Background

SC pathology occurs early in the course of MS. However, few studies have investigated the relationship between lesions, diffuse changes and mean upper cervical cord area (MUCCA) in MS patients with different levels of disability in detail.

Objectives

To explore spinal cord (SC) pathology in multiple sclerosis (MS) patients with different levels of disability and MS phenotypes.

Methods

638 MS patients with different degrees of disability and 102 healthy controls (HC) underwent MRI on a 3T (MAGNETOM Skyra, Siemens Healthcare, Erlangen, Germany). The MRI protocol comprised transversal 3D-T2WI for MUCCA, sagittal T2WI-Fat-Sat and PDWI for SC pathology, and 3D-MPRAGE for regional brain volume (BV). MUCCA was measured automatically between the C3 and C4 vertebra (ScanView.cz). Global and regional BVs were estimated by the fully automated MorphoBox prototype (Siemens Healthcare, Erlangen, Germany). Diffuse changes, number and location of SC lesions were assessed manually. Patients and HC were matched by sex and age using propensity scores. MUCCA, regional BVs and SC pathology were compared among matched subgroups of: 54 patients with mild disability (EDSS=<1.5), 54 patients with mild-to-moderate disability (EDSS 2-3.5), 54 patients with severe disability (EDSS 4-4.5), 54 patients with very severe disability (EDSS>=5), 18 primary progressive (PP) patients, and 54 controls from the HC group. ANOVA test was used for between-group comparison.

Results

There was a trend of lower MUCCA with higher disability level. Mean MUCCA was 76.5±10.8 mm² invery severe, 80.1±9.6 mm² in severe, 85.7±8.0 mm² in moderate, 85.6±8.5 mm² in mild disability, and 90±7.7 mm² in HC groups. There was a significant difference in MUCCA between HC and mild disability group (p<0.001). SC pathology was prominent in 64.1% of the patients with mild disability, compared to 90.4% patients with very severe disability. The percentage of diffuse changes varied greatly between the groups, with prevalence increasing almost four times between patients with mild and very severe disability.

Conclusions

SC pathology is present in all disability MS groups. MUCCA differentiated between patients with mild disability and healthy controls, suggesting that it may be promising for the implementation in diagnostic protocols. The evaluation of diffuse changes can help to predict disability. Low MUCCA together with prominent diffuse changes could help differentiate PP MS from other MS phenotypes.

Background

Sexual dysfunction is a common, but underestimated symptom of multiple sclerosis (MS). Although sexual dysfunction may occur even as early symptom of disease or in people with mild neurological disability, only few patients report this symptom to their physician. Only few studies investigated association between sexual dysfunction and MS-related cerebral changes. But no studies specifically investigating sexual dysfunction and spinal cord pathology in MS.

Objectives

Objectives: 1) to identify the sexual dysfunction (SD) in females with MS using the Female Sexual Function Index (FSFI = 19-item questionnaire of the FSFI that concerns sexual function and satisfaction in sex life).

2) to explore the association between SD, physical disability and MR measures, especially lesion topology and spinal cord pathology.

Methods

In 251 women with MS (mean age: 43.3 ± 8.9 years; mean disease duration 14.7 ± 6.2), sexual functions were evaluated by using the Female Sexual Function Index (FSFI).

We determined potential confounding factors of sexual dysfunction: age; disease duration; physical disability; depression.

Global and regional brain volumes were measured by Morphobox Prototype; Lesion load and topography was assessed by LeMan-PV Prototype. Spinal cord (SC) volume was measured semi-automatically by ScanView.cz; SC lesions and diffuse abnormalities were assessed manually between C1 and Th4. We correlated disability measures and FSFI domains with one another and with MRI measures.

Results

Of the 251 female patients, 147 replied completely, with a response rate of 58.5%. Using a cut-off value of 28 for FSFI scoring, 60 out of 141 (42.5%) had sexual dysfunction (SD). FSFI total score and subscores correlated moderately with BDI (0.331, p=0.011), FSS (0.45, p=0.05) and weak to moderate negative correlations with EDSS (0.481, p=0.002), sensory (0.441, p=0.005), bowel and bladder (0.346, p=0.031), pyramidal (0.481, p=0.002), cerebellar (0.434, p=0.006) and cerebral FS (0.39, p=0.014)scores. Women with- and without SD did not differ in cerebral lesion load and/or lesion topography.

Conclusions

We found no association between measures of SD, total and regional brain volumes, spinal cord volume, cerebral lesion load and topology. SD in women with MS is associated with higher disability, disease duration, and degree of concomitant fatigue and depression rather than specific lesion topology. The major limitation of this interpretation is the absence of a SC imaging distal from Th4.

Supported by grant of Czech Ministry of Education Progres Q27/LF1.