Elia Sechi1, B Mark Keegan2, Timothy J Kaufmann1, Orhun H Kantarci1, Brian G Weinshenker1, Eoin P Flanagan2. 1. From the Department of Neurology (E.S., B.M.K., O.H.K., B.G.W., E.P.F.), Department of Radiology, Division of Neuroradiology (T.J.K.), and Department of Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic College of Medicine, Rochester, MN. 2. From the Department of Neurology (E.S., B.M.K., O.H.K., B.G.W., E.P.F.), Department of Radiology, Division of Neuroradiology (T.J.K.), and Department of Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic College of Medicine, Rochester, MN. flanagan.eoin@mayo.edu keegan.bmark@mayo.edu.
Abstract
OBJECTIVE: Progressive motor impairment anatomically attributable to a single critical demyelinating lesion on eloquent corticospinal tract locations occurs in progressive solitary sclerosis and in some patients with multiple sclerosis (MS) with highly restricted CNS lesion burden (2-5 lesions). We determined whether a similar critical lesion is found in patients with MS with unilateral motor progression and unlimited lesion burden. METHODS: In this observational study, we retrospectively identified Mayo Clinic patients (January 1, 1996-December 31, 2017) with an MS diagnosis (2017 McDonald criteria), ≥1 year of exclusively unilateral motor progression, and >5 demyelinating lesions on MRI. A blinded neuroradiologist identified a single critical lesion (last available MRI) based on prominent size, atrophy, and eloquent corticospinal tract location (spinal cord lateral columns, medullary pyramids, cerebral peduncles, internal capsules). We then determined whether the motor impairment was anatomically attributable to the identified lesion. RESULTS: Thirty-eight patients with MS were included: 20 (53%) with primary progressive MS and 18 (47%) with secondary progressive MS. Median age at progression onset was 54 (range 39-73) years. Median Expanded Disability Status Scale score was 5 (range 2.5-7.5) at the last follow-up (median 132.5 months from symptom onset, range 23-390 months). A single critical lesion was identified in 25 of 38 cases (66%): 19 in the cervical cord and 6 in the thoracic cord. In the remaining patients, >1 potential critical lesions were present. The overall probability to detect demyelinating lesions was higher along the corticospinal tract where the motor deficit localized (38 of 38 [100%]) than on the contralateral side (15 of 38 [39%]) (p < 0.0001). CONCLUSIONS: In patients with MS with unilateral motor progression, the motor deficit may be attributable to a single critical corticospinal tract lesion.
OBJECTIVE: Progressive motor impairment anatomically attributable to a single critical demyelinating lesion on eloquent corticospinal tract locations occurs in progressive solitary sclerosis and in some patients with multiple sclerosis (MS) with highly restricted CNS lesion burden (2-5 lesions). We determined whether a similar critical lesion is found in patients with MS with unilateral motor progression and unlimited lesion burden. METHODS: In this observational study, we retrospectively identified Mayo Clinic patients (January 1, 1996-December 31, 2017) with an MS diagnosis (2017 McDonald criteria), ≥1 year of exclusively unilateral motor progression, and >5 demyelinating lesions on MRI. A blinded neuroradiologist identified a single critical lesion (last available MRI) based on prominent size, atrophy, and eloquent corticospinal tract location (spinal cord lateral columns, medullary pyramids, cerebral peduncles, internal capsules). We then determined whether the motor impairment was anatomically attributable to the identified lesion. RESULTS: Thirty-eight patients with MS were included: 20 (53%) with primary progressive MS and 18 (47%) with secondary progressive MS. Median age at progression onset was 54 (range 39-73) years. Median Expanded Disability Status Scale score was 5 (range 2.5-7.5) at the last follow-up (median 132.5 months from symptom onset, range 23-390 months). A single critical lesion was identified in 25 of 38 cases (66%): 19 in the cervical cord and 6 in the thoracic cord. In the remaining patients, >1 potential critical lesions were present. The overall probability to detect demyelinating lesions was higher along the corticospinal tract where the motor deficit localized (38 of 38 [100%]) than on the contralateral side (15 of 38 [39%]) (p < 0.0001). CONCLUSIONS: In patients with MS with unilateral motor progression, the motor deficit may be attributable to a single critical corticospinal tract lesion.
Authors: Benan Barakat; Steve Messina; Shreya Nayak; Roman Kassa; Elia Sechi; Eoin P Flanagan; Orhun Kantarci; Brian G Weinshenker; B Mark Keegan Journal: Mult Scler J Exp Transl Clin Date: 2022-01-12
Authors: Elia Sechi; Karl N Krecke; Steven A Messina; Marina Buciuc; Sean J Pittock; John J Chen; Brian G Weinshenker; A Sebastian Lopez-Chiriboga; Claudia F Lucchinetti; Nicholas L Zalewski; Jan Mendelt Tillema; Amy Kunchok; Salvatore Monaco; Padraig P Morris; James P Fryer; Adam Nguyen; Tammy Greenwood; Stephanie B Syc-Mazurek; B Mark Keegan; Eoin P Flanagan Journal: Neurology Date: 2021-07-14 Impact factor: 9.910