Dünschede Jutta, Ruschil Christoph, Bender Benjamin, Mengel Annerose, Lindig Tobias, Ziemann Ulf, Kowarik Markus C
Department of Neurology & Stroke, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany.
Department of Neuroradiology, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany.
J Clin Med. 2023 Jan 17;12(3):739. doi: 10.3390/jcm12030739.
Relapses in multiple sclerosis (MS) patients are usually defined as subacute clinical symptoms that last for at least 24 h. To validate a clinical relapse on magnetic resonance imaging (MRI), an anatomically fitting lesion with gadolinium enhancement in the central nervous system (CNS) would be mandatory. The aim of this study was to validate clinical relapses in regard to the concomitant detection of active, anatomically fitting MRI lesions.
We performed a retrospective analysis of 199 MS patients with acute relapse who had received an MRI scan before the initiation of methylprednisolone (MPS) therapy. Clinical data and MRIs were systematically reanalyzed by correlating clinical symptoms with their anatomical representation in the CNS. Patients were then categorized into subgroups with a clinical-radiological match (group 1) or clinical-radiological mismatch (group 2) between symptoms and active, topographically fitting lesions and further analyzed in regard to clinical characteristics.
In 43% of our patients, we observed a clinical-radiological mismatch (group 2). Further analysis of patient characteristics showed that these patients were significantly older at the time of relapse. MS patients in group 2 also showed a significantly longer disease duration and significantly more previous relapses when compared to group 1. Comparing symptom clusters, the appearance of motor dysfunction during the current relapse was significantly more frequent in group 2 than in group 1. The overall dose of MPS treatment was significantly lower in group 2 than in group 1 with a similar treatment response in both groups.
The substantial clinical-radiological mismatch during acute relapse in our study could be explained by several factors, including a psychosomatic component or disturbance of network connectivity. Alternatively, secondary progression or a diffuse neuro-inflammatory process might cause clinical symptoms, especially in older patients with a longer disease duration. As a consequence, treatment of clinical relapses and the definition of breakthrough disease should be reconsidered in regard to combined clinical and MRI criteria and/or additional biomarkers. Further studies are necessary to address the contribution of diffuse neuro-inflammation to the clinical presentation of symptoms.
多发性硬化症（MS）患者的复发通常被定义为持续至少24小时的亚急性临床症状。为了在磁共振成像（MRI）上验证临床复发，中枢神经系统（CNS）中具有钆增强的解剖学匹配病变将是必需的。本研究的目的是就同时检测到的活跃的、解剖学匹配的MRI病变来验证临床复发。
我们对199例急性复发的MS患者进行了回顾性分析，这些患者在开始甲基强的松龙（MPS）治疗前接受了MRI扫描。通过将临床症状与其在CNS中的解剖学表现相关联，对临床数据和MRI进行了系统的重新分析。然后，根据症状与活跃的、地形学匹配的病变之间的临床-放射学匹配（第1组）或临床-放射学不匹配（第2组）将患者分为亚组，并进一步分析其临床特征。
在我们43%的患者中，观察到临床-放射学不匹配（第2组）。对患者特征的进一步分析表明，这些患者在复发时年龄明显更大。与第1组相比，第2组的MS患者疾病持续时间也明显更长，既往复发次数明显更多。比较症状群，第2组在当前复发期间运动功能障碍的出现明显比第1组更频繁。第2组的MPS治疗总剂量明显低于第1组，两组的治疗反应相似。
我们研究中急性复发期间大量的临床-放射学不匹配可能由多种因素解释，包括身心因素或网络连接紊乱。或者，继发进展或弥漫性神经炎症过程可能导致临床症状，尤其是在疾病持续时间较长的老年患者中。因此，应结合临床和MRI标准和/或其他生物标志物重新考虑临床复发的治疗和突破性疾病的定义。有必要进行进一步的研究来探讨弥漫性神经炎症对症状临床表现的影响。
