Neuropsychological and magnetic resonance imaging (MRI) diagnostics in secondary progressive multiple sclerosis
Vol 5, Issue 2, 2022
VIEWS - 404 (Abstract) 184 (PDF)
Abstract
Background: Multiple sclerosis is often a longitudinal disease continuum with an initial relapsing-remitting phase (RRMS) and later secondary progression (SPMS). Most currently approved therapies are not sufficiently effective in SPMS. Early detection of SPMS conversion is therefore critical for therapy selection. Important decision-making tools may include testing of partial cognitive performance and magnetic resonance imaging (MRI). Aim of the work: To demonstrate the importance of cognitive testing and MRI for the prediction and detection of SPMS conversion. Elaboration of strategies for follow-up and therapy management in practice, especially in outpatient care. Material and methods: Review based on an unsystematic literature search. Results: Standardized cognitive testing can be helpful for early SPMS diagnosis and facilitate progression assessment. Annual use of sensitive screening tests such as Symbol Digit Modalities Test (SDMT) and Brief Visual Memory Test-Revised (BVMT-R) or the Brief International Cognitive Assessment for MS (BICAMS) test battery is recommended. Persistent inflammatory activity on MRI in the first three years of disease and the presence of cortical lesions are predictive of SPMS conversion. Standardized MRI monitoring for features of progressive MS can support clinically and neurocognitively based suspicion of SPMS. Discussion: Interdisciplinary care of MS patients by clinically skilled neurologists, supported by neuropsychological testing and MRI, has a high value for SPMS prediction and diagnosis. The latter allows early conversion to appropriate therapies, as SPMS requires different interventions than RRMS. After drug switching, clinical, neuropsychological, and imaging vigilance allows stringent monitoring for neuroinflammatory and degenerative activity as well as treatment complications.
Keywords
Full Text:
PDFReferences
1. Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. New England Journal of Medcine 2018; 378: 169–180.
2. Deutsche Gesellschaft für Neurologie. Diagnosis and Therapy of Multiple Sclerosis (German) [Diagnose und Therapie der Multiplen Skerose]. Stuttgart: Deutsche Gesellschaft für Neurologie; 2014.
3. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: Results of an international survey. Neurology 1996; 46: 907–911.
4. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology 2014; 83: 278–286.
5. Bradl M, Lassmann H. Progressive multiple sclerosis. Seminars Immunopathology 2009; 31: 455–465.
6. Lassmann H, Van Horssen J, Mahad D. Progressive multiple sclerosis: Pathology and pathogenesis. Nature Reviews Neurology 2012; 8: 647–656.
7. Baecher-Allan C, Kaskow BJ, Weiner HL. Multiple sclerosis: Mechanisms and immunotherapy. Neuron 2018; 97: 742–768.
8. Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nature Reviews Immunology 2015; 15: 545–558.
9. Filippi M, Rocca MA. MRI evidence for multiple sclerosis as a diffuse disease of the central nervous system. Journal of Neurology 2005; 252: v16–v24.
10. Mallik S, Samson RS, Wheeler-Kingshott CAM, et al. Imaging outcomes for trials of remyelination in multiple sclerosis. Journal of Neurology, Neurosurgry & Psychiatry 2014; 85: 1396–1404.
11. Moccia M, De Stefano N, Barkhof F. Imaging outcome measures for progressive multiple sclerosis trials. Multiple Sclerosis Journal 2017; 23: 1614–1626.
12. Wattjes MP, Lutterbey GG, Gieseke J, et al. Double inversion recovery brain imaging at 3T: Diagnostic value in the detection of multiple sclerosis lesions. American Journal of Neuroradiology 2007; 28: 54–59.
13. Vigeveno RM, Wiebenga OT, Wattjes MP, et al. Shifting imaging targets in multiple sclerosis: From inflammation to neurodegeneration. Journal of Magnetic Resonance Imaging 2012; 36: 1–19.
14. Giovannoni G, Butzkueven H, Dhib-Jalbut S, et al. Brain health: Time matters in multiple sclerosis. Multiple Sclerosis and Related Disorders 2016; 9(Suppl1): S5–S48.
15. Casanova B, Coret F, Valero C, et al. High clinical inflammatory activity prior to the development of secondary progression: A prospective 5-year follow-up study. Multiple Sclerosis Journal 2002; 8: 59–63.
16. Katz Sand I, Krieger S, Farrell C, et al. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis. Multiple Sclerosis Journal 2014; 20: 1654–1657.
17. European Medicines Agency. EPAR-An overview of Mayzent and why it is authorised in the EU. London (UK): European Medicines Agency; 2020.
