Quantitative susceptibility mapping of both ring and non-ring white matter lesions in relapsing remitting multiple sclerosis.

BACKGROUND: Recent evidence suggests that the presence of magnetic susceptibility changes in MS lesions correlates with patients' expanded disability status scale (EDSS). PURPOSE: This study evaluated the presence of ring lesions (RLs) and non-RLs, as well as changes in lesion susceptibility and lesion volume over a two-year time period in relapsing-remitting multiple sclerosis (RRMS) patients and compared these measures to the EDSS. STUDY TYPE: Longitudinal cohort. MATERIALS AND METHODS: A total of forty-three (43) patients with RRMS were recruited for this study. All subjects underwent 3 T MRI at baseline and forty-one (41) subjects had follow-up scans over a two-year period. The protocol included T2 fluid attenuated inversion recovery (FLAIR), pre- and post-contrast 2D T1-weighted gradient echo imaging and susceptibility weighted imaging (SWI) sequences. All data were acquired prior to gadolinium-based contrast agent injection except for SWI and post-contrast T1-weighted data. Mean and peak susceptibilities of lesions were measured using quantitative susceptibility mapping (QSM). For the RLs, inner-/outer-diameters from SWI data and absolute intensity from the FLAIR data were measured. The susceptibility and volumes of RLs and non-RLs were correlated with EDSS. RESULTS: The number of RLs correlated positively with EDSS (p-value = 0.04), but the RL volumes did not show a correlation with EDSS. Measurements of the annular ring and regions with high susceptibility remained constant over time (p = 0.2). For non-ring QSM-positive (QSM+) lesions, the average susceptibility was significantly correlated to EDSS (p < 0.01.) This was also the case for lesion volume, as well as the product of volume and susceptibility when compared to EDSS (p < 0.01 for both). CONCLUSIONS: The susceptibility distribution and lesion volumes for the RLs remained almost constant over time, suggesting that the changes in pathophysiology of the RLs is a gradual process. On the other hand, the presence of more than one RL along with both volume and susceptibility of non-RL QSM+ lesions were significantly associated with increased disability as measured by EDSS. These findings may strengthen the role of QSM in assessing MS patients radiologically.

Nutraceuticals as immune-stimulating therapy to fight COVID-19. Combination of elements to improve the efficacy.

COVID-19 pandemic has underlined that unknown viral infections, which jump from animals to humans, can be extremely dangerous. In case of new viruses as SARS-CoV2, available drugs can fail to contrast the virus aggressiveness leading patients to death. Long time is necessary to create a vaccine, but immediate solutions are necessary to stop the mortality COVID-19 related. We have learned that the immune-system is the key to reduce the severity of COVID-19 and, through its modulation, it has been possible saving people's life. In this short communication, we discuss the use of nutraceuticals to modulate and stimulate the immune answer for reducing the severity of COVID-19 symptoms. The nutraceuticals are safe and can be administered to all ages. In addition, combination of natural anti-viral elements and immune-stimulating molecules already successfully tested against others upper-respiratory tract infections-could be efficient against SARS-CoV2. We believe that these natural molecules could really be a valid ally against COVID-19, especially in this moment in which a SARS-CoV2 vaccine is still not available.

Relevance of cerebrospinal fluid findings in patients with multiple sclerosis and seizures.

Seizures occur 2-3 times more frequently in Multiple Sclerosis (MS) patients compared to the general population. The prevalence of seizures is reported to be 1.5-7.8% in MS population. However, it is unclear if seizure is an indirect symptom of neuroinflammation in MS. In our study, we explored the relevance of cerebrospinal fluid (CSF) findings in this unique patient cohort with MS and seizures. We retrospectively reviewed the charts of 32 MS patients with subsequent seizures (MSSS) and 12 patients with seizures followed by MS (SFMS). These two study groups were compared with two control groups - MS without seizures (MSNOS) and seizures without MS (SNOMS). Clinical characteristics and CSF findings between these groups were compared using boot strapped independent t-test. The CSF lymphocyte percentage of the SFMS group (95.6 ±â€¯3) was significantly higher compared to MSNOS (66.0 ±â€¯36.9, p = .04) and SNOMS (81.7 ±â€¯10.0, p = .03). The CSF IgG index was significantly higher in SFMS group (1.9 ±â€¯1.2, p = .02) as compared to MSSS group (0.99 ±â€¯0.4). Patients with seizures as initial symptom of MS may have higher degree of CNS inflammation. Nonspecific clinical symptoms and atypical imaging findings in patients presenting with seizures may warrant close monitoring for development of MS.

The role of vestibular evoked myogenic potentials in multiple sclerosis-related vertigo. A systematic review of the literature.

