BACKGROUND
Growing evidence supports choroid plexus (CP) involvement in MS pathophysiology, but phase-specific associations according to recent inflammatory activity and longitudinal dynamics remain unclear.
OBJECTIVE
To characterize CP alterations in MS using volumetric and quantitative magnetic resonance imaging (MRI) and explore associations with neuroinflammation and neurodegeneration.
METHODS
We analyzed cross-sectional and 2-year longitudinal data from 101 patients with active relapsing MS (RMS), 83 with inactive progressive MS (PMS), and 100 controls, with MS groups stratified by inflammatory activity within the prior year. CP volume, quantitative T1, and magnetization transfer saturation (MTsat) were assessed alongside imaging, serum, and clinical measures, with validation in a second cohort (62 active/357 inactive MS).
RESULTS
CP volume was increased in both active RMS and inactive PMS and was associated with lower total and cortical brain volumes. Associations with brain microstructural damage were more pronounced in periventricular regions, compatible with a surface-in pattern. Similar associations were observed in controls, suggesting CP volume may reflect processes beyond MS-specific pathology, including physiological factors. Longitudinally, CP volume increased exclusively in active RMS, with faster expansion associated with thalamic atrophy. CP MTsat was associated with cortical and paramagnetic rim lesions in inactive PMS.
CONCLUSION
CP enlargement is consistent across MS phases. Longitudinal expansion occurs in active inflammatory disease and is associated with neurodegenerative changes.
M. Mastantuono, A. Cagol, M. Ocampo-Pineda et al.· Multiple Sclerosis· 0 citations
Background and Objectives Neuromyelitis optica spectrum disorder (NMOSD) is a severe condition usually associated with aquaporin-4 (AQP4) antibodies. A clinical presentation suggestive of NMOSD can also be associated with myelin oligodendrocyte glycoprotein (MOG) antibodies (MOGAD). NMOSD can be diagnosed in the absence of autoantibodies (double-negative NMOSD [DN-NMOSD]), but this subgroup has been poorly investigated. We conducted a systematic review and meta-analysis to define the clinical spectrum, prognosis, and treatment response in DN-NMOSD vs AQP4-NMOSD/MOGAD. Methods We searched on PubMed, Scopus, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov databases of studies on patients fulfilling inclusion criteria. Patient characteristics, outcome measures, and treatment regimens were extracted. Results We included 41 of 1,027 articles screened and analyzed 671 patients with DN-NMOSD (median age 38.6 years [range IQR: 32.5–42.85]; female-to-male ratio 1.5:1; median follow-up 44.4 months [range 1–600]), 73.6% of which relapsed. In the meta-analysis, mean annualized relapse rate (ARR) was higher, albeit not significantly, in DN-NMOSD (1.08; 95% CI 0.73–1.43) vs AQP4-NMOSD (0.84; 95% CI 0.45–1.23) and MOGAD (0.61; 95% CI 0.39–0.83, p = 0.08). Administration of maintenance immunosuppression in DN-NMOSD led to a significant ARR reduction (pooled rate ratio 0.19, 95% CI 0.07–0.49; p = 0.001), with high heterogeneity (I2 = 90%, p < 0.0001). In meta-regression, no covariates were associated with ARR reduction, including the administration of specific drugs (rituximab, p = 0.288; azathioprine, p = 0.291; mycophenolate, p = 0.918). The pooled mean difference in pre‑ and post‑maintenance treatment Expanded Disability Status Scale values indicated a significant change in disability in MOGAD (−0.93, 95% CI −1.67 to −0.19, p = 0.02) but not in AQP4-NMOSD (−0.62, 95% CI −1.85 to 0.61, p = 0.27) or DN-NMOSD (−0.52 (95% CI −1.30 to 0.25, p = 0.16). Discussion DN-NMOSD is a heterogenous, severe and highly relapsing disease, where attacks lead to irreversible dysfunction. The administration of maintenance immunotherapy reduces the relapse risk and should be considered early to prevent further disability.
A. Malvaso, F. Bovis, Giacomo Greco et al.· Neurology(R) neuroimmunology...· 0 citations