18. Kappos L, Bar-Or A, Cree BAC, et al. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): A double-blind, randomised, phase 3 study. The Lancet 2018; 391: 1263–1273.
19. Lorscheider J, Buzzard K, Jokubaitis V, et al. Defining secondary progressive multiple sclerosis. Brain 2016; 139: 2395–2405.
20. Arnold DL, Fox R, Bar-Or A, et al. Effect of siponimod on cortical grey matter and thalamic volume in patients with secondary progressive multiple sclerosis-results of the EXPAND study. ECTRIMS 2019; 25: 382.
21. Filippi M, Preziosa P, Langdon D, et al. Identifying progression in multiple sclerosis: New perspectives. Annals Neurology 2020; 88(3): 438–452.
22. Benedict RH, Drake AS, Irwin LN, et al. Benchmarks of meaningful impairment on the MSFC and BICAMS. Multiple Sclerosis Journal 2016; 22: 1874–1882.
23. Ruet A, Deloire M, Hamel D, et al. Cognitive impairment, health-related quality of life and vocational status at early stages of multiple sclerosis: A 7-year longitudinal study. Journal of Neurology 2013; 260: 776–784.
24. Kobelt G, Thompson A, Berg J, et al. New insights into the burden and costs of multiple sclerosis in Europe. Multiple Sclerosis Journal 2017; 23: 1123–1136.
25. Flensner G, Landtblom AM, Soderhamn O, et al. Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: A cross-sectional study. BMC Public Health 2013; 13: 224.
26. Potagas C, Giogkaraki E, Koutsis G, et al. Cognitive impairment in different MS subtypes and clinically isolated syndromes. Journal of the Neurological Sciences 2008; 267: 100–106.
27. Ruano L, Portaccio E, Goretti B, et al. Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Multiple Sclerosis Journal 2017; 23: 1258–1267.
28. Planche V, Gibelin M, Cregut D, et al. Cognitive impairment in a population-based study of patients with multiple sclerosis: Differences between late relapsing-remitting, secondary progressive and primary progressive multiple sclerosis. European Journal of Neurology 2016; 23: 282–289.
29. Patti F. Cognitive impairment in multiple sclerosis. Multiple Sclerosis Journal 2009; 15: 2–8.
30. Deloire MSA, Bonnet MC, Salort E, et al. How to detect cognitive dysfunction at early stages of multiple sclerosis? Multiple Sclerosis Journal 2006; 12: 445–452.
31. Renner A, Baetge SJ, Filser M, et al. Characterizing cognitive deficits and potential predictors in multiple sclerosis: A large nationwide study applying brief international cognitive assessment for multiple sclerosis in standard clinical care. Journal of Neuropsychology 2020; 14(3): 347–369.
32. Huijbregts SCJ, Kalkers NF, De Sonneville LMJ, et al. Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology 2004; 63: 335–339.
33. Rovira A, Wattjes MP, Tintore M, et al. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nature Reviews Neurology 2015; 11: 471–482.
34. Wattjes MP, Rovira A, Miller D, et al, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-establishing disease prognosis and monitoring patients. Nature Review Neurology 2015; 11: 597–606.
35. Brownlee WJ, Altmann DR, Prados F, et al. Early imaging predictors of long-term outcomes in relapse-onset multiple sclerosis. Brain 2019; 142: 2276–2287.
36. Chung KK, Altmann D, Barkhof F, et al. A 30-year clinical and magnetic resonance imaging observational study of multiple sclerosis and clinically isolated syndromes. Annals of Neurology 2020; 87: 63–74.
37. Scalfari A, Romualdi C, Nicholas RS, et al. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology 2018; 90: e2107–e2118.
38. Tintore M, Arrambide G, Otero-Romero S, et al. The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS. Multiple Sclerosis Journal 2019; 26(13).
39. Eden D, Gros C, Badji A, et al. Spatial distribution of multiple sclerosis lesions in the cervical spinal cord. Brain 2019; 142: 633–646.
40. Filippi M, Preziosa P, Barkhof F, et al. Diagnosis of progressive multiple sclerosis from the imaging perspective: A review. JAMA Neurology 2020; 78(3): 351–364.
41. Kutzelnigg A, Lucchinetti CF, Stadelmann C, et al. Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain 2005; 128: 2705–2712.
42. Li DKB, Held U, Petkau J, et al. MRI T2 lesion burden in multiple sclerosis: A plateauing relationship with clinical disability. Neurology 2006; 66: 1384–1389.
43. Moraal B, Wattjes MP, Geurts JJG, et al. Improved detection of active multiple sclerosis lesions: 3D subtraction imaging. Radiology 2010; 255:154–163.
