state. MR imaging techniques therefore are considered the standard tools for monitoring disease activity and severity. These efforts have produced improved therapy for patients with MS. Two classes of agents, interferon beta and glatiramer acetate, have been approved by the US Food and Drug Administration for use. A major challenge for clinicians is to provide early diagnosis and determine appropriate treatment. New neuroprotective and anti-inflammatory drugs are on the horizon.

scholarly journals Approved and Emerging Disease Modifying Therapies on Neurodegeneration in Multiple Sclerosis

2020 ◽  
Vol 21 (12) ◽  
pp. 4312 ◽  
Author(s):  
Madeline Bross ◽  
Melody Hackett ◽  
Evanthia Bernitsas
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Research ◽  
Disease Progression ◽  
Spinal Cord Atrophy ◽  
Brain Volume Loss ◽  
Chronic Progressive Disease ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
The Impact

Multiple sclerosis (MS) is an autoimmune, chronic, progressive disease leading to a combination of inflammation, demyelination, and neurodegeneration throughout the central nervous system (CNS). The outcome of these processes can be visualized in magnetic resonance imaging (MRI) scans as brain atrophy, or brain volume loss (BVL), as well as lesions, “black holes” and spinal cord atrophy. MRI outcomes such as BVL have been used as biomarkers of neurodegeneration and other measures of MS disease progression in clinical research settings. Several FDA-approved medications seek to alleviate disease progression by reducing the impact of such factors as demyelination and neurodegeneration, but there are still many shortcomings that current clinical research aims to mitigate. This review attempts to provide an overview of the FDA-approved medications available for treating multiple sclerosis and their effect on neurodegeneration, measured by BVL.

scholarly journals Advances in spinal cord imaging in multiple sclerosis

2019 ◽  
Vol 12 ◽  
pp. 175628641984059 ◽  
Author(s):  
Marcello Moccia ◽  
Serena Ruggieri ◽  
Antonio Ianniello ◽  
Ahmed Toosy ◽  
Carlo Pozzilli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Imaging Techniques ◽  
Quantitative Imaging ◽  
Automated Analysis ◽  
Spinal Cord Atrophy ◽  
Recent Developments ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Imaging

The spinal cord is frequently affected in multiple sclerosis (MS), causing motor, sensory and autonomic dysfunction. A number of pathological abnormalities, including demyelination and neuroaxonal loss, occur in the MS spinal cord and are studied in vivo with magnetic resonance imaging (MRI). The aim of this review is to summarise and discuss recent advances in spinal cord MRI. Advances in conventional spinal cord MRI include improved identification of MS lesions, recommended spinal cord MRI protocols, enhanced recognition of MRI lesion characteristics that allow MS to be distinguished from other myelopathies, evidence for the role of spinal cord lesions in predicting prognosis and monitoring disease course, and novel post-processing methods to obtain lesion probability maps. The rate of spinal cord atrophy is greater than that of brain atrophy (−1.78% versus −0.5% per year), and reflects neuroaxonal loss in an eloquent site of the central nervous system, suggesting that it can become an important outcome measure in clinical trials, especially in progressive MS. Recent developments allow the calculation of spinal cord atrophy from brain volumetric scans and evaluation of its progression over time with registration-based techniques. Fully automated analysis methods, including segmentation of grey matter and intramedullary lesions, will facilitate the use of spinal cord atrophy in trial designs and observational studies. Advances in quantitative imaging techniques to evaluate neuroaxonal integrity, myelin content, metabolic changes, and functional connectivity, have provided new insights into the mechanisms of damage in MS. Future directions of research and the possible impact of 7T scanners on spinal cord imaging will be discussed.

