Portaccio E, Stromillo M L, Goretti B, Zipoli V, Siracusa G, Battaglini M, Giorgio A, Bartolozzi M L, Guidi L, Sorbi S, Federico A, Amato M P, De Stefano N
Department of Neurology, University of Florence, Italy.
Neurology. 2009 Aug 18;73(7):498-503. doi: 10.1212/WNL.0b013e3181b351fd. Epub 2009 Jul 29.
To assess whether neuropsychological tests and MRI measures could be used as predictors of short-term disease evolution in a population of patients with benign multiple sclerosis (B-MS).
The definition of B-MS is controversial. Recent data suggest that neuropsychological tests and MRI measures can provide valuable information for a more correct definition and interpretation of B-MS.
Sixty-three patients with B-MS (Expanded Disability Status Scale [EDSS] < or =3.0 and disease duration > or =15 years) underwent neuropsychological assessment using the Rao's Brief Repeatable Neuropsychological Battery and the Stroop Test. At that time, conventional brain MRI and magnetization transfer (MT) imaging was performed. White matter lesion load, global and regional brain volumes, and MT ratio in lesions and normal-appearing brain were measured. After a mean follow-up of 5 years, patients still having an EDSS score < or =3.5 were classified as still benign, whereas patients who had developed a secondary progressive course or who had an EDSS score > or =4.0 were defined as no longer benign (NLB).
At end of follow-up, 29% of patients were classified as NLB. Male gender (hazard ratio [HR] = 2.9; 95% confidence interval [CI] 1.2-7.5; p = 0.02), number of neuropsychological tests failed (HR = 1.4; 95% CI 1.1-1.7; p = 0.003), and T1-weighted lesions (HR = 1.3; 95% CI 1.1-1.5; p = 0.002) were related to NLB status. In a model including these 3 variables, the NLB status was predicted with an accuracy of 82%.
Cognitive assessment and MRI metrics can predict short-term disease evolution in benign multiple sclerosis (B-MS). This information can be useful to correctly identify patients with B-MS.
评估神经心理学测试和磁共振成像（MRI）测量是否可作为良性多发性硬化（B-MS）患者短期疾病进展的预测指标。
B-MS的定义存在争议。近期数据表明，神经心理学测试和MRI测量可为更准确地定义和解释B-MS提供有价值的信息。
63例B-MS患者（扩展残疾状态量表[EDSS]≤3.0且病程≥15年）使用Rao简明可重复神经心理成套测验和Stroop测验进行神经心理学评估。此时，进行常规脑MRI和磁化传递（MT）成像。测量白质病变负荷、全脑和局部脑体积以及病变和正常脑区的MT比率。平均随访5年后，EDSS评分仍≤3.5的患者被分类为仍为良性，而出现继发进展病程或EDSS评分≥4.0的患者被定义为不再良性（NLB）。
随访结束时，29%的患者被分类为NLB。男性（风险比[HR]=2.9；95%置信区间[CI]1.2-7.5；p=0.02）、未通过的神经心理学测试数量（HR=1.4；95%CI 1.1-1.7；p=0.003）和T1加权病变（HR=1.3；95%CI 1.1-1.5；p=0.002）与NLB状态相关。在包含这3个变量的模型中，预测NLB状态的准确率为82%。
认知评估和MRI指标可预测良性多发性硬化（B-MS）的短期疾病进展。该信息有助于正确识别B-MS患者。