44. De Graaf WL, Kilsdonk ID, Lopez-Soriano A, et al. Clinical application of multi-contrast 7-T MR imaging in multiple sclerosis: Increased lesion detection compared to 3 T confined to grey matter. European Radiology 2013; 23: 528–540.
45. Sethi V, Yousry TA, Muhlert N, et al. Improved detection of cortical MS lesions with phase-sensitive inversion recovery MRI. Journal of Neurology, Neurosurgery & Psychiatry 2012; 83: 877–882.
46. Van De Pavert SHP, Muhlert N, Sethi V, et al. DIR-visible grey matter lesions and atrophy in multiple sclerosis: Partners in crime? Journal of Neurology, Neurosurgery & Psychiatry 2016; 87: 461–467.
47. Geurts JJG, Roosendaal SD, Calabrese M, et al. Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 2011; 76: 418–424.
48. Zecca C, Disanto G, Sormani MP, et al. Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis. Multiple Sclerosis Journal 2016; 22: 782–791.
49. Magliozzi R, Howell O, Vora A, et al. Meningeal B-cell follicles in secondary progressive multiple sclerosis associate with early onset of disease and severe cortical pathology. Brain 2007; 130: 1089–1104.
50. Zurawski J, Lassmann H, Bakshi R. Use of magnetic resonance imaging to visualize leptomeningeal inflammation in patients with multiple sclerosis: A review. JAMA Neurology 2017; 74: 100–109.
51. Absinta M, Vuolo L, Rao A, et al. Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis. Neurology 2015; 85: 18–28.
52. Kilsdonk ID, Schoonheim M, Wattjes MP. In vivo imaging of meningeal inflammation in multiple sclerosis: Presence of evidence or evidence of presence? Multiple Sclerosis Journal 2017; 23: 1169–1171.
53. Dal-Bianco A, Grabner G, Kronnerwetter C, et al. Slow expansion of multiple sclerosis iron rim lesions: Pathology and 7 T magnetic resonance imaging. Acta Neuropathologica 2017; 133: 25–42.
54. Elliott C, Wolinsky JS, Hauser SL, et al. Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Multiple Sclerosis Journal 2019; 25: 1915–1925.
55. Wattjes MP, Steenwijk MD, Stangel M. MRI in the diagnosis and monitoring of multiple sclerosis: An update. Clinical Neuroradiology 2015; 25(Suppl2): 157–165.
56. Marrie RA, Rudick R, Horwitz R, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology 2010; 74: 1041–1047.
57. Kilsdonk ID, Wattjes MP, Lopez-Soriano A, et al. Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla. European Radiology 2014; 24: 841–849.
58. Calabrese M, Agosta F, Rinaldi F, et al. Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis. Archives of Neurology 2009; 166: 1144–1150.
59. Calabrese M, Rinaldi F, Mattisi I, et al. Widespread cortical thinning characterizes patients with MS with mild cognitive impairment. Neurology 2010; 74: 321–328.
60. Rocca MA, Amato MP, De Stefano N, et al. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. The Lancet Neurology 2015; 14: 302–317.
61. Di Filippo M, Portaccio E, Mancini A, et al. Multiple sclerosis and cognition: Synaptic failure and network dysfunction. Nature Reviews Neuroscience 2018; 19: 599–609.
62. Minagar A, Barnett MH, Benedict RHB, et al. The thalamus and multiple sclerosis: Modern views on pathologic, imaging, and clinical aspects. Neurology 2013; 80: 210–219.
63. University of California, San Francisco MS, Cree BAC, et al. Silent progression in disease activity-free relapsing multiple sclerosis. Annals of Neurology 2019; 85: 653–666.
64. Pitteri M, Romualdi C, Magliozzi R, et al. Cognitive impairment predicts disability progression and cortical thinning in MS: An 8-year study. Multiple Sclerosis Journal 2017; 23: 848-854
65. Schoonheim MM, Meijer KA, Geurts JJG. Network collapse and cognitive impairment in multiple sclerosis. Frontiers in Neurology 2015; 16: 82.
66. Arnold DL, Giovannoni G, Cree B, et al. Relationship between grey matter atrophy, disability and cognition in patients with secondary progressive multiple sclerosis: Analysis from the EXPAND study. ECTRIMS 2019; 25: 1057.
67. Gold R, Kappos L, Bar-Or A, et al. Efficacy of siponimod in secondary progressive multiple sclerosis patients with active disease: The expand study subgroup analysis. ECTRIMS 2019; 750.
68. Novartis. Technical Information of Mayzent (German) [Fachinformation Mayzent]. Basel: Novartis; 2020.
DOI: http://dx.doi.org/10.24294/irr.v5i2.1752
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This site is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.