Proton Magnetic Resonance Spectroscopy In Primary And Secondary/Progressive Multiple Sclerosis
Cucurella MG, Rovira A, Rio J, Pedraza S, Tintoré MM, Montalban X, Alonso J
NMR Biomed 2000 Apr;13(2):57-63
Institut de Diagnostic per la Imatge, Unitat de Ressonancia Magnetica, Centre Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
The objective of this study was to characterize and compare the Proton Magnetic Resonance spectrum of a Voxel (volume element), containing lesions or Normal-Appearing White Matter (NAWM), in Primary/Progressive (P/P) and Secondary/Progressive (S/P) Multiple Sclerosis (MS) patients.
Single-Voxel Proton Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging were performed in 35 MS patients (17 P/P and 18 S/P) and 17 controls.
Spectra from an 8 ml Voxel located in the Parieto-Occipital region were obtained with a Spin-Echo pulse sequence (1600 ms/135 ms/256, TR/TE/acquisitions).
Resonance areas due to N-AcetylAspartate (NAA), Creatine/PhosphoCreatine (Cr) and Choline compounds (Cho) were determined, and results expressed in terms of area in arbitrary units or as metabolite ratios.
With respect to the control group, there were significant reductions in NAA and NAA/Cho ratio in the P/P-lesion, S/P-lesion, P/P-NAWM and S/P-NAWM groups. There were no significant differences between the P/P-NAWM and S/P-NAWM groups.
These results support the existence of metabolic changes in the White Matter of P/P and S/P patients and suggest that there is Neuronal damage and/or loss in both clinical courses.
Finally, characterization of the Parieto-Occipital region showed no significant differences in the Spectral pattern of NAWM between P/P and S/P clinical courses of MS.
Copyright 2000 John Wiley & Sons, Ltd.
Autologous Stem Cell transplantation In Progressive Multiple Sclerosis
An interim analysis of efficacy
Fassas A, Anagnostopoulos A, Kazis A, Kapinas K, Sakellari I, Kimiskidis V, Smias C, Eleftheriadis N, Tsimourtou V
J Clin Immunol 2000 Jan;20(1):24-30
The George Papanicolaou General Hospital, Dept of Hematology, Thessaloniki, Greece
PMID# 10798604; UI# 20256462
Based on the good results of experimental transplantation in animal models of Multiple Sclerosis and of other AutoImmne Diseases, we have treated 24 patients suffering from Chronic/Progressive Multiple Sclerosis with high-dose ChemoTherapy (BEAM regimen) followed by autologous blood Stem Cell rescue and AntiThymocyte Globulin.
Blood Stem Cells were mobilized with Cyclophosphamide at 4g/m2 and G- (or GM-) CSF. In 9 cases, additional CD34+ cell-selection of the graft was performed.
Here we update previously published results of this novel treatment, mainly with regard to clinical efficacy, as the median follow-up time has reached 40 months (range, 21-51).
Infections were the principal toxicity early after the procedure, with death of a patient from Aspergillosis 65 days post Stem Cell infusion.
No serious late events occurred apart from a case of AutoImmune Thyroiditis that developed 11 months after transplant in a patient who had received a CD34+ cell-depleted graft.
Mild and transient NeuroToxicity was observed in 10 patients (42%), most probably associated with fever and infections.
Eighteen patients (18/23; 78%) responded to the treatment, i.e., they were improved or stabilized, while five patients progressed, of which 4 had Primary/Progressive disease.
Of those improved or stabilized (18), 9 patients have maintained stable condition whereas 9 developed relapses or they slowly resumed progression, although their Disability scores have not gotten worse than they were before transplantation.
The probability of progression-free survival (compared to entry status) at 3 years is 92% for patients with Secondary/Progressive disease and 39% for the Primary/Progressive type.
CD34+ cell-selection did not seem to yield better results except for a delay in progression or in relapse after transplantation.
These results appear better than those achieved by any other treatment of Progressive Multiple Sclerosis, including ß-Interferon.
But, they need to be confirmed by other open or controlled studies in view of the well-known difficulty of judging objectively the effect of a treatment in patients with this disease.
Magnetization Transfer Ratio Of The Spinal Cord In Multiple Sclerosis: Relationship To Atrophy And Neurologic Disability
Lycklama a Nijeholt GJ, Castelijns JA, Lazeron RH, van Waesberghe JH, Polman CH, Uitdehaag BM, Barkhof F
J NeuroImaging 2000 Apr;10(2):67-72
Vrije Universiteit Hospital, Dept of Radiology, Amsterdam, The Netherlands
PMID# 10800258; UI# 20260052
The authors compare the Spinal Cord Magnetization Transfer ratio (MTR) of Multiple Sclerosis (MS) patients to healthy volunteers, relate MTR to Cord Atrophy, and relate these and other Magnetic Resonance (MR) imaging parameters to Disability.
Sixty-five patients with MS (14 Relapsing/Remitting [RR], 34 Secondary/Progressive [S/P], and 17 Primary/Progressive [P/P] MS), and 9 healthy volunteers were studied using MR at 1.0 T. Disability of the patients was assessed using the Expanded Disability Status Scale (EDSS).
Magnetic Resonance parameters were upper Spinal Cord MTR, number of Focal Spinal lesions, presence of diffuse abnormalities, and Spinal Cord Cross-Sectional Area (CSA).
Correlations were assessed using Spearman's rank correlation coefficient (r). Magnetization Transfer ratio was higher in the controls (median, 33%; range, 30%-38%) than in patients with MS (median, 30%; range, 16-36; p < 0.05).
In patients with MS EDSS correlated with Spinal Cord MTR, albeit weakly (r = -0.25, p < 0.05). Correlation between EDSS and Spinal Cord CSA was better (SRCC = -0.40, p < 0.01).
No correlation was found between MTR and CSA (r = 0.1, p = 0.4). Combining MTR with Spinal Cord CSA improved correlation with EDSS (r = -0.46, p < 0.001), suggesting an independent correlation between Disability and these 2 MR parameters.
Expanded Disability Status Scale scores were higher in patients who had diffuse Spinal Cord abnormality regardless of focal lesions (median, 6; range, 1.5-7.5) than in patients without diffuse abnormalities (median, 3.5; range, 0-8; p < 0.01).
CSA was lower in patients with diffuse Spinal Cord abnormalities (median, 62; range, 46-89 mm2) than in patients without diffuse abnormalities (median, 73; range, 47-89 mm2; p < 0.01).
MTR was slightly lower in patients with diffuse Spinal Cord abnormalities (median, 29; range, 21%-33%) than in patients without diffuse abnormalities (median, 31; range, 16-36; t-test, p < 0.05).