Noninvasive Assessment Follow-Up of Progress in MS Patients

Multiple sclerosis (MS) is the leading cause of disability in young adults. We aimed to monitor disease progression characteristics using cognitive and physical parameters with optical coherence tomography (OCT) and Magnetic Resonance Spectroscopy (MRS).

Fifteen relapsing remitting (RRMS), thirteen secondary progressive (SPMS) and twelve primary progressive (PPMS) patients were included. The Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test (9 HPT), Timed 25-Foot Walk Test (T25FWT), Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Montreal Cognitive Assessment (MoCA), MRS and OCT examinations were performed at baseline and follow-up.

EDSS, Beck Depression Scale scores, 9-HPT and T25FWT duration scores were higher in the PPMS group compared to the other groups, whereas MoCA, SDMT, CVLT2, and BVMT-R scores were the lowest in this group. Retinal nerve fiber layer (RNFL) measurements in the right (p=0.023) and left (p=0.028) nasal quadrants were found to be higher in the RRMS group compared to the progressive groups. Baseline MRS showed a lower Thalamus myoinositol/creatinine (mI/Cr) ratio in progressed patients compared to stable patients (p=0.003). A cut-off value of baseline Thalamus mI/Cr ratio <0.066 for predicting disease progression based on baseline Thalamus mI/Cr was determined to be <0.066, with an 81.82% sensitivity, and 79.17% specificity, 64.29% positive predictive value (PPV), and 90.48% negative predictive value (NPV) (p=0.003).

Early detection of disease progression has critical importance for MS. Besides prognostic serum or cerebrospinal fluid biomarker tests, noninvasive methods such as disability scales and/or imaging techniques may have a significant impact and are easily replicable. As an advanced imaging technique, MRS has the potential for ongoing tissue inflammation. In parallel with that, we have obtained a cut-off thalamic mI/Cr ratio value as a significant predictor of disease progression in MS patients.