Chemical pathology of acute demyelinating lesions and its correlation with disability.
We report the chemical pathological changes on magnetic resonance spectroscopic images of 4 patients, each of whom had a single large demyelinating plaque. The patients were followed from soon after the onset of the symptoms for a minimum of 7 months to a maximum of 3 1/2 years. We observed increases in the relative resonance intensities of choline-containing compounds, lactate, and myo-inositol inside the lesion acutely. Decreases in relative resonance intensities of N-acetylaspartate and creatine were seen both in and around the magnetic resonance imaging-detected lesions. In all patients neurological deficits improved and creatine, lactate, and myo-inositol resonance intensities normalized during the follow-up. Choline compounds recovered more slowly and were still abnormally high in 1 patient after 7 months. Partial recovery of the N-acetylaspartate resonance was seen for all patients. Evaluation of the relationships between indices of cerebral chemical pathology, brain lesion volumes, and functional disability showed highly significant negative correlations between N-acetylaspartate resonance intensities and both brain lesion volumes (r = -0.80, p < 0.0001) and clinical disability (r = -0.73, p < 0.0001). As N-acetylaspartate is localized solely in neurons in the adult central nervous system, our results suggest that neuronal dysfunction may be a proximate mechanism of disability even in inflammatory disorders primarily affecting myelin and oligodendroglial cells.
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Quebec, Canada.
N
N
De Stefano
P M
PM
Matthews
J P
JP
Antel
M
M
Preul
G
G
Francis
D L
DL
Arnold
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001923:Brain Chemistry; D002794:Choline / Q000378:metabolism; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007294:Inositol / Q000032:analysis; D007773:Lactates / Q000032:analysis; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male
D007773:Lactates; D001224:Aspartic Acid; D007294:Inositol; C000179:N-acetylaspartate; D002794:Choline