Unfolding the long-term pathophysiological processes following an acute inflammatory demyelinating lesion of multiple sclerosis |
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Authors: | Wafaa Zaaraoui,Audrey Rico,Bertrand Audoin,Franç oise Reuter,Irina Malikova,Elisabeth Soulier,Patrick Viout,Yann Le Fur,Sylviane Confort-Gouny,Patrick J. Cozzone,Jean Pelletier,Jean-Philippe Ranjeva |
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Affiliation: | 1. CRMBM UMR CNRS 6612–Medical School of Marseille, 13005 Marseille, France;2. Department of Neurology, Timone University Hospital, 13005 Marseille, France |
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Abstract: | BackgroundAcute symptomatic inflammation is a main feature of multiple sclerosis but pathophysiological processes underlying total or partial recovery are poorly understood.ObjectiveTo characterize in vivo these processes at molecular, structural and functional levels using multimodal MR methods.MethodsA neuroimaging 3-year follow-up (Weeks 0, 3, 11, 29, 59 and 169) was conducted on a 41-year-old woman presenting at baseline with a large acute demyelinating lesion of multiple sclerosis. Conventional magnetic resonance imaging (MRI), magnetization transfer imaging, diffusion-weighted imaging, functional MRI and magnetic resonance spectroscopy were conducted at 1.5 T.ResultsPatient presenting with subacute left hemiplegia recovered progressively (expended disability status scale 7 to 5.5). The MR exploration demonstrated structural functional and metabolic impairments at baseline. Despite restoration of the blood brain barrier integrity, high lactate levels persisted for several weeks concomitant with glial activation. Slow and progressive structural and metabolic restorations occurred from baseline to W169 (lesion volume −64%; apparent diffusion coefficient −14.7%, magnetization transfer ratio +14%, choline −51%, lipids −78%, N-acetylaspartate +77%) while functionality of the motor system recovered.ConclusionsMultimodal MRI/MRS evidenced long-term dynamics recovery processes involving tissue repair, glial activation, recovery of neuronal function and functional systems. This may impact on customized rehabilitation strategies generally focused on the first months following the onset of symptoms. |
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Keywords: | Inflammation Multiple sclerosis Human Brain Recovery Magnetic resonance imaging Magnetic resonance spectroscopy FMRI |
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