MRI correlates of clinical disability and hand-motor performance in multiple sclerosis phenotypes

Claudio Cordani, Milagros Hidalgo de la Cruz, Alessandro Meani, Paola Valsasina, Federica Esposito, Elisabetta Pagani, Massimo Filippi, Maria A Rocca
Multiple Sclerosis: Clinical and Laboratory Research 2020 September 14, : 1352458520958356

BACKGROUND: Hand-motor impairment affects a large proportion of multiple sclerosis (MS) patients; however, its substrates are still poorly understood.

OBJECTIVES: To investigate the association between global disability, hand-motor impairment, and alterations in motor-relevant structural and functional magnetic resonance imaging (MRI) networks in MS patients with different clinical phenotypes.

METHODS: One hundred thirty-four healthy controls (HC) and 364 MS patients (250 relapsing-remitting MS (RRMS) and 114 progressive MS (PMS)) underwent Expanded Disability Status Scale (EDSS) rating, nine-hole peg test (9HPT), and electronic finger tapping rate (EFTR). Structural and resting state (RS) functional MRI scans were used to perform a source-based morphometry on gray matter (GM) components, to analyze white matter (WM) tract diffusivity indices and to perform a RS seed-based approach from the primary motor cortex involved in hand movement (hand-motor cortex). Random forest analyses identified the predictors of clinical impairment.

RESULT: In RRMS, global measures of atrophy and lesions together with measures of structural damage of motor-related regions predicted EDSS (out-of-bag (OOB)- R 2  = 0.19, p -range = <0.001-0.04), z9HPT (right: OOB- R 2  = 0.14; left: OOB- R 2  = 0.24, p -range = <0.001-0.03). No RS functional connectivity (FC) abnormalities were identified in RRMS models. In PMS, cerebellar and sensorimotor regions atrophy, cerebellar peduncles integrity and increased RS FC between left hand-motor cortex and right inferior frontal gyrus predicted EDSS (OBB- R 2  = 0.16, p -range = 0.02-0.04).

CONCLUSION: In RRMS, only measures of structural damage contribute to explain motor impairment, whereas both structural and functional MRI measures predict clinical disability in PMS. A multiparametric MRI approach could be relevant to investigate hand-motor impairment in different MS phenotypes.

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