MRI Texture Analysis Reveals Deep Gray Nuclei Damage in Amyotrophic Lateral Sclerosis.

BACKGROUND AND PURPOSE: Amyotrophic Lateral Sclerosis (ALS) is characterized by extensive corticospinal damage, but extrapyramidal involvement is suggested in pathological studies. Texture analysis (TA) is an image processing technique that evaluates the distribution of gray levels between pixels in a given region of interest (ROI). It provides quantitative data and has been employed in several neurodegenerative disorders. Here, we used TA to investigate possible deep gray nuclei (DGN) abnormalities in a cohort of ALS patients. METHODS: Thirty-two ALS patients and 32 healthy controls underwent MRI in a 3T scanner. The T1 volumetric sequence was used for DGN segmentation and extraction of 11 texture parameters using the MaZda software. Statistical analyses were performed using the Mann-Whitney non-parametric test, with a significance level set at α = 0.025 (FDR-corrected) for TA. RESULTS: Patients had significantly higher values for the parameter correlation (CO) in both thalami and in the right caudate nucleus compared to healthy controls. Also, the parameter Inverse Difference Moment or Homogeneity (IDM) presented significantly smaller values in the ALS group in both thalami. CONCLUSIONS: TA of T1 weighted images revealed DGN alterations in patients with ALS, namely in the thalami and caudate nuclei.

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients.

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS.

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients / Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica

OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70 percentWPI:30 percentMS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70 percentWPI:30 percentMS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70 percentWPI:30 percentMS may be useful in the nutritional therapy of patients with ALS.

OBJETIVO: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70 por centoWPI:30 por centoMS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). MÉTODO: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70 por centoWPI:30 por centoMS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. RESULTADOS: Nos pacientes que receberam o suplemento 70 por centoWPI:30 por centoMS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. CONCLUSÃO: Nossos resultados indicam que o aglomerado 70 por centoWPI:30 por centoMS pode ser útil na terapia de pacientes com ALS.

Brain tumor-like lesion in Behçet disease.

We report a patient with longstanding Behçet disease who presented sudden onset of headache and facial paresis. The magnetic resonance imaging (MRI) showed a mass in the right thalamus, extending to the lentiform nucleus, subthalamic area, right cerebral peduncle and deep subcortical white matter. Stereotactic brain biopsy disclosed gliosis with no signs of malignancy. The diagnosis of a pseudotumoral form of neuro-Behçet disease was done and she was treated with pulse methylpredinisolone and intravenous cyclophosphamide. After 8 weeks she had improved and a new MRI showed disappearance of the tumor-like lesion. The differential diagnosis, especially with central nervous system tumor is emphasized.