Deep Gray Matter Perfusion in Multiple Sclerosis

Abstract

To assess the presence of perfusion abnormalities in the deep gray matter of patients with relapsingremitting and primary progressive multiple sclerosis (MS) in comparison with healthy controls and to investigate the impact of perfusion impairment on clinical disability and fatigue. Design: Survey. Setting: Research-oriented hospital. Patients: Twenty-two patients with MS and 11 age-and sex-matched healthy volunteers. Intervention: Absolute cerebral blood flow, cerebral blood volume, and mean transit time were measured in the thalamus, putamen, and caudate nuclei. Main Outcome Measures: Decrease of cerebral blood flow in the deep gray matter of patients with MS and correlation between perfusion impairment and the severity of fatigue. Results:The cerebral blood flow value averaged over the thalamus, putamen, and caudate nuclei was significantly lower in patients with primary progressive MS (PϽ.001) and in patients with relapsing-remitting MS (P=.01) compared with controls, and there was a trend for patients with primary progressive MS to have lower average cerebral blood flow than patients with relapsingremitting MS (P=.06). With respect to cerebral blood volume, there was a significant difference between patients with primary progressive MS and controls (PϽ.001) and between the 2 groups of patients (P = .03) but not between patients with relapsing-remitting MS and controls (PϾ.30). The fatigue score was significantly correlated with cerebral blood flow (r = 0.4; PϽ.001) and cerebral blood volume (r=0.5; P=.004). Conclusion:The decrease of tissue perfusion in the deep gray matter of patients with MS is associated with the severity of fatigue.

Perfusion reduction in the absence of structural differences in cognitively impaired versus unimpaired RRMS patients

“…After Bonferroni correction, deep GM CBV and CBF correlated with the color-word interference inhibition switching test and with the Rey Complex Figure Test, respectively. 24 In a separate study, Inglese et al 25 reported deep GM CBF reduction in the caudate in RRMS patients compared to healthy controls although no correlation with cognition was attempted. Rashid et al demonstrated CBF reduction in cortical and deep GM and WM in primary and SPMS, but not RRMS, patients compared to healthy controls.…”

Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics

“…Other researchers [337,338] demonstrated that hypoperfusion correlates with disease and fatigue severity in MS. PET studies show that hypometabolism of particular brain areas, especially the frontal and subcortical circuits, is associated with fatigue [37,339,340]. MRI, PET and functional MRI studies indicate that fatigue is related to gray matter disease, in the thalamus and caudate areas and particularly the cerebral cortex [341]. …”

Serum lipid profiles are associated with disability and MRI outcomes in multiple sclerosis

“…MS is also associated with significant amounts of cerebral vascular endothelial dysfunction [28,29] and with cerebral hypoperfusion [30,31]. Our working hypothesis is that the pro-inflammatory and thrombogenic processes associated with dyslipidemia could plausibly contribute to disease progression in MS via diverse mechanisms at the blood brain barrier vascular endothelium, e.g., by enhancing leukocyte recruitment, increasing endothelial dysfunction and by increasing the risk of hypoperfusion.…”