Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona
Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases

Author Of 2 Presentations

Imaging Poster Presentation

P0556 - Characterization of multiple sclerosis lesions with distinct clinical correlates through diffusion MRI properties (ID 845)

Abstract

Background

Background: Diffusion magnetic resonance imaging can reveal quantitative information about the tissue changes in multiple sclerosis. The recently developed multi-compartment spherical mean technique can map different microscopic properties based only on local diffusion signals, and it may provide specific information on the underlying microstructural modifications that arise in multiple sclerosis.

Objectives

Objective: Given that the lesions in multiple sclerosis may reflect different degrees of damage, we hypothesized that quantitative diffusion maps may help characterize the severity of lesions “in vivo” and correlate these to an individual’s clinical profile.

Methods

Methods: We evaluated a cohort of 59 MS patients (62% female, mean age 44.7 years), for whom demographic and disease information was obtained, and who underwent a comprehensive physical and cognitive evaluation. MRI protocol included conventional sequences to define focal lesions and multi-shell diffusion imaging. Quantitative diffusion properties were used to discriminate distinct types of lesions through a k-means clustering algorithm, and the number and volume of those lesions were correlated with parameters of the disease.

Results

Results: The combination of microscopic and macroscopic diffusion properties differentiated two types of lesions, with a prediction strength of 0.931. The type B lesions had larger diffusion changes compared to the type A lesions, irrespective of their location (P <0.001). The number and volume of type B lesions was related to the severity of disease evolution, clinical disability and cognitive decline (P =0.004, Bonferroni correction). Specifically, more and larger type B lesions were correlated with a worse Multiple Sclerosis Severity Score, cerebellar function and cognitive performance, and a greater need for high-efficacy treatments.

Conclusions

Conclusions: The severity of damage within focal lesions have the potential to permit more specific understanding of the mechanisms that drive disease evolution.

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Neuropsychology and Cognition Poster Presentation

P0820 - Phase II trial of cognitive rehabilitation in patients with multiple sclerosis: preliminary results (ID 847)

Abstract

Background

Around 50% of patients with multiple sclerosis (MS) present a decline in cognitive behavior that impacts negatively on their autonomy, social and working skills. The benefits of cognitive rehabilitation on cognition and brain plasticity are not well understood due to methodological limitations of most studies, such the use of an inappropriate control group or the small number of patients included.

Objectives

To study the efficacy on attention, processing speed and working memory of a cognitive training program in patients with MS.

Methods

Multi-center, phase II, double-blind and randomized clinical trial to a treatment group (upward intensity training) or control group (low intensity static training). Patients were assessed using Rao's battery before and after 12 weeks of online training with the Guttmann, NeuroPersonalTrainer® (GNPT). The main objective was to demonstrate an improvement in attention and working memory tests (Pasat Auditory Serial Addition Test, PASAT, and Symbol Digit Modalities Test, SDMT) in the treatment group.

Results

The recruitment is still active. In an interim analysis on May 2020, 61 patients had been evaluated, of whom 35 fulfilled the inclusion criteria, and 23 had completed the follow-up period (age 48.8±7.4, disease duration 19.2±9.3 years). Ten patients had been assigned to the treatment group and 13 to the control group. The treatment group showed a significant reduction in z-scores of attention and working memory tests (z-score=-1.68±0.90 at baseline and -1.26±1.05 at follow up) compared to the control group (-1.78±0.63 at baseline and -1.45±1.06 at follow up), p corrected=0.003, and a trend for verbal memory (treatment group z-score -2.19±1.14 and -1.61±1.68 and sham group z-score -1.38±1.32 and -1.34±1.5 at baseline and follow up respectively, corrected p=0.074). There were no significant changes in other cognitive domains (verbal, visual, and fluency memory).

Conclusions

This preliminary analysis shows that intensive rehabilitation focused on attention, information processing speed and working memory can improve these cognitive functions.

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