Application of Artificial Intelligence in Magnetic Resonance Imaging to reduce Gadolinium accumulation in patients with multiple sclerosis: A Review

2021 ◽  
Vol 1 (4) ◽  
pp. 416-428
Author(s):  
Vijay Anant Athavale ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Artificial Intelligence ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
New Onset

Gadolinium (Gd) is a based contrast agent is used for Magnetic Resonance Imaging (MRI). In India, gadobutrolhas been is approved for MRI of the Central Nervous System (CNS), liver, kidneys, and breast. It has been noted in several studies that the accumulation of gadolinium occurs in different structures in the brain. Patients with Multiple Sclerosis (MS) are regularly followed up with MRI scans and MRI with contrast enhancement is the most common method of distinguishing new-onset pathological changes. Developments in technology and methods in artificial intelligence have shown that there is reason to map out the X-ray technician’s work with examinations and medicines administered to patients may be altered to prevent the accumulation of gadolinium.

scholarly journals Advances in brain imaging in multiple sclerosis

2019 ◽  
Vol 12 ◽  
pp. 175628641985972 ◽  
Author(s):  
Rosa Cortese ◽  
Sara Collorone ◽  
Olga Ciccarelli ◽  
Ahmed T. Toosy
Keyword(s):  
Multiple Sclerosis ◽  
Brain Imaging ◽  
Imaging Techniques ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Disability Outcome ◽  
Magnetic Resonance Imaging Mri ◽  
Ms Pathogenesis

Brain imaging is increasingly used to support clinicians in diagnosing multiple sclerosis (MS) and monitoring its progression. However, the role of magnetic resonance imaging (MRI) in MS goes far beyond its clinical application. Indeed, advanced imaging techniques have helped to detect different components of MS pathogenesis in vivo, which is now considered a heterogeneous process characterized by widespread damage of the central nervous system, rather than multifocal demyelination of white matter. Recently, MRI biomarkers more sensitive to disease activity than clinical disability outcome measures, have been used to monitor response to anti-inflammatory agents in patients with relapsing–remitting MS. Similarly, MRI markers of neurodegeneration exhibit the potential as primary and secondary outcomes in clinical trials for progressive phenotypes. This review will summarize recent advances in brain neuroimaging in MS from the research setting to clinical applications.

scholarly journals Automated Detection of Multiple Sclerosis Lesions in Normal Appearing White Matter from Brain MRI: A Survey

2021 ◽  
Vol 10 (1) ◽  
pp. 38-44
Author(s):  
Manoj V. Khatokar ◽  
M. Hemanth Kumar ◽  
K. Chandrahas ◽  
M. D. Swetha ◽  
Preeti Satish
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Soft Tissues ◽  
Diffusion Tensor ◽  
Brain Mri ◽  
The Body ◽  
Normal Appearing White Matter ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Multiple Sclerosis is an inoperable disease of the Central Nervous System (CNS) that irritates the myelin sheath by forming lesions. This affects all organs of the CNS; the vital of them is the brain. This disease can be detected by diagnosis like Magnetic Resonance Imaging (MRI). It is a non-invasive diagnostic test that provides detailed images of the soft tissues of the body. Out of the different variations of MRI, MS lesions are predominantly visible in the DTI (Diffusion Tensor Imaging) variant of MRI. DTI gives enhanced visualization of normal-appearing white matter tracts of the organs, hence providing a better image of the MS lesion. In this paper, the latest methodologies regarding the identification of the MS lesions in MRI scans like T2 FLAIR or DTI, using automated techniques like deep learning, computer vision, neural network and many more are surveyed. Furthermore, this paper consists of a proposed model which would focus on correlating the lesions found in DTI scan with the basic MRI scan like T2. It would identify the MS lesion in DTI scan and eventually highlight that lesion position in the T2 image scan. This would help radiologist in a way to effectively handle multiple MRI scans.

Neuroimaging in Multiple Sclerosis

2016 ◽  
Author(s):  
Megan Esch ◽  
Nancy L. Sicotte
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Imaging Techniques ◽  
White Matter Lesions ◽  
Mri Imaging ◽  
Conventional Mri ◽  
Integral Role ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) of the brain and spinal cord plays an integral role in establishing the diagnosis of multiple sclerosis (MS). The use of MRI leads to earlier recognition of MS, allowing for earlier treatment initiation and more efficient monitoring of disease treatment and progress. This chapter outlines conventional MRI imaging sequences that are used to evaluate MS white matter lesions in the central nervous system. It also addresses the incorporation of new imaging techniques that have increased understanding of clinically definite MS, its variants, and how various diseases can mimic traditional MS. Finally, it examines novel imaging protocols that have been implemented in MS research, which have elucidated radiographic and pathophysiologic nuances and involvement of deeper central nervous system structures and tracts that play a role in MS progression.

