The clinical impact of cerebellar grey matter pathology in multiple sclerosis.
BACKGROUND
The cerebellum is an important site for cortical demyelination in multiple sclerosis, but the functional significance of this finding is not fully understood.


OBJECTIVE
To evaluate the clinical and cognitive impact of cerebellar grey-matter pathology in multiple sclerosis patients.


METHODS
Forty-two relapsing-remitting multiple sclerosis patients and 30 controls underwent clinical assessment including the Multiple Sclerosis Functional Composite, Expanded Disability Status Scale (EDSS) and cerebellar functional system (FS) score, and cognitive evaluation, including the Paced Auditory Serial Addition Test (PASAT) and the Symbol-Digit Modalities Test (SDMT). Magnetic resonance imaging was performed with a 3T scanner and variables of interest were: brain white-matter and cortical lesion load, cerebellar intracortical and leukocortical lesion volumes, and brain cortical and cerebellar white-matter and grey-matter volumes.


RESULTS
After multivariate analysis high burden of cerebellar intracortical lesions was the only predictor for the EDSS (p<0.001), cerebellar FS (p = 0.002), arm function (p = 0.049), and for leg function (p<0.001). Patients with high burden of cerebellar leukocortical lesions had lower PASAT scores (p = 0.013), while patients with greater volumes of cerebellar intracortical lesions had worse SDMT scores (p = 0.015).


CONCLUSIONS
Cerebellar grey-matter pathology is widely present and contributes to clinical dysfunction in relapsing-remitting multiple sclerosis patients, independently of brain grey-matter damage.
Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.
Alfredo
A
Damasceno
Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.
Benito Pereira
BP
Damasceno
Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.
Fernando
F
Cendes
D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D003711:Demyelinating Diseases / Q000473:pathology / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D066128:Gray Matter / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D015999:Multivariate Analysis; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D066127:White Matter / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult