Author Of 2 Presentations
P0537 - Analysis of Vascular abnormalities for lesions in MS using USPIO (ID 781)
Abstract
Background
Multiple Sclerosis (MS) is a progressive, inflammatory and neurodegenerative disease of the CNS, characterized by a wide range of symptoms, autoimmune responses, and vascular dysfunction. Ultra-small superparamagnetic iron oxides (USPIO) agent, Ferumoxytol, was administered to induce an increase in susceptibility in both arterial and venous blood; which helped in revealing the cerebral microvasculature.
Objectives
To reveal and examine the vascular anomalies in MS patients using Ferumoxytol and high-resolution susceptibility weighted imaging (SWI).
Methods
Six subjects with relapsing remitting MS were included in the study (47.33 ± 11.75 years with 3 females and 3 males) and were scanned with a 3T MRI scanner (Ferumoxytol dose = 4 mg/kg). All patients were scanned with a dual-echo optimized gradient echo sequence (TE1/TE2/TR = 7.5ms/15ms/27ms) with an in-plane resolution of 0.22×0.44 mm2 interpolated to 0.22×0.22 mm2 and a slice thickness of 1 mm (3 subjects) and 1.5 mm (3 subjects). 3D FLAIR data was also acquired with: TR/TE/TI = 6000ms/405ms/2000ms and a resolution of 0.88×0.88×2mm3. Composite SWI-FLAIR data was generated by registering the FLAIR data to the high resolution SWI data and then multiplying the phase mask onto the registered FLAIR data to highlight the vascular information on the white matter hyperintensities (WMH). The lesions with anomalous vascular behavior such as engorged and shortened vessels within WMHs, small WMHs appearing only at the vessel boundary and developmental venous angiomas were identified for each subject. For the remaining WMHs, the central vessel sign (CVS) and, due to the presence of several underlying vessels, multiple vessel sign (MVS) were identified on pre- and post-contrast SWI-FLAIR data.
Results
A total of 489 lesions were identified across all patients. The total number of CVS and MVS on pre-contrast data were 142 and 12, respectively; whereas the total number of CVS and MVS on post-contrast data were 308 and 81, respectively. This shows a significant increase in visibility of the vasculature after Ferumoxytol administration. Additionally, the vessel anomalies observed within WMHs increased from 11 on pre-contrast to 72 on post-contrast data.
Conclusions
By inducing a non-zero susceptibility into the blood using Ferumoxytol, both small arteries and veins at the sub-voxel level of 50-100 µm were revealed, which was only possible previously in cadaver brain studies. This approach has the potential to monitor the venous vasculature present in MS lesions, catalogue their characteristics and compare the vascular structures spatially to the presence of WMH, which may provide new insight into the pathophysiology of MS.
P1112 - Transcranial Direct Current Stimulation (tDCS) Results in Lasting Reduction in MS-Related Fatigue (ID 1916)
Abstract
Background
Fatigue is a common and often debilitating symptom of multiple sclerosis (MS) that remains without an effective treatment. Noninvasive brain stimulation with transcranial direct current stimulation (tDCS) is a promising therapeutic approach with controlled clinical trials demonstrating its near-term benefit in reducing MS fatigue. However, the persisting benefit of treatment has not yet been characterized.
Objectives
To test whether there is persisting benefit for the treatment of MS-related fatigue with noninvasive brain stimulation using tDCS.
Methods
As part of a larger study participants with MS-related fatigue completed the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) at baseline and following 20 daily at-home remotely supervised or RS-tDCS sessions (open-label, 20min x 2.0mA, anode over left DLPFC and cathode over right DLPFC) paired with computerized cognitive training (BrainHQ). Assessments were repeated at 3-months post-treatment.
Results
Participants were n=17 with MS, mean age 49.1 ± 10.8, EDSS median 5.0 (0-7) and clinically significant fatigue at baseline (FSS= 51.2 ± 10.4). Consistent with prior studies, there was a significant reduction in fatigue following 20 daily treatment sessions (51.6 ± 15.5 vs. 37.9 ± 13.1, mean difference -13.7, p= 0.007). Statistically significant reductions in fatigue were further seen across all MFIS sub scores: physical (24.1 ± 7.3 vs. 19.0 ± 7.55, p= 0.024), cognitive (22.5 ± 9.1 vs. 14.9 ± 7.8, p= 0.004), and psychological/social (5.0 ± 2.0 vs. 4.0 ± 1.6, p= 0.033). At three months post treatment, fatigue benefit persisted (51.6 ± 15.5 vs. 41.4 ± 11.7, mean difference -10.2, p= 0.02). Statistically significant reductions in fatigue were maintained 3-months post-treatment in the social (p= 0.004) and physical (p= 0.02) MFIS sub scores.
Conclusions
A period of repeated daily treatment with left anodal dorsolateral prefrontal cortex tDCS can lead to persisting reductions in MS-related fatigue 3-months post treatment.