Is the walk ratio a window to the cerebellum in multiple sclerosis? A structural magnetic resonance imaging study

Abstract

Background and purpose Existing research studies have demonstrated a relationship between magnetic resonance imaging (MRI) neuroimaging measures and walking speed in people with multiple sclerosis (PwMS). However, to date there are no data as to the brain structures involved in gait coordination and control in PwMS. Therefore, the aim of our study was to investigate the association between walk ratio, an indicator of gait coordination, and related brain structures in PwMS. Methods A brain MRI was performed by a 3.0‐T MR scanner in conjunction with a volumetric analysis based on three‐dimensional T1‐weighted images. Regions of interest were volumes of the hippocampus, amygdala, putamen, caudate, pallidum, thalamus, cerebellum and the corpus callosum regions. Walking speed and walk ratio, defined as step length divided by step rate, was measured whilst walking on an electronic walkway. Results In all, 343 PwMS (41.1 ± 13.4 years, 69.1% female, median Expanded Disability Status Scale 2.5) were included in the study. A significant association was found between the left cerebellum volume and walk ratio after controlling for age, gender, total cranial volume and disability; R2 = 0.379, P = 0.002. A similar association was found between the right cerebellum volume and walk ratio, R2 = 0.364, P = 0.002. No correlations were observed between walk ratio and the thalamus, basal ganglia, hippocampus, amygdala and the corpus callosum volumes. No association was found between walking speed and all brain measures. Conclusions The walk ratio should be considered when evaluating and assessing PwMS presenting with ataxia. Furthermore, it is also hypothesized that a low walk ratio indicates a lower cerebellum volume in the MS population.

Patterns of brain degeneration in early-stage relapsing-remitting multiple sclerosis

“…The observed GM volume changes in this study are in line with previous studies reporting early-stage cerebellar atrophy [19] and they are unsurprising as the cerebellum has been shown to play an essential role in both sensorimotor and cognitive dysfunction in MS [77–80].…”

On the Effects of Transcranial Direct Current Stimulation on Cerebral Glucose Uptake During Walking: A Report of Three Patients With Multiple Sclerosis

“…In addition to the globus pallidus and putamen (corpus striatum), they make up the basal ganglia ( Villablanca, 2010 ). The caudate nuclei have both behavioral and motor functions, including body and limb posture and controlling approach-attachment behaviors, respectively ( Kalron et al, 2020 ). Of note, the basal ganglia have strong anatomical and functional connections with the cortex, thalamus, and brainstem, and play a relevant role in initiating and controlling locomotion ( Villablanca, 2010 ; Onu et al, 2015 ; Kalron et al, 2018 , 2020 ).…”

“…The caudate nuclei have both behavioral and motor functions, including body and limb posture and controlling approach-attachment behaviors, respectively ( Kalron et al, 2020 ). Of note, the basal ganglia have strong anatomical and functional connections with the cortex, thalamus, and brainstem, and play a relevant role in initiating and controlling locomotion ( Villablanca, 2010 ; Onu et al, 2015 ; Kalron et al, 2018 , 2020 ). Previous studies examining the association between magnetic resonance imaging (MRI) measures and gait in PwMS have found that gray matter volume of the putamen, caudate, globus pallidus, and nucleus accumbens were all linked to the Timed 25-ft Walk (T25FW) test in relapsing-remitting MS ( Alexander et al, 1990 ; Onu et al, 2015 ), whereas cerebellar volume was associated with the T25FW test in primary progressive MS ( Alexander et al, 1990 ; Bhatia and Marsden, 1994 ).…”

Basic Spatiotemporal Gait Variables of Young and Older Healthy Volunteers Walking Along a Novel Figure-of-8 Path

“…In the study by Nakakubo et al ( 60 ), a small WR is associated with falling in the past year in a cohort of a community-dwelling elderly people, even if these had no slowing of gait speed. In patients with multiple sclerosis, an association was found between the volume of the cerebellum and walk ratio ( 61 ).…”