Michael Deppe1, Karsten Tabelow2, Julia Krämer3, Jan-Gerd Tenberge3, Patrick Schiffler3, Stefan Bittner3, Wolfram Schwindt4, Frauke Zipp5, Heinz Wiendl3, Sven G Meuth3. 1. Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany mail@Michael-Deppe.de. 2. Weierstrass Institute, Berlin, Germany. 3. Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany. 4. Department of Clinical Radiology, Westfälische Wilhelms University, Münster, Germany. 5. Department of Neurology, Rhine Main Neuroscience Network, Johannes Gutenberg University Medical Centre Mainz, Germany.
Abstract
BACKGROUND: Common symptoms of multiple sclerosis (MS) such as gait ataxia, poor coordination of the hands, and intention tremor are usually the result of dysfunctionality in the cerebellum. Magnetic resonance imaging (MRI) has frequently failed to detect cerebellar damage in the form of inflammatory lesions in patients presenting with symptoms of cerebellar dysfunction. OBJECTIVE: To detect microstructural cerebellar tissue alterations in early MS patients with a "normal appearing" cerebellum using diffusion tensor imaging (DTI). METHODS: A total of 68 patients with relapsing-remitting MS (RRMS) and without cerebellar lesions and 26 age-matched healthy controls were admitted to high-resolution MRI and DTI to assess microstructure and volume of the cerebellar white matter (CBWM). RESULTS: We found cerebellar fractional anisotropy (FA) and CBWM volume reductions in the group of 68 patients. Interestingly, a subgroup of these patients that was derived by including only patients with early and mild MS (N=23, median age 30 years, median Expanded Disability Status Scale =1.5, median duration 28 months) showed already cerebellar FA but no CBWM volume reductions. FA reductions were correlated with disability, atrophy, and disease duration. CONCLUSION: "Normal appearing" cerebellar white matter can be damaged in a very early stage of RRMS. DTI seems to be a sensitive tool for detecting this hidden cerebellar damage.
BACKGROUND: Common symptoms of multiple sclerosis (MS) such as gait ataxia, poor coordination of the hands, and intention tremor are usually the result of dysfunctionality in the cerebellum. Magnetic resonance imaging (MRI) has frequently failed to detect cerebellar damage in the form of inflammatory lesions in patients presenting with symptoms of cerebellar dysfunction. OBJECTIVE: To detect microstructural cerebellar tissue alterations in early MSpatients with a "normal appearing" cerebellum using diffusion tensor imaging (DTI). METHODS: A total of 68 patients with relapsing-remitting MS (RRMS) and without cerebellar lesions and 26 age-matched healthy controls were admitted to high-resolution MRI and DTI to assess microstructure and volume of the cerebellar white matter (CBWM). RESULTS: We found cerebellar fractional anisotropy (FA) and CBWM volume reductions in the group of 68 patients. Interestingly, a subgroup of these patients that was derived by including only patients with early and mild MS (N=23, median age 30 years, median Expanded Disability Status Scale =1.5, median duration 28 months) showed already cerebellar FA but no CBWM volume reductions. FA reductions were correlated with disability, atrophy, and disease duration. CONCLUSION: "Normal appearing" cerebellar white matter can be damaged in a very early stage of RRMS. DTI seems to be a sensitive tool for detecting this hidden cerebellar damage.
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