Contributions
Abstract: P297
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Fatigue is well characterized as a disabling symptom in adult MS patients, while there is limited available information in pediatric patients although it has been reported in a sizable proportion of children and adolescents with MS. Functional and structural thalamic abnormalities have been related to fatigue, in particular in early MS.
Aims: This study has been conducted with the aim to identify the contribution of microstructural thalamic and cortico-thalamic connection damage to determine fatigue in pediatric MS patients.
Methods: Using a 3.0 T scanner, dual-echo, 3D T1-weighted and diffusion tensor (DT) MRI scans were acquired from 50 pediatric MS patients and 26 gender- and age-matched healthy controls (HC). Diffusion Tractography-Based Parcellation was used to segment the thalamus into connectivity defined regions (CDRs) and to trace cortico-thalamic connections. Fatigue was assessed with Fatigue Severity Scale (FSS). Between-group differences of CDRs and cortico-thalamic tract DT MRI metrics were assessed using Mann-Whitney test. The relationships of DTI metrics of thalamic CDR and cortico-thalamic tract with FSS scores were tested using the Spearman"s Rank correlation coefficient.
Results: Pediatric MS patients and HC showed lower factional anisotropy (FA) and higher mean diffusivity (MD) in the temporal-CDR (T-CDR) bilaterally as well as in several cortico-thalamic tracts. Although no correlation was found between fatigue and DT metrics in CDRs, fatigue severity was significantly related to increased MD in bilateral frontal cortico-thalamic tracts (r=0.43, p=0.005; r=0.39, p=0.001) and occipital (O-T) cortico-thalamic tracts (r=0.32, p=0.04; r=0.36, p=0.02). Higher FSS score was significantly correlated with reduced FA in the right post-central thalamic tract (r=-0.38, p=0.01) and left O-T tract (r=-0.34, p=0.03).
Conclusions: As demonstrated in adult MS patients, also in pediatric MS patients fatigue was associated to a widespread normal appearing white matter damage. This study confirmed the involvement of frontal lobes and specifically of their thalamic connections in determining fatigue, whereas no association was found between FSS scores and thalamic damage, suggesting that fatigue in the earliest phases of the disease is mainly due to NAWM pathology.
Partially supported by a grant from Italian Ministry of Health (GR-2009-1529671) and Fondazione Italiana Sclerosi Multipla (FISM2011/R/19 & FISM 2012/R/8).
Disclosure:
Drs De Meo, Pagani, Moiola, Veggiotti, Vacchi, Fiorino, Pippolo, Pera, and Falini have nothing to disclose.
Dr Rocca received speakers honoraria from Biogen Idec, Novartis and ExceMed and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla. A Ghezzi has received honoraria for speaking from Biogen, Merck Serono, Novartis, and Sanofi-Aventis; for consultancy from Merck Serono, Teva, and Novartis; and support for participation in national and international congresses from Bayer-Schering, Biogen-Dompè, Merck Serono, Novartis, and Sanofi-Aventis.
Ruggero Capra received consulting fees from Novartis,Merck Serono, BiogenIdec and lecture fees fromBayer, BiogenIdec, Dompé, Genzyme and Sanofi-Aventis.
Maria P Amato serves on scientific advisory boards for Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis and receives research support and honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis.
Prof. Comi has received consulting fees for participating on advisory boards from Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Actelion and honorarium for speaking activities for Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Biogen, Excemed.
Prof. Filippi is Editor-in-Chief of the Journal of Neurology; serves on scientific advisory boards for Teva Pharmaceutical Industries; has received compensation for consulting services and/or speaking activities from Biogen Idec, Excemed, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer´s Drug Discovery Foundation (ADDF), the Jacques and Gloria Gossweiler Foundation (Switzerland), and ARiSLA (Fondazione Italiana di Ricerca per la SLA).
Abstract: P297
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Fatigue is well characterized as a disabling symptom in adult MS patients, while there is limited available information in pediatric patients although it has been reported in a sizable proportion of children and adolescents with MS. Functional and structural thalamic abnormalities have been related to fatigue, in particular in early MS.
Aims: This study has been conducted with the aim to identify the contribution of microstructural thalamic and cortico-thalamic connection damage to determine fatigue in pediatric MS patients.
Methods: Using a 3.0 T scanner, dual-echo, 3D T1-weighted and diffusion tensor (DT) MRI scans were acquired from 50 pediatric MS patients and 26 gender- and age-matched healthy controls (HC). Diffusion Tractography-Based Parcellation was used to segment the thalamus into connectivity defined regions (CDRs) and to trace cortico-thalamic connections. Fatigue was assessed with Fatigue Severity Scale (FSS). Between-group differences of CDRs and cortico-thalamic tract DT MRI metrics were assessed using Mann-Whitney test. The relationships of DTI metrics of thalamic CDR and cortico-thalamic tract with FSS scores were tested using the Spearman"s Rank correlation coefficient.
Results: Pediatric MS patients and HC showed lower factional anisotropy (FA) and higher mean diffusivity (MD) in the temporal-CDR (T-CDR) bilaterally as well as in several cortico-thalamic tracts. Although no correlation was found between fatigue and DT metrics in CDRs, fatigue severity was significantly related to increased MD in bilateral frontal cortico-thalamic tracts (r=0.43, p=0.005; r=0.39, p=0.001) and occipital (O-T) cortico-thalamic tracts (r=0.32, p=0.04; r=0.36, p=0.02). Higher FSS score was significantly correlated with reduced FA in the right post-central thalamic tract (r=-0.38, p=0.01) and left O-T tract (r=-0.34, p=0.03).
Conclusions: As demonstrated in adult MS patients, also in pediatric MS patients fatigue was associated to a widespread normal appearing white matter damage. This study confirmed the involvement of frontal lobes and specifically of their thalamic connections in determining fatigue, whereas no association was found between FSS scores and thalamic damage, suggesting that fatigue in the earliest phases of the disease is mainly due to NAWM pathology.
Partially supported by a grant from Italian Ministry of Health (GR-2009-1529671) and Fondazione Italiana Sclerosi Multipla (FISM2011/R/19 & FISM 2012/R/8).
Disclosure:
Drs De Meo, Pagani, Moiola, Veggiotti, Vacchi, Fiorino, Pippolo, Pera, and Falini have nothing to disclose.
Dr Rocca received speakers honoraria from Biogen Idec, Novartis and ExceMed and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla. A Ghezzi has received honoraria for speaking from Biogen, Merck Serono, Novartis, and Sanofi-Aventis; for consultancy from Merck Serono, Teva, and Novartis; and support for participation in national and international congresses from Bayer-Schering, Biogen-Dompè, Merck Serono, Novartis, and Sanofi-Aventis.
Ruggero Capra received consulting fees from Novartis,Merck Serono, BiogenIdec and lecture fees fromBayer, BiogenIdec, Dompé, Genzyme and Sanofi-Aventis.
Maria P Amato serves on scientific advisory boards for Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis and receives research support and honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis.
Prof. Comi has received consulting fees for participating on advisory boards from Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Actelion and honorarium for speaking activities for Novartis, Teva Pharmaceutical Ind. Ltd, Sanofi, Genzyme, Merck Serono, Bayer, Biogen, Excemed.
Prof. Filippi is Editor-in-Chief of the Journal of Neurology; serves on scientific advisory boards for Teva Pharmaceutical Industries; has received compensation for consulting services and/or speaking activities from Biogen Idec, Excemed, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer´s Drug Discovery Foundation (ADDF), the Jacques and Gloria Gossweiler Foundation (Switzerland), and ARiSLA (Fondazione Italiana di Ricerca per la SLA).