Background

In multiple sclerosis, the interplay of neurodegeneration, demyelination and inflammation leads to changes in neurophysiological functioning.

Objectives

This study aims to characterise the relation between reduced brain volumes and spectral power in multiple sclerosis patients and matched healthy subjects.

Methods

During resting-state eyes closed, we collected magnetoencephalographic data in 67 multiple sclerosis patients and 47 healthy subjects, matched for age and gender. Additionally, we quantified different brain volumes (white matter, cortical and deep grey matter, FLAIR lesion load and volume of black holes) and calculated the power spectral density. Instead of using the traditionally used frequency bands, we calculated the source reconstructed power spectral density in frequency bins of 0.25 Hz (range: 0-40 Hz) and corrected for multiple comparisons through permutation testing.

Results

First, a principal component analysis (PCA) of brain volumes demonstrates that atrophy can be largely described by two components: one overall degenerative component that is indicative of brain integrity and correlates strongly with different cognitive tests, and one component that mainly captures degeneration of the cortical grey matter that strongly correlates with age. As the first PC was observed both when performing the PCA on the full cohort and on the two subcohorts, we denote this component as an index of brain integrity. Logically, this component was more strongly expressed in the MS cohort.

Next, a multimodal correlation analysis indicates that reduced brain integrity is accompanied by increased alpha1 power in the temporoparietal junction (TPJ). Patients showing this local increase in alpha-peak also scored significantly worse on different cognitive tests and reduced thalamic volumes. The increase in alpha1-power comes from both a slowing of the main alpha-peak and an increase in power.

Conclusions

MS patients with reduced brain integrity demonstrated increased alpha1 power in the TPJ and impaired cognitive functioning.

Background

To date, no studies have explored the relationship between brain atrophy and MS disability using differing MRI protocols and scanners at multiple sites.

Objectives

To assess the association between brain atrophy and MS disability, as measured by EDSS and 6-month confirmed disability progression (CDP).

Methods

In this retrospective study at 4 MS centres, a total of 1300 patients had brain MRI imaging assessed by icobrain. Relapse-onset MS patients were included if they had two clinical MRIs 12 (±3) months apart and ≥2 EDSS scores post MRI-2, the first ≤3 months from MRI-2, with ≥6 months between first and last EDSS. Volumetric data were analysed if the alignment similarity between two images was as good as that of same-scanner scan-rescan images (normalised mutual information ≥0.2). The percentage brain volume change (PBVC), percentage grey matter change (PGMC), FLAIR lesion volume change, whole brain volume, grey matter volume, FLAIR lesion volume and T1 hypointense lesion volume at MRI-2 were calculated. Ordinal mixed effect models were used to determine the association between these volumetric MRI measures and all EDSS scores post MRI-2. Cox proportional hazards models were used for the 6-month CDP outcome, using a subset of patients with ≥3 EDSS. Models were adjusted for proportion of time spent on disease-modifying therapy during MRIs ± whole brain/grey matter volume at baseline MRI.

Results

Of the 260 relapse-onset MS patients included, 204 (78%) MRI pairs were performed in the same scanner and 56 (22%) pairs were from different scanners. During the follow-up period (median 3.8 years, range 1.3-8.9), 29 of 244 (12%) patients experienced 6-month CDP. There was no evidence for association between annualised PBVC or PGMC and CDP or EDSS (p>0.05). Cross-sectional whole brain and grey matter volume (at MRI-2) tended to associate with CDP (HR 0.99, 95% CI 0.98-1.00, p=0.06). Every 1ml of whole brain or grey matter volume lost represented a 1% higher chance of reaching 6-month CDP. Only whole brain volume (at MRI-2) was associated with EDSS score (β -0.03, SE 0.01, p<0.001) and the slope of EDSS change over time (β -0.001, SE 0.0003, p=0.02). On average, every 33ml reduction of brain volume was associated with a 1 step increase in EDSS.

Conclusions

In this real-world clinical setting where a fifth of the brain atrophy analysis were performed on different scanners, we found no association between individual brain atrophy and MS disability. However, there was an association between cross-sectional whole brain volume with EDSS and slope of EDSS change.

Background

Classic health care (HC) models are currently being challenged by the ‘coronavirus disease of 2019’ (COVID-19) pandemic for which social isolation and unprecedented mobility restrictions have been deployed as essential measures of constrain. Digital communication services have the potential to preserve and improve access to specialized medical facilities in a cost- and time-efficient manner. Nonetheless, studies on live interaction between patients with multiple sclerosis (MS) and HC providers for neurological follow-up are still scarce. In a recent pilot project, we have shown that individual real-time audiovisual teleconsultations (TCs) over the internet are feasible and highly appreciated in patients with MS, but compliance and technical reliability over time remain to be demonstrated.

Objectives

To evaluate feasibility of real-time audiovisual TCs over the internet for neurological follow-up of patients with MS.

Methods

Thirty patients with MS presenting at a specialized center in Belgium were recruited for this ongoing study, and scheduled to receive 4 TCs over the course of 12 months. Patients were provided a unique hyperlink by mail in advance, leading them automatically and directly to the virtual waiting room, where they could accept or decline our incoming call. All TCs are performed by a trained HC professional with the intention to keep the conversation similar to what is usually discussed during a classic face-to-face MS consultation. The approach will be considered feasible if at least 80% of the planned TCs can be successfully completed at the foreseen moment. We present the results of an interim analysis (July 8, 2020), when at least 2 TCs were executed in each participant. Patient satisfaction (technical quality, convenience, quality of care and added value) was evaluated via telephone by means of 5-point Likert scales containing the categories very unsatisfied, unsatisfied, neutral, satisfied and highly satisfied.

Results

Three participants dropped out of the study due to loss of interest (2) or a broken device (1). Sixty of the 75 scheduled TCs were successfully completed (80%). Failures were due to patients not responding (7/56) or technical issues (8/56). Out of the 27 active participants, 24 responded to the telephone call for satisfaction analysis. Rates of patients declaring themselves satisfied or highly satisfied regarding the TCs were 19/24 for technical quality, 23/24 for convenience, 22/24 for quality of care and 21/24 for added value.

Conclusions

Real-time audiovisual TCs over the internet appear to be feasible and well-received in patients with MS. Full completion of this trial is expected early next year. Incorporation of digital communication services in routine MS practice is expected to improve access to specialized care, particularly in dire times such as the current COVID-19 crisis.