title: q-Space Myelin Map imaging for longitudinal analysis of demyelination and remyelination in multiple sclerosis patients treated with fingolimod: A preliminary study.
abstract: BACKGROUND
  Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models.
  
  
  OBJECTIVE
  To analyze feasibility of a novel q-space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MS patients.
  
  
  METHODS
  Treatment outcomes of 24 consecutive MS patients treated with FTY were analyzed. A longitudinal analysis of q-space Myelin Map imaging was performed in a subset of these patients.
  
  
  RESULTS
  During the treatment course (average of 16.1months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state ("optimal responders"). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q-space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions.
  
  
  CONCLUSIONS
  FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q-Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MS patients.
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Tanikawa
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: nakahara@a6.keio.jp.
authors.forename: Jin
authors.initials: J
authors.lastname: Nakahara
authors.affiliation: Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Laboratory for Marmoset Neural Architecture, RIKEN Brain Science Institute, 2-1 Hirosawa, Wako, Saitama 351-0106, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hata
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan.
authors.forename: Kanehiro
authors.initials: K
authors.lastname: Fujiyoshi
authors.affiliation: Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, 160-8582, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, 160-8582, Japan.
authors.forename: Suketaka
authors.initials: S
authors.lastname: Momoshima
authors.affiliation: Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, 160-8582, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Laboratory for Marmoset Neural Architecture, RIKEN Brain Science Institute, 2-1 Hirosawa, Wako, Saitama 351-0106, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Okano
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: nrsuzuki@a2.keio.jp.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D009186:Myelin Sheath / Q000187:drug effects*; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging / Q000187:drug effects; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride
keywords: Fingolimod; MRI; Multiple sclerosis; Remyelination; q-Space Myelin Map