Contributions
Abstract: P979
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: Acute transverse myelitis is a frequent presentation of a clinically isolated syndrome. A subgroup of these patients experiences recurrent myelitis (RM) without other neurological manifestations, thus not allowing the diagnosis of a specific inflammatory condition, such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). In this study, we evaluated whether patients with RM show differences in lesion distribution and white matter (WM) tract involvement compared to those with NMOSD and MS.
Methods: Brain WM lesion distribution was obtained from the T2-lesion masks of 17 RM subjects, 20 NMOSD and 20 relapsing-remitting MS patients matched for age and disease duration. Lesional volumes (LV) were split among WM tracts of the Johns Hopkins University (JHU) atlas, co-registered in the standard Montreal Neurological Institute (MNI) space. The impact on each region (minimum of 5 voxels) was assessed. Intragroup and intergroup analyses of LV distribution and WM involvement were performed.
Results: RM patients had a selective damage of the motor pathways: superior corona radiata (CR) 18% of LV, middle cerebellar peduncle (MCP) 13%, cortico-spinal tract (CST) 12% (p vs other tracts=0.03). MS and NMOSD patients showed a higher involvement of the optic radiations (OR) and of the CR (p=0.04, p=0.03 respectively than other regions). The intergroup comparison of patients' LV distribution confirmed the preferential involvement of MCP (p=0.007) and CST (p=0.04) in RM vs MS, while no difference emerged from the comparison between RM vs NMOSD. The analysis of WM tracts involvement confirmed the preferential damage of the OR and CR in NMOSD and MS (NMODS p=0.03, MS p=0.02 than other tracts), while RM patients had a preferential involvement of posterior CR (78.6%, p 0.01 vs other tracts).
Conclusions: Despite a monomorphic clinical presentation, RM patients experience the involvement of the motor pathway also in the brain, suggesting a different pathogenetic mechanism from other WM diseases.
Disclosure: L. Cacciaguerra, E. Pagani, and M. Radaelli have nothing to disclose
V. Martinelli reports consultancy, speaking fees and/or travel expenses from Biogen‐Dompé SG, Merck Serono, Bayer Schering, Novartis, Sanofi‐Aventis, Genzyme Europe and Teva Pharmaceuticals.
G. 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.
M. Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).
M.A. Rocca received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.
Abstract: P979
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: Acute transverse myelitis is a frequent presentation of a clinically isolated syndrome. A subgroup of these patients experiences recurrent myelitis (RM) without other neurological manifestations, thus not allowing the diagnosis of a specific inflammatory condition, such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). In this study, we evaluated whether patients with RM show differences in lesion distribution and white matter (WM) tract involvement compared to those with NMOSD and MS.
Methods: Brain WM lesion distribution was obtained from the T2-lesion masks of 17 RM subjects, 20 NMOSD and 20 relapsing-remitting MS patients matched for age and disease duration. Lesional volumes (LV) were split among WM tracts of the Johns Hopkins University (JHU) atlas, co-registered in the standard Montreal Neurological Institute (MNI) space. The impact on each region (minimum of 5 voxels) was assessed. Intragroup and intergroup analyses of LV distribution and WM involvement were performed.
Results: RM patients had a selective damage of the motor pathways: superior corona radiata (CR) 18% of LV, middle cerebellar peduncle (MCP) 13%, cortico-spinal tract (CST) 12% (p vs other tracts=0.03). MS and NMOSD patients showed a higher involvement of the optic radiations (OR) and of the CR (p=0.04, p=0.03 respectively than other regions). The intergroup comparison of patients' LV distribution confirmed the preferential involvement of MCP (p=0.007) and CST (p=0.04) in RM vs MS, while no difference emerged from the comparison between RM vs NMOSD. The analysis of WM tracts involvement confirmed the preferential damage of the OR and CR in NMOSD and MS (NMODS p=0.03, MS p=0.02 than other tracts), while RM patients had a preferential involvement of posterior CR (78.6%, p 0.01 vs other tracts).
Conclusions: Despite a monomorphic clinical presentation, RM patients experience the involvement of the motor pathway also in the brain, suggesting a different pathogenetic mechanism from other WM diseases.
Disclosure: L. Cacciaguerra, E. Pagani, and M. Radaelli have nothing to disclose
V. Martinelli reports consultancy, speaking fees and/or travel expenses from Biogen‐Dompé SG, Merck Serono, Bayer Schering, Novartis, Sanofi‐Aventis, Genzyme Europe and Teva Pharmaceuticals.
G. 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.
M. Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).
M.A. Rocca received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.