Comparative study of AQP4‑NMOSD, MOGAD and seronegative NMOSD: a single‑center Belgian cohort

peer reviewedObjectives: To emphasize physio-pathological, clinical and prognosis differences between conditions causing serious and sometimes very similar clinical manifestations: anti-aquaporin-4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies related diseases, and seronegative NMOSD (neuromyelitis optica spectrum disorders). Methods: Based on diagnostic criteria for NMOSD and MOGAD (MOG associated disorders), we retrospectively surveyed 10 AQP4-NMOSD, 8 MOGAD and 2 seronegative NMOSD, followed at the specialized neuroimmunology unit of the CHU Liege. Results: Female predominance was only observed in AQP4 group. Age at onset was 37.8 and 27.7 years old for AQP4-NMOSD and MOGAD, respectively. In both groups, the first clinical event most often consisted of optic neuritis (ON), followed by isolated myelitis. Fifteen of our 20 patients encountered a relapsing course with 90% relapses in AQP4-NMOSD, 62.5% in MOGAD and 50% in the seronegative group, and a mean period between the first and second clinical event of 7.1 and 4.8 months for AQP4-NMOSD and MOGAD, respectively. In total, we counted 54 ON, with more ON per patient in MOGAD. MOG-associated ON mainly affected the anterior part of the optic nerve with a papilledema in 79.2% of cases. Despite a fairly good visual outcome after MOG-associated ON, retinal nerve fiber layer (RNFL) thickness decreased, suggesting a fragility of the optic nerve toward further attacks. Conclusion: As observed in larger cohorts, our MOGAD and AQP4-NMOSD cases differ by clinical and prognostic features. A better understanding of these diseases should encourage prompt biological screening and hasten proper diagnosis and treatment

Using quantitative magnetic resonance imaging to track cerebral alterations in multiple sclerosis brain: A longitudinal study

peer reviewedIntroduction: Quantitative MRI quantifies tissue microstructural properties and supports the characterization of cerebral tissue damages. With an MPM protocol, 4 parameter maps are constructed: MTsat, PD, R1 and R2*, reflecting tissue physical properties associated with iron and myelin contents. Thus, qMRI is a good candidate for in vivo monitoring of cerebral damage and repair mechanisms related to MS. Here, we used qMRI to investigate the longitudinal microstructural changes in MS brain. Methods: Seventeen MS patients (age 25-65, 11 RRMS) were scanned on a 3T MRI, in two sessions separated with a median of 30 months, and the parameters evolution was evaluated within several tissue classes: NAWM, NACGM and NADGM, as well as focal WM lesions. An individual annual rate of change for each qMRI parameter was computed, and its correlation to clinical status was evaluated. For WM plaques, three areas were defined, and a GLMM tested the effect of area, time points, and their interaction on each median qMRI parameter value. Results: Patients with a better clinical evolution, that is, clinically stable or improving state, showed positive annual rate of change in MTsat and R2* within NAWM and NACGM, suggesting repair mechanisms in terms of increased myelin content and/or axonal density as well as edema/inflammation resorption. When examining WM lesions, qMRI parameters within surrounding NAWM showed microstructural modifications, even before any focal lesion is visible on conventional FLAIR MRI. Conclusion: The results illustrate the benefit of multiple qMRI data in monitoring subtle changes within normal appearing brain tissues and plaque dynamics in relation with tissue repair or disease progression. Emilie Lommers and Christophe Phillips equally contributed to the work

Prevalence of vasculare risk factors in different stages of prodromal Alzheimer’s disease and its influence on cognitive decline

peer reviewe

Multiple sclerosis : therapy update.

editorial reviewedMultiple sclerosis is still a severe disease potentially associated with a short- or long-term disability in young adults. Since a few years therapeutic progresses are considerable. New drugs and new therapy rationale considerably improved our knowledge and patient's care. Early treatment is a key within dedicated specialized and multidisciplinary units. Clinical and neuroradiological no evidence of disease activity (NEDA) is a goal, which is more often reached. Patient's evolution and follow-up is completely changed in recent years with more efficacy.La sclérose en plaques (SEP) reste une maladie grave du système nerveux central (SNC), potentiellement responsable d’un handicap, physique ou non, à moyen et long termes, chez des adultes jeunes. Les progrès thérapeutiques au cours des dernières années ont été considérables grâce à l’avènement de nouvelles molécules, mais aussi, et peut-être surtout, de schémas thérapeutiques nettement plus performants. Les progrès des connaissances en immunologie ont eu un impact majeur dans ce domaine. La prise en charge précoce des patients au sein d’unités intégrées et multidisciplinaires est une étape essentielle qui permet de guider l’utilisation rationnelle des médicaments. L’obtention d’une stabilité clinique et neuroradiologique est un défi qui est, de plus en plus souvent, relevé avec un bénéfice majeur pour les patients

