Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey

Granella, Franco; Tsantes, Elena; Graziuso, Stefania; Bazzurri, Veronica; Crisi, Girolamo; Curti, Erica

doi:10.1007/s00415-019-09526-3

Cited by 20 publications

(9 citation statements)

References 17 publications

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“…However, the additional analysis of MS patients showed that 55.6% of spinal MS lesions were not associated with a bilateral sensorimotor deficit. Thus, as described previously ( 28 – 31 ), a great number of spinal lesions remain oligosymptomatic and do not present with the hallmark of NTSCI, a bilateral deficit.…”

Section: Discussionsupporting

confidence: 64%

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients

et al. 2021

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Introduction: Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., “myelopathy-mimics” (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management.Methods: Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsened bilateral sensorimotor deficit were defined as possible NTSCI. We then compared clinical and imaging findings and allocated patients into NTSCIs and MMs.Results: Of ninety-three included cases, thirty-six (38.7%) were diagnosed with NTSCI. Fifty-two patients (55.9%) were classified as MMs. In five patients (5.4%) the underlying pathology remained unclear. Predominant causes of NTSCI were spinal metastases (33.3%), inflammatory disorders (22.2%) and degenerative pathologies (19.4%). 58.6% of NTSCI patients required emergency treatment. Presence of a sensory level (p = <0.001) and sphincter dysfunction (p = 0.02) were the only significant discriminators between NTSCI and MMs.Conclusion: In our study, one-third of patients presenting with a new bilateral sensorimotor deficit had NTSCI. Of these, the majority required emergency treatment. Since there is a significant clinical overlap with non-spinal disorders, a standardized diagnostic work-up including routine spinal MRI is recommended for NTSCI management, rather than an approach that is mainly based on clinical findings.

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Section: Discussionsupporting

confidence: 64%

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients

et al. 2021

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“…We were unable to fully characterise cervical cord lesions due to the limited field of view afforded by the use of a transmit/receive head coil necessary for 7T imaging. However, lesions are primarily observed in the cervical spinal cord (59%),(Weier et al, 2012), clearly affecting both upper and lower limb function and early MS spinal cord lesions are often asymptomatic(Granella et al, 2019) and do not predict disability progression(Dekker et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Functional activation changes at ultra-high field related to upper and lower limb impairments in multiple sclerosis

Strik

Shanahan

Walt³

et al. 2020

Preprint

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Upper and lower limb impairments are common in people with multiple sclerosis (pwMS), yet difficult to clinically identify in early stages of disease progression. Tasks involving complex motor control can potentially reveal more subtle deficits in early stages, and can be performed during functional MRI acquisition, to investigate underlying neural mechanisms, providing markers for early motor progression. We investigated brain activation during visually-guided force-matching of hand or foot in 28 minimally disabled pwMS and 17 healthy controls (HC) using ultra-high field 7-Tesla fMRI, allowing us to visualise sensorimotor network activity in high detail. Task activations and performance (tracking lag and error) were compared between groups, and correlations were performed. PwMS showed delayed (+124 s, p=0.002) and more erroneous (+0.15 N, p=0.001) lower limb tracking, together with higher primary motor and premotor cortex activation, and lower cerebellar activation compared to HC. No differences were seen in upper limb performance or activation. Functional activation levels of cerebellar, visual and motor areas correlated with task performance. These results demonstrate that ultra-high field fMRI during complex hand and foot tracking can identify subtle impairments in movement and brain activity, and differentiates upper and lower limb impairments in minimally disabled pwMS.

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“…117 Spinal cord imaging can identify asymptomatic spinal cord lesions that can occur in some patients without clinical symptoms or lesions on brain MRI. 118,119 Periodic spinal cord imaging to identify lesions, even in the absence of new symptoms attributable to the spinal cord, may be useful in selected patients, particularly in those with spinal cord-predominant disease. The recommended sequences include a sagittal T2-weighted and a proton attenuation (STIR) or T1-weighted inversion recovery sequence with phase-sensitive reconstruction.…”

Section: Mrimentioning

confidence: 99%

Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

Freedman

Devonshire

Duquette

et al. 2020

Can. J. Neurol. Sci.

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Abstract:The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.

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Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey

Cited by 20 publications

References 17 publications

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients

Functional activation changes at ultra-high field related to upper and lower limb impairments in multiple sclerosis

Treatment Optimization in Multiple Sclerosis: Canadian MS Working Group Recommendations

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