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Brain Sciences
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Pathophysiology and Imaging Diagnosis of Demyelinating Disorders
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Pathophysiology and Imaging Diagnosis of Demyelinating Disorders

A special issue of Brain Sciences (ISSN 2076-3425).

Deadline for manuscript submissions: closed (30 April 2017) | Viewed by 91837

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Dr. Evanthia Bernitsas

E-Mail Website
Guest Editor
Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, MI 48201, USA
Interests: neuroimmunology; cognition; fatigue; neuroimaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Demyelinating disorders are chronic autoimmune disorders characterized by inflammation, demyelination, axonal degeneration, and neuronal loss. They have complex pathophysiology and diverse clinical presentations. The etiology of these disorders lies in the interaction between genetic and environmental factors. Due to the complexity in pathophysiology and presentation, diagnosis and treatment can be challenging. Advanced technology, including modern imaging techniques, as well as optical coherence tomography (OCT), enrich our understanding of the disease process, improve diagnostic accuracy, and may guide treatment decisions.

In this Special Issue, we invite and welcome manuscripts addressing, but not limited to: Genetics, etiology, pathogenesis, differential diagnosis, brain imaging, OCT, therapeutics, biomarkers related to disability progression, and critical reviews of clinical trials. Of greatest interest are articles focusing on: (1) advanced MRI imaging modalities and OCT in the differential diagnosis and treatment decisions. (2) novel agents treating symptoms, relapses, and promoting axonal/myelin repair.

We kindly invite you to contribute a manuscript to this Special Issue of Brain Sciences.

Evanthia Bernitsas, MD
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • demyelinating disorders
  • multiple sclerosis
  • therapeutics
  • neuroimaging
  • optical coherence tomography
  • autoimmune
  • remyelination

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Published Papers (10 papers)

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Editorial

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3 pages, 140 KiB  
Editorial
Pathophysiology and Imaging Diagnosis of Demyelinating Disorders
by Evanthia Bernitsas
Brain Sci. 2018, 8(3), 44; https://doi.org/10.3390/brainsci8030044 - 14 Mar 2018
Cited by 3 | Viewed by 4015
Abstract
The spectrum of “demyelinating disorders” is broad and it includes various disorders with central nervous system (CNS) demyelination[...] Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)

