Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS 6612, Faculté de Médecine, Université de la Méditerranée, Marseille, France.
J Neurol. 2011 May;258(5):811-9. doi: 10.1007/s00415-010-5845-4. Epub 2010 Dec 4.
Brain neuronal injury is present in patients suffering from multiple sclerosis (MS) from the earliest stage of the disease; however, the functional counterpart of early neuronal injury is largely unknown. The goal of this study was to assess the potential impact of early neuronal dysfunction affecting white matter (WM), grey matter (GM), or the cerebellum on cognitive deterioration and/or EDSS progression during the first 5 years of MS. Magnetic resonance spectroscopic (MRS) examinations and neuropsychological assessments were performed in 23 patients included after the first clinical attack of MS and 24 healthy controls. The same protocol was performed in patients after a follow-up of 5 years. Metabolic neuronal function was assessed in WM (splenium of corpus callosum), GM (dorsal posterior cingulate cortex), and the cerebellum by evaluating N-acetylaspartate (NAA) levels. During follow-up, 39% of patients showed cognitive deterioration and 43% showed a deterioration in their EDSS. Patients with cognitive deterioration had greater NAA level reductions during follow-up in the cerebellum (p = 0.003) and WM (p = 0.02) compared to patients without cognitive deterioration. In addition, patients with cognitive deterioration had higher progression of T2 lesion load (T2LL) during the follow-up period compared to patients without cognitive deterioration (p = 0.03). No differences between patients with and without EDSS progression in terms of NAA levels or T2LL were observed. The present longitudinal study found evidence that, during the first 5 years of MS, cognitive deterioration is associated with the progression of neuronal dysfunction and tissue injury as assessed by MRS and T2LL, respectively.
脑神经元损伤存在于多发性硬化症（MS）患者中，从疾病的最早阶段开始；然而，早期神经元损伤的功能对应物在很大程度上是未知的。本研究的目的是评估影响白质（WM）、灰质（GM）或小脑的早期神经元功能障碍对 MS 发病后的前 5 年内认知恶化和/或 EDSS 进展的潜在影响。对 23 例 MS 首次临床发作后和 24 例健康对照者进行磁共振波谱（MRS）检查和神经心理学评估。在随访 5 年后对患者进行相同的检查。通过评估 N-乙酰天冬氨酸（NAA）水平，评估 WM（胼胝体压部）、GM（后扣带回皮质背侧）和小脑中的代谢性神经元功能。在随访期间，39%的患者出现认知恶化，43%的患者 EDSS 恶化。与无认知恶化的患者相比，认知恶化的患者在小脑（p = 0.003）和 WM（p = 0.02）中 NAA 水平在随访期间的降低更大。此外，与无认知恶化的患者相比，认知恶化的患者在随访期间 T2 病变负荷（T2LL）的进展更高（p = 0.03）。在 NAA 水平或 T2LL 方面，无 EDSS 进展的患者之间没有差异。本纵向研究发现，在 MS 发病后的前 5 年内，认知恶化与 MRS 和 T2LL 分别评估的神经元功能障碍和组织损伤的进展有关。