BACKGROUND: Vertigo is a common symptom of multiple sclerosis (MS) that can be caused by a central or peripheral involvement of the vestibular pathways. Magnetic Resonance Imaging (MRI) is commonly used to evaluate progression of MS but is not sensitive enough to detect small lesions. Vestibular evoked myogenic potentials (VEMPs) are commonly used to evaluate function of vestibular-cochlear pathways. The aim of this literature review is to evaluate the role of VEMPs in patients with MS-related vertigo as a tool to detect demyelinating lesions in the vestibular pathways of MS patients and to monitor MS progression. METHODS: Following the PRISMA guidelines, we performed a literature search with the following keywords: multiple sclerosis, vertigo, dizziness, equilibrium disorders, vestibular disorders, and VEMPs. Three different databases (PubMed, Scopus, and Google Scholar) were independently screened by two researchers. Publications in English, Italian, French, and Spanish were considered and reviewed by a native speaker. Details on patients' gender, age, and stage of MS, as well as VEMPs, MRI, and vertigo features (including their onset as a function of MS stage) were collected. Percentage and odds ratio were calculated. Spearman test was used to correlate vertigo, VEMPs, and MRI features. RESULTS: Thirty-five articles and 819 patients were included in the study. Nearly 37% of MS patients suffered from vertigo and 71% showed altered VEMPs. Central vestibular pathways were involved in the MS demyelination mostly in the early stage of the disease, while the peripheral vestibular system was mainly affected in late stage MS. A significant percentage (35.4%) of the patients with altered VEMPs showed normal MRI. CONCLUSIONS: Our results suggest that VEMPs may detect very small lesions in the vestibular pathways of MS patients; thus, they could have a role in the diagnosis of MS-related vertigo and in the monitoring of vertigo in MS patients as a tool additional to traditional MRI.

Multiple Sclerosis Fatigue: A Longitudinal Structural MRI and Diffusion Tensor Imaging Study.

BACKGROUND AND PURPOSE: Previous cross-sectional studies have reported the involvement of thalamus, pallidum, superior cerebellar peduncle, temporal cortex, and fronto-parietal white matter in multiple sclerosis (MS)-related fatigue. However, the longitudinal imaging correlates of fatigue severity variation in MS remain unclear. METHODS: Structural and diffusion tensor imaging (DTI) data were collected from 43 relapsing remitting MS (RRMS) patients with fatigue (Fatigue Severity Scale [FSS] range: 1-7). Subcortical nuclei volume using FreeSurfer and cortical diffusion indices using a cross-modality technique were measured at baseline and year 1. RESULTS: The pallidal volume had significantly decreased (P = .002) by year 1, although the fatigue score variation was not significant. At year 1, the pallidal volume (P = .023) and fractional anisotropy (FA, P = .013) of right temporal cortex (RTC) correlated significantly with FSS. CONCLUSIONS: The pallidal volume and the FA-RTC may be used to evaluate longitudinal fatigue severity variation. Our study proposes new biomarkers to monitor fatigue severity in MS patients.

Sudden hearing loss as an early detector of multiple sclerosis: a systematic review.

OBJECTIVE: To evaluate whether Sudden Sensorineural Hearing Loss (S-SNHL) may be an early symptom of Multiple Sclerosis (MS). MATERIALS AND METHODS: A systematic review was conducted using the following keywords: "Multiple sclerosis, hearing loss, sudden hearing loss, vertigo, tinnitus, magnetic resonance imaging, otoacoustic emission, auditory brainstem responses, white matter lesions, sensorineural hearing loss, symptoms of MS and otolaryngology, nerve disease and MS". Only the articles that included results of at least one auditory test and MRI were considered. We evaluated the prevalence of SNHL in patients with MS, the presence of different forms of SNHL (S-SNHL and Progressive SNHL (P-SNHL)) and their correlation with the stage of MS, the results of electrophysiological tests, and the location (if any) of MS lesions as detected by white matter hyperintensities in the MRI. RESULTS: We reviewed a total of 47 articles, which included 29 case reports, 6 prospective studies, 6 cohort studies, 4 case-control studies, and 2 retrospective studies. 25% of patients suffered from SNHL. S-SNHL typically occurred in the early stage of the disease (92% of patients) and was the only presenting symptom in 43% of female subjects. Instead, P-SNHL occurred in the late stage of MS (88% of patients). Auditory Brainstem Responses (ABR) were abnormal in all MS patients with S-SNHL. When S-SNHL appeared during the early stage of the disease, MS lesions were found in the brain in 60% of patients and in the Internal Auditory Canal in 40% of patients. ABR remained abnormal after recovery. CONCLUSIONS: S-SNHL can be an early manifestation of MS and should always be considered in the differential diagnosis of this condition, especially in women. The pathophysiology can be explained by the involvement of microglia attacking the central and/or peripheral auditory pathways as indicated by WMHs.