Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Neurology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China.
Mult Scler Relat Disord. 2021 Aug;53:103048. doi: 10.1016/j.msard.2021.103048. Epub 2021 May 28.
Neuropathic pain (NP) is a highly disturbing sensory experience in patients with neuromyelitis optica spectrum disorders (NMOSD). However, the brain changes in NMOSD patients with NP have rarely been studied.
The aim of the cross-sectional and follow-up longitudinal study was to investigate the brain changes in NMOSD patients with NP.
In the cross-sectional study, comparisons were performed between groups with NP (W-NP) and without NP (Wo-NP), and age, sex and years of education were adjusted. We compared the voxel-wise whole-brain gray matter (GM) volume, cortical thickness (CT), cortical surface area (CSA) and local gyrification index (LGI). Probabilistic tractography started from regions with significant between-group differences in GM volume, CT, CSA and LGI. We also compared fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) of the white matter (WM) skeleton using Tract-Based Spatial Statistics (TBSS). In the longitudinal study, the patients were followed for 2.0±0.0 years and underwent the same imaging scanning as the cross-sectional study. Changes of the CT, CSA, LGI and WM were obtained.
Patients in the W-NP group were older than those in the Wo-NP group and showed significantly reduced LGI of the left temporal lobe and adjacent regions(regions of interest, ROIs), which participated in neuropathic pain processing, possibly by emotion and attention control. Probabilistic tractography started from ROIs, and the generated WM tracts showed decreased MD and RD in the W-NP group compared to the Wo-NP group. Using TBSS, both MD and RD decreased in extensive WM skeleton in the right hemisphere of the patients in the W-NP group. Additionally, in the follow-up longitudinal study, compared with patients in the Wo-NP group, patients in the W-NP group showed lower mean reduction rates of LGI of ROIs, and less increase of FA and more increases of MD, AD and RD in the extensive WM skeleton.
These findings support the hypothesis that brain changes might correlate with NP in NMOSD patients and predict the changes related to NP over time.
神经痛（NP）是视神经脊髓炎谱系疾病（NMOSD）患者高度困扰的感觉体验。然而，NMOSD 伴 NP 患者的大脑变化很少被研究。
本横断面和随访纵向研究旨在探讨 NMOSD 伴 NP 患者的大脑变化。
在横断面研究中，我们对伴有 NP（W-NP）和不伴有 NP（Wo-NP）的两组患者进行了比较，并调整了年龄、性别和受教育年限。我们比较了全脑灰质（GM）体积、皮质厚度（CT）、皮质表面积（CSA）和局部脑回指数（LGI）的体素水平。从 GM 体积、CT、CSA 和 LGI 存在显著组间差异的区域开始进行概率性束追踪。我们还使用基于体素的空间统计学（TBSS）比较了白质（WM）骨架的各向异性分数（FA）、平均扩散系数（MD）、径向扩散系数（RD）和轴向扩散系数（AD）。在纵向研究中，患者随访 2.0±0.0 年，并进行了与横断面研究相同的影像学扫描。获得 CT、CSA、LGI 和 WM 的变化。
W-NP 组患者较 Wo-NP 组年龄更大，左侧颞叶及相邻区域（感兴趣区，ROI）LGI 明显降低，可能通过情绪和注意力控制参与神经痛处理。概率性束追踪从 ROI 开始，生成的 WM 束显示 W-NP 组 MD 和 RD 较 Wo-NP 组降低。使用 TBSS，W-NP 组患者右侧半球广泛 WM 骨架中 MD 和 RD 均降低。此外，在随访纵向研究中，与 Wo-NP 组患者相比，W-NP 组患者 ROI 的 LGI 平均降低率较低，FA 增加，广泛 WM 骨架中 MD、AD 和 RD 增加较多。
这些发现支持大脑变化可能与 NMOSD 伴 NP 患者的 NP 相关，并能预测随时间变化的 NP 相关变化的假说。