Research

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750 KiB  
Article
Structural and Neuronal Integrity Measures of Fatigue Severity in Multiple Sclerosis
by Evanthia Bernitsas, Kalyan Yarraguntla, Fen Bao, Rishi Sood, Carla Santiago-Martinez, Rajkumar Govindan, Omar Khan and Navid Seraji-Bozorgzad
Brain Sci. 2017, 7(8), 102; https://doi.org/10.3390/brainsci7080102 - 12 Aug 2017
Cited by 32 | Viewed by 6027
Abstract
Fatigue is a common and disabling symptom in Multiple Sclerosis (MS). However, consistent neuroimaging correlates of its severity are not fully elucidated. In this article, we study the neuronal correlates of fatigue severity in MS. Forty-three Relapsing Remitting MS (RRMS) patients with MS-related [...] Read more.
Fatigue is a common and disabling symptom in Multiple Sclerosis (MS). However, consistent neuroimaging correlates of its severity are not fully elucidated. In this article, we study the neuronal correlates of fatigue severity in MS. Forty-three Relapsing Remitting MS (RRMS) patients with MS-related fatigue (Fatigue Severity Scale (FSS) range: 1–7) and Expanded Disability Status Scale (EDSS) ≤ 4, were divided into high fatigue (HF, FSS ≥ 5.1) and low fatigue groups (LF, FSS ≤ 3). We measured T2 lesion load using a semi-automated technique. Cortical thickness, volume of sub-cortical nuclei, and brainstem structures were measured using Freesurfer. Cortical Diffusion Tensor Imaging (DTI) parameters were extracted using a cross modality technique. A correlation analysis was performed between FSS, volumetric, and DTI indices across all patients. HF patients showed significantly lower volume of thalamus, (p = 0.02), pallidum (p = 0.01), and superior cerebellar peduncle ((SCP), p = 0.002). The inverse correlation between the FSS score and the above volumes was significant in the total study population. In the right temporal cortex (RTC), the Radial Diffusivity ((RD), p = 0.01) and Fractional Anisotropy ((FA), p = 0.01) was significantly higher and lower, respectively, in the HF group. After Bonferroni correction, thalamic volume, FA-RTC, and RD-RTC remained statistically significant. Multivariate regression analysis identified FA-RTC as the best predictor of fatigue severity. Our data suggest an association between fatigue severity and volumetric changes of thalamus, pallidum, and SCP. Early neuronal injury in the RTC is implicated in the pathogenesis of MS-related fatigue. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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4894 KiB  
Article
Evaluation of Visual-Evoked Cerebral Metabolic Rate of Oxygen as a Diagnostic Marker in Multiple Sclerosis
by Nicholas A. Hubbard, Yoel Sanchez Araujo, Camila Caballero, Minhui Ouyang, Monroe P. Turner, Lyndahl Himes, Shawheen Faghihahmadabadi, Binu P. Thomas, John Hart, Hao Huang, Darin T. Okuda and Bart Rypma
Brain Sci. 2017, 7(6), 64; https://doi.org/10.3390/brainsci7060064 - 11 Jun 2017
Cited by 4 | Viewed by 7445
Abstract
A multiple sclerosis (MS) diagnosis often relies upon clinical presentation and qualitative analysis of standard, magnetic resonance brain images. However, the accuracy of MS diagnoses can be improved by utilizing advanced brain imaging methods. We assessed the accuracy of a new neuroimaging marker, [...] Read more.
A multiple sclerosis (MS) diagnosis often relies upon clinical presentation and qualitative analysis of standard, magnetic resonance brain images. However, the accuracy of MS diagnoses can be improved by utilizing advanced brain imaging methods. We assessed the accuracy of a new neuroimaging marker, visual-evoked cerebral metabolic rate of oxygen (veCMRO2), in classifying MS patients and closely age- and sex-matched healthy control (HC) participants. MS patients and HCs underwent calibrated functional magnetic resonance imaging (cfMRI) during a visual stimulation task, diffusion tensor imaging, T1- and T2-weighted imaging, neuropsychological testing, and completed self-report questionnaires. Using resampling techniques to avoid bias and increase the generalizability of the results, we assessed the accuracy of veCMRO2 in classifying MS patients and HCs. veCMRO2 classification accuracy was also examined in the context of other evoked visuofunctional measures, white matter microstructural integrity, lesion-based measures from T2-weighted imaging, atrophy measures from T1-weighted imaging, neuropsychological tests, and self-report assays of clinical symptomology. veCMRO2 was significant and within the top 16% of measures (43 total) in classifying MS status using both within-sample (82% accuracy) and out-of-sample (77% accuracy) observations. High accuracy of veCMRO2 in classifying MS demonstrated an encouraging first step toward establishing veCMRO2 as a neurodiagnostic marker of MS. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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Review

