Pain and spinal cord imaging measures in children with demyelinating disease

Abstract

Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.

Revisiting the Pathoetiology of Multiple Sclerosis: Has the Tail Been Wagging the Mouse?

“…The apparent limited demyelination in the spinal cord in CPZ, unlike that seen in EAE, is less consistent with MS in which spinal cord lesions are seen, but less so than in the brain ( 108 – 111 ). However, the detection of spinal cord demyelination in humans is technically demanding (due to the thin cord, cerebrospinal fluid, bone, fat) with conventional imaging techniques and may go undiagnosed during asymptomatic stages ( 109 , 110 , 112 , 113 ). Moreover, differential pathological outcomes are found in different segments of the spinal cord of MS patients; for example, lesions are more common in the cervical (~60%) than the thoracic or lumbar spinal cord ( 114 , 115 ).…”

MR imaging in children with transverse myelitis and acquired demyelinating syndromes

“…Transverse myelitis (TM) is an inflammation of the spinal cord defined by the presence of clinical signs suggestive of spinal cord involvement, typical magnetic resonance imaging (MRI) findings and laboratory features such as increased cerebrospinal fluid (CSF) cell count or the presence of CSF oligoclonal bands (OCBs). Patients with TM develop a (sub-)acute loss of sensory, motor and/or autonomous functions attributed to the affected segment (Proposed diagnostic 2002, Wolf et al, 2012, Barakat et al, 2015.…”