scholarly journals Multifocal glioblastoma multiform with “encephalitis-like presentation” : a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Issam Sa’adeh ◽  
Mohamed Jamal Saadh
Keyword(s):  
Vasogenic Edema ◽  
Neurological Deficits ◽  
Herpes Simplex Virus 1 ◽  
Glioblastoma Multiform ◽  
Atypical Clinical Presentation ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Simplex Virus ◽  
Multifocal Glioblastoma

Abstract Background Glioblastoma multiform is the most common and aggressive type of primary malignant tumor that affects the central nervous system in adults. It clinically presents with seizures, headache, and/or progressive focal neurological deficits. Radiologically, glioblastoma multiform appears as a single distinguishable, large heterogeneous lesion affecting the cerebrum with characteristic central necrosis, marginal enhancement, and surrounding vasogenic edema. This article describes a patient that exhibited an atypical clinical presentation of multifocal glioblastoma multiform with misleading early radiological features that simulated herpetic encephalitis. Results A 66-year-old female that presented with left-sided hemiparesis and left partial motor seizures underwent multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) scans. A cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test was also performed to screen for herpes simplex virus 1 (HSV-1). Conclusions The early stages of glioblastoma may manifest as symptoms typical to encephalitis, which can delay diagnosis and treatment. Therefore, early diagnosis and identification of atypical glioblastoma multiform presentations, as reported in this article, are essential.

Robot-Assisted Stereotactic Shunting as a Novel Treatment for Pontine Glioependymal Cysts

2021 ◽  
Author(s):  
Simon Schieferdecker ◽  
Stefan Hunsche ◽  
Faycal El Majdoub ◽  
Mohammad Maarouf
Keyword(s):  
Abducens Nerve ◽  
Ependymal Cells ◽  
Robot Assisted ◽  
Quick Recovery ◽  
Glioependymal Cyst ◽  
Novel Treatment ◽  
First Case ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

AbstractIn this case report, the authors describe the first case of a glioependymal cyst of the brainstem managed by robot-assisted, stereotactic, cysto-ventricular shunting. Glioependymal cysts are rare congenital cystic lesions that are thought to form by displacement of ependymal cells during the embryonal period. Glioependymal cysts have been reported in a variety of different locations within the central nervous system. However, glioependymal cysts of the brainstem have only been described once before. Here, we report the case of a 53-year-old man who was referred to our department due to hemiparesis, hemihypesthesia, and hemidysesthesia, as well as facial and abducens nerve palsy. A large pontine glioependymal cyst was confirmed via magnetic resonance imaging (MRI) scans. The cyst was subsequently decompressed by connecting the cyst with the fourth ventricle via robot-assisted stereotactic shunt placement. In the postoperative course, the patient made a quick recovery and did not report any permanent neurologic deficits.

A phase II trial of anti-CD4 antibodies in the treatment of multiple sclerosis

1996 ◽  
Vol 1 (6) ◽  
pp. 339-342 ◽  
Author(s):  
BW vanOosten ◽  
M Lai ◽  
F Barkhof ◽  
DH Miller ◽  
IF Moseley ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Statistical Power ◽  
Primary Outcome Measure ◽  
T Helper ◽  
Effector Cells ◽  
Natural History Studies ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Experimental Allergic

In multiple sclerosis (MS) myelin damage is the result of a chronic inflammatory process mediated by CD4 positive T helper/effector cells. In experimental allergic encephalomyelitis (EAE), the animal model of MS, treatment with anti-CD4 antibodies can prevent the onset of disease. Natural history studies have demonstrated that gadolinium enhanced magnetic resonance imaging (MRI) of the brain is more sensitive and objective in assessing inflammatory disease activity in MS than clinical monitoring, so that less patients and shorter studies suffice to reach the same statistical power as compared to trials using clinical outcome parameters. In this paper we describe the design of an exploratory trial of chimeric monoclonal anti-CD4 antibodies in the treatment of MS. For this study we chose the number of active MS lesions on monthly gadolinium enhanced MRI scans as the primary outcome measure.

Sign in / Sign up

Export Citation Format

Share Document