Evidence for early, non-lesional cerebellar damage in patients with multiple sclerosis: DTI measures correlate with disability, atrophy, and disease duration.
BACKGROUND
Common symptoms of multiple sclerosis (MS) such as gait ataxia, poor coordination of the hands, and intention tremor are usually the result of dysfunctionality in the cerebellum. Magnetic resonance imaging (MRI) has frequently failed to detect cerebellar damage in the form of inflammatory lesions in patients presenting with symptoms of cerebellar dysfunction.


OBJECTIVE
To detect microstructural cerebellar tissue alterations in early MS patients with a "normal appearing" cerebellum using diffusion tensor imaging (DTI).


METHODS
A total of 68 patients with relapsing-remitting MS (RRMS) and without cerebellar lesions and 26 age-matched healthy controls were admitted to high-resolution MRI and DTI to assess microstructure and volume of the cerebellar white matter (CBWM).


RESULTS
We found cerebellar fractional anisotropy (FA) and CBWM volume reductions in the group of 68 patients. Interestingly, a subgroup of these patients that was derived by including only patients with early and mild MS (N=23, median age 30 years, median Expanded Disability Status Scale =1.5, median duration 28 months) showed already cerebellar FA but no CBWM volume reductions. FA reductions were correlated with disability, atrophy, and disease duration.


CONCLUSIONS
"Normal appearing" cerebellar white matter can be damaged in a very early stage of RRMS. DTI seems to be a sensitive tool for detecting this hidden cerebellar damage.
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany mail@Michael-Deppe.de.
Michael
M
Deppe
Weierstrass Institute, Berlin, Germany.
Karsten
K
Tabelow
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Julia
J
Krämer
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Jan-Gerd
JG
Tenberge
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Patrick
P
Schiffler
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Stefan
S
Bittner
Department of Clinical Radiology, Westfälische Wilhelms University, Münster, Germany.
Wolfram
W
Schwindt
Department of Neurology, Rhine Main Neuroscience Network, Johannes Gutenberg University Medical Centre Mainz, Germany.
Frauke
F
Zipp
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Heinz
H
Wiendl
Department of Neurology, Westfälische Wilhelms University, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany.
Sven G
SG
Meuth
D000328:Adult; D001284:Atrophy / Q000473:pathology; D002526:Cerebellar Diseases / Q000209:etiology / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology*; D012720:Severity of Illness Index; D013997:Time Factors; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
Diffusion tensor imaging; atrophy; cerebellum; degeneration; multiple sclerosis