Dynamics of choroid plexus volume is associated with the presence and development of fatigue in multiple sclerosis.

IF 8.7 1区医学 Q1 CLINICAL NEUROLOGY Journal of Neurology, Neurosurgery, and Psychiatry Pub Date : 2024-10-10 DOI:10.1136/jnnp-2024-334913

Martina Rubin, Paolo Preziosa, Monica Margoni, Alessandro Meani, Elisabetta Pagani, Gianluca Corazzolla, Loredana Storelli, Damiano Mistri, Massimo Filippi, Maria A Rocca

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Abstract

Background: Immune-mediated processes are implicated in the pathogenesis of fatigue, a common symptom in multiple sclerosis (MS). The choroid plexus (CP) regulates central nervous system (CNS) immune homeostasis and undergoes volumetric modifications possibly contributing to MS-related fatigue. We explored the association between MS-related CP volume changes and fatigue dynamics.

Method: Eighty-five patients with MS and 68 healthy controls (HC) underwent brain 3T MRI, neurological evaluation and Modified Fatigue Impact Scale (MFIS) at two timepoints (median follow-up=1.4 years). Normalised brain and regional grey matter (GM) volumes were obtained using FSL-SIENAx, FIRST, SIENA and tensor-based morphometry. CP volumes were quantified with in-house methods, and longitudinal changes were analysed using linear mixed models.

Results: At baseline, 25 (29%) patients with MS had fatigue (f-MS) (MFIS ≥38). Compared with HC, patients with MS had significantly higher brain T2-lesion volume, lower brain, deep GM, cortical volumes and higher CP volume (false discovery rate (FDR)-p ≤0.024). Compared with non-fatigued (nf-MS) patients, f-MS were older, more disabled (FDR-p ≤0.002) and showed numerically higher CP volume (FDR-p=0.076). At follow-up, 41 (68%) nf-MS remained non-fatigued (nf-FU-MS) and 19 (32%) developed fatigue (f-FU-MS). Patients with MS showed higher brain and deep GM atrophy rates versus HC (FDR-p ≤0.048), whereas clinical, lesional and brain volumetric changes were not significantly different among MS groups (FDR-p ≥0.287). CP volume significantly increased in all MS groups compared with HC (FDR-p ≤0.043), with greater enlargement in f-FU-MS versus nf-FU-MS (FDR-p=0.048).

Conclusions: Larger CP and greater enlargement are associated with the presence and development of fatigue in MS, likely reflecting dynamic inflammatory states within the CNS, supporting the immunological contribution to MS-related fatigue.

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脉络丛体积的动态变化与多发性硬化症患者疲劳的存在和发展有关。

背景：疲劳是多发性硬化症（MS）的常见症状，免疫介导的过程与疲劳的发病机制有关。脉络丛（CP）调节中枢神经系统（CNS）的免疫平衡，并发生体积变化，这可能是导致多发性硬化症相关疲劳的原因之一。我们探讨了与多发性硬化症相关的脉络丛体积变化与疲劳动态之间的关联：85名多发性硬化症患者和68名健康对照组（HC）在两个时间点（中位随访时间=1.4年）接受了脑部3T磁共振成像、神经学评估和改良疲劳影响量表（MFIS）。使用 FSL-SIENAx、FIRST、SIENA 和基于张量的形态测量法获得归一化大脑和区域灰质（GM）体积。CP体积采用内部方法进行量化，纵向变化采用线性混合模型进行分析：基线时，25 名（29%）多发性硬化症患者有疲劳感（f-MS）（MFIS ≥38）。与HC相比，多发性硬化症患者的脑T2-病灶体积明显增大，脑、深部GM、皮质体积降低，CP体积增大（假发现率（FDR）-p≤0.024）。与非疲劳症（nf-MS）患者相比，疲劳症患者年龄更大，残疾程度更高（FDR-p ≤0.002），CP 容量更高（FDR-p=0.076）。在随访中，41 名 nf-MS 患者（68%）仍未出现疲劳（nf-FU-MS），19 名患者（32%）出现疲劳（f-FU-MS）。多发性硬化症患者的脑萎缩率和深部GM萎缩率高于HC患者（FDR-p≤0.048），而多发性硬化症组间的临床、病变和脑容量变化无显著差异（FDR-p≥0.287）。与HC相比，所有MS组的CP体积均明显增大（FDR-p≤0.043），其中f-FU-MS与nf-FU-MS相比CP体积增大更多（FDR-p=0.048）：结论：CP增大和扩大与多发性硬化症患者疲劳的出现和发展有关，可能反映了中枢神经系统内的动态炎症状态，支持免疫学对多发性硬化症相关疲劳的贡献。

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来源期刊

Journal of Neurology, Neurosurgery, and Psychiatry 医学-精神病学

CiteScore

15.70

自引率

1.80%

发文量

888

审稿时长

6 months

期刊介绍： The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.