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207 KiB  
Review
Role of Immunological Memory Cells as a Therapeutic Target in Multiple Sclerosis
by Tanima Bose
Brain Sci. 2017, 7(11), 148; https://doi.org/10.3390/brainsci7110148 - 7 Nov 2017
Cited by 13 | Viewed by 5351
Abstract
Pharmacological targeting of memory cells is an attractive treatment strategy in various autoimmune diseases, such as psoriasis and rheumatoid arthritis. Multiple sclerosis is the most common inflammatory disorder of the central nervous system, characterized by focal immune cell infiltration, activation of microglia and [...] Read more.
Pharmacological targeting of memory cells is an attractive treatment strategy in various autoimmune diseases, such as psoriasis and rheumatoid arthritis. Multiple sclerosis is the most common inflammatory disorder of the central nervous system, characterized by focal immune cell infiltration, activation of microglia and astrocytes, along with progressive damage to myelin sheaths, axons, and neurons. The current review begins with the identification of memory cell types in the previous literature and a recent description of the modulation of these cell types in T, B, and resident memory cells in the presence of different clinically approved multiple sclerosis drugs. Overall, this review paper tries to determine the potential of memory cells to act as a target for the current or newly-developed drugs. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
4140 KiB  
Review
Pattern Recognition of the Multiple Sclerosis Syndrome
by Rana K. Zabad, Renee Stewart and Kathleen M. Healey
Brain Sci. 2017, 7(10), 138; https://doi.org/10.3390/brainsci7100138 - 24 Oct 2017
Cited by 20 | Viewed by 13825
Abstract
During recent decades, the autoimmune disease neuromyelitis optica spectrum disorder (NMOSD), once broadly classified under the umbrella of multiple sclerosis (MS), has been extended to include autoimmune inflammatory conditions of the central nervous system (CNS), which are now diagnosable with serum serological tests. [...] Read more.
During recent decades, the autoimmune disease neuromyelitis optica spectrum disorder (NMOSD), once broadly classified under the umbrella of multiple sclerosis (MS), has been extended to include autoimmune inflammatory conditions of the central nervous system (CNS), which are now diagnosable with serum serological tests. These antibody-mediated inflammatory diseases of the CNS share a clinical presentation to MS. A number of practical learning points emerge in this review, which is geared toward the pattern recognition of optic neuritis, transverse myelitis, brainstem/cerebellar and hemispheric tumefactive demyelinating lesion (TDL)-associated MS, aquaporin-4-antibody and myelin oligodendrocyte glycoprotein (MOG)-antibody NMOSD, overlap syndrome, and some yet-to-be-defined/classified demyelinating disease, all unspecifically labeled under MS syndrome. The goal of this review is to increase clinicians’ awareness of the clinical nuances of the autoimmune conditions for MS and NMSOD, and to highlight highly suggestive patterns of clinical, paraclinical or imaging presentations in order to improve differentiation. With overlay in clinical manifestations between MS and NMOSD, magnetic resonance imaging (MRI) of the brain, orbits and spinal cord, serology, and most importantly, high index of suspicion based on pattern recognition, will help lead to the final diagnosis. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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1236 KiB  
Review
Melanocortins, Melanocortin Receptors and Multiple Sclerosis
by Robert P. Lisak and Joyce A. Benjamins
Brain Sci. 2017, 7(8), 104; https://doi.org/10.3390/brainsci7080104 - 14 Aug 2017
Cited by 21 | Viewed by 7702
Abstract
The melanocortins and their receptors have been extensively investigated for their roles in the hypothalamo-pituitary-adrenal axis, but to a lesser extent in immune cells and in the nervous system outside the hypothalamic axis. This review discusses corticosteroid dependent and independent effects of melanocortins [...] Read more.
The melanocortins and their receptors have been extensively investigated for their roles in the hypothalamo-pituitary-adrenal axis, but to a lesser extent in immune cells and in the nervous system outside the hypothalamic axis. This review discusses corticosteroid dependent and independent effects of melanocortins on the peripheral immune system, central nervous system (CNS) effects mediated through neuronal regulation of immune system function, and direct effects on endogenous cells in the CNS. We have focused on the expression and function of melanocortin receptors in oligodendroglia (OL), the myelin producing cells of the CNS, with the goal of identifying new therapeutic approaches to decrease CNS damage in multiple sclerosis as well as to promote repair. It is clear that melanocortin signaling through their receptors in the CNS has potential for neuroprotection and repair in diseases like MS. Effects of melanocortins on the immune system by direct effects on the circulating cells (lymphocytes and monocytes) and by signaling through CNS cells in regions lacking a mature blood brain barrier are clear. However, additional studies are needed to develop highly effective MCR targeted therapies that directly affect endogenous cells of the CNS, particularly OL, their progenitors and neurons. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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1494 KiB  
Review
Multiple Sclerosis: Immunopathology and Treatment Update
by Narges Dargahi, Maria Katsara, Theodore Tselios, Maria-Eleni Androutsou, Maximilian De Courten, John Matsoukas and Vasso Apostolopoulos
Brain Sci. 2017, 7(7), 78; https://doi.org/10.3390/brainsci7070078 - 7 Jul 2017
Cited by 210 | Viewed by 25481
Abstract