Multiple sclerosis : a neurological dysimmune inflammatory disease.

editorial reviewedMultiple sclerosis is a central nervous system autoimmune disease of the white and grey matters. Its pathophysiology is much better well known. It results from the interaction between genetic and environmental susceptibility factors. The role of EBV virus has recently been highlighted. Imaging techniques and neuropathology knowledge allow to distinguish several distinct processes responsible for focal and more diffuse inflammation. Therapeutic advances in recent years have been considerable. Different molecules and treatment sequences can be proposed to the patient with a demonstrated positive impact on the risk of disability secondary progression. Precise follow-up is a key. It requires optimal and early use of various treatments. The therapeutic choice must be guided by obtaining stabilization of the disease, both clinically and in terms of imaging, without exposing the patient to an excessive risk of side effects. Continuous and sequential treatments are available.: La sclérose en plaques est une maladie auto-immune du système nerveux central qui concerne la substance blanche mais aussi la substance grise. Sa physiopathologie est beaucoup mieux connue. Elle résulte de l’interaction entre des facteurs génétiques de susceptibilité et environnementaux. Le rôle du virus EBV a été récemment souligné. Les techniques d’imagerie et les connaissances de neuropathologie ont permis de distinguer plusieurs processus distincts responsables d’une inflammation focale, mais également plus diffuse. Les progrès thérapeutiques des dernières années sont considérables. Différentes molécules et séquences de traitements peuvent être proposées au patient avec un impact positif démontré sur le risque de progression secondaire du handicap. La précision du suivi est un élément clé de la prise en charge. Elle requiert une utilisation optimale, et surtout précoce, des différents traitements. Le choix thérapeutique doit être guidé par l’obtention d’une stabilisation de la maladie, tant sur le plan clinique qu’en imagerie, sans exposer le patient à un risque excessif d’effets secondaires négatifs. Des traitements continus et séquentiels sont disponibles

Using quantitative MRI to track cerebral damage in multiple sclerosis: a longitudinal study

Contrary to conventional MRI (cMRI), quantitative MRI (qMRI) quantifies tissue physical microstructural properties and improves the characterization of cerebral damages in relation with various neurological diseases. With a multi-parameter mapping (MPM) protocol, 4 parameter maps are constructed: saturated magnetization transfer (MTsat), proton density (PD), longitudinal relaxation (R1) and effective transverse relaxation (R2*) rates, reflecting tissue physical properties associated with iron and myelin contents. Here, we used qMRI to investigate the microstructural changes happening over time in multiple sclerosis (MS). Seventeen MS patients (age 25-65, 11 RRMS) were scanned on a 3T MRI, with at least one year separation between two acquisition sessions, and the evolution of their parameters was evaluated within several tissue classes: normal appearing white matter (NAWM), normal appearing cortical and deep gray matter (NACGM and NADGM) as well as focal white matter (WM) lesions. Brain tissue segmentation was performed using US-with-Lesion, an adapted version of the Unified Segmentation (US) algorithm accounting for the lesion tissue class, based on qMRI and FLAIR images. An individual annual rate of change for each qMRI parameter was computed, and its correlation to clinical status was evaluated. As for WM plaques, three areas were defined within them. A Generalized Linear Mixed Model (GLMM) tested the effect of area and time points, as well as their interaction on each median qMRI parameter value. Patients with a better clinical evolution showed positive annual rate of change in MT and R2* within NAWM and NACGM, suggesting repair mechanisms in terms of increased myelin content and/or axonal density. When examining focal WM lesions, qMRI parameters within surrounding NAWM showed modification in terms of reduction in MT, R1 and R2* combined with increased of PD even before any focal lesion is visible on conventional FLAIR MRI. The results illustrate the benefit of multiple qMRI data in monitoring subtle changes within normal appearing brain tissues and plaque dynamics in relation with tissue repair or disease progression.Preprin