Muscle elastography: a new imaging technique for multiple sclerosis spasticity measurement

Area of Science:

• Neurology
• Biomedical Engineering
• Medical Imaging

Background:

• Multiple sclerosis (MS) spasticity assessment relies on subjective neurological exams like the Ashworth Scale (AS) and 0-10 Numerical Rating Scale (NRS).
• Quantifying spasticity severity objectively remains a challenge in MS patient care.

Purpose of the Study:

• To investigate the utility of real-time elastography (RTHE) ultrasounds for objective muscle fiber status evaluation in MS spasticity.
• To assess the changes in muscle rigidity using RTHE following a novel antispasticity treatment.

Main Methods:

• Study A: 110 MS patients underwent neurological evaluation (AS) and RTHE, with RTHE images scored using the Muscle Elastography Multiple Sclerosis Score (MEMSs) (1-5 scale).
• Study B: 55 MS patients with resistant spasticity treated with THC:CBD oromucosal spray were assessed at baseline and 4 weeks using NRS and MEMSs.
• Correlation analysis between AS and MEMSs, and assessment of NRS and MEMSs changes in relation to treatment response.

Main Results:

• A statistically significant correlation was found between the Ashworth Scale (AS) and the MEMSs score in Study A.
• In Study B, 65% of patients responded to THC:CBD treatment, showing significant reductions in both NRS (1.87) and MEMSs (1.97) scores (P<0.0001).
• Even non-responder patients exhibited a significant mean reduction in MEMSs (0.8, P=0.002), indicating objective changes in muscle rigidity.

Conclusions:

• Real-time elastography (RTHE), operationalized via the MEMSs score, provides an objective measure for evaluating MS muscle spasticity.
• RTHE and MEMSs demonstrate potential as a gold standard for assessing the effectiveness of antispasticity therapies in multiple sclerosis.