The treatment of multiple sclerosis (MS) has changed over the last 20 years. All immunotherapeutic drugs target relapsing remitting MS (RRMS) and it still remains a medical challenge in MS to develop a treatment for progressive forms. The most common injectable disease-modifying therapies [...] Read more.
The treatment of multiple sclerosis (MS) has changed over the last 20 years. All immunotherapeutic drugs target relapsing remitting MS (RRMS) and it still remains a medical challenge in MS to develop a treatment for progressive forms. The most common injectable disease-modifying therapies in RRMS include β-interferons 1a or 1b and glatiramer acetate. However, one of the major challenges of injectable disease-modifying therapies has been poor treatment adherence with approximately 50% of patients discontinuing the therapy within the first year. Herein, we go back to the basics to understand the immunopathophysiology of MS to gain insights in the development of new improved drug treatments. We present current disease-modifying therapies (interferons, glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod, mitoxantrone), humanized monoclonal antibodies (natalizumab, ofatumumab, ocrelizumab, alemtuzumab, daclizumab) and emerging immune modulating approaches (stem cells, DNA vaccines, nanoparticles, altered peptide ligands) for the treatment of MS. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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920 KiB  
Review
The Role of Peripheral CNS‐Directed Antibodies in Promoting Inflammatory CNS Demyelination
by Silke Kinzel and Martin S. Weber
Brain Sci. 2017, 7(7), 70; https://doi.org/10.3390/brainsci7070070 - 22 Jun 2017
Cited by 14 | Viewed by 7002
Abstract
In central nervous system (CNS) demyelinating disorders, such as multiple sclerosis (MS), neuromyelitis optica (NMO) and related NMO-spectrum disorders (NMO-SD), a pathogenic role for antibodies is primarily projected into enhancing ongoing CNS inflammation by directly binding to target antigens within the CNS. This [...] Read more.
In central nervous system (CNS) demyelinating disorders, such as multiple sclerosis (MS), neuromyelitis optica (NMO) and related NMO-spectrum disorders (NMO-SD), a pathogenic role for antibodies is primarily projected into enhancing ongoing CNS inflammation by directly binding to target antigens within the CNS. This scenario is supported at least in part, by antibodies in conjunction with complement activation in the majority of MS lesions and by deposition of anti-aquaporin-4 (AQP-4) antibodies in areas of astrocyte loss in patients with classical NMO. A currently emerging subgroup of AQP-4 negative NMO-SD patients expresses antibodies against myelin oligodendrocyte glycoprotein (MOG), again suggestive of their direct binding to CNS myelin. However, both known entities of anti-CNS antibodies, anti-AQP-4- as well as anti-MOG antibodies, are predominantly found in the serum, which raises the questions why and how a humoral response against CNS antigens is raised in the periphery, and in a related manner, what pathogenic role these antibodies may exert outside the CNS. In this regard, recent experimental and clinical evidence suggests that peripheral CNS-specific antibodies may indirectly activate peripheral CNS-autoreactive T cells by opsonization of otherwise unrecognized traces of CNS antigen in peripheral compartments, presumably drained from the CNS by its newly recognized lymphatic system. In this review, we will summarize all currently available data on both possible roles of antibodies in CNS demyelinating disorders, first, directly enhancing damage within the CNS, and second, promoting a peripheral immune response against the CNS. By elaborating on the latter scenario, we will develop the hypothesis that peripheral CNS-recognizing antibodies may have a powerful role in initiating acute flares of CNS demyelinating disease and that these humoral responses may represent a therapeutic target in its own right. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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596 KiB  
Review
Contribution of the Degeneration of the Neuro-Axonal Unit to the Pathogenesis of Multiple Sclerosis
by Hannah E. Salapa, Sangmin Lee, Yoojin Shin and Michael C. Levin
Brain Sci. 2017, 7(6), 69; https://doi.org/10.3390/brainsci7060069 - 18 Jun 2017
Cited by 20 | Viewed by 8140
Abstract
Multiple sclerosis (MS) is a demyelinating, autoimmune disease of the central nervous system. In recent years, it has become more evident that neurodegeneration, including neuronal damage and axonal injury, underlies permanent disability in MS. This manuscript reviews some of the mechanisms that could [...] Read more.
Multiple sclerosis (MS) is a demyelinating, autoimmune disease of the central nervous system. In recent years, it has become more evident that neurodegeneration, including neuronal damage and axonal injury, underlies permanent disability in MS. This manuscript reviews some of the mechanisms that could be responsible for neurodegeneration and axonal damage in MS and highlights the potential role that dysfunctional heterogeneous nuclear ribonucleoprotein A1 (hnRNP A1) and antibodies to hnRNP A1 may play in MS pathogenesis. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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201 KiB  
Review
Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson’s Disease?
by Taylor E. Purvis, Daniel Lubelski and Thomas E. Mroz
Brain Sci. 2017, 7(4), 39; https://doi.org/10.3390/brainsci7040039 - 10 Apr 2017
Cited by 9 | Viewed by 5579
Abstract
A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the [...] Read more.
A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment. Full article
(This article belongs to the Special Issue Pathophysiology and Imaging Diagnosis of Demyelinating Disorders)
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