Patients with a clinically isolated syndrome had significantly elevated myo-inositol concentrations in normal-appearing white matter compared to healthy controls (3.82 vs 3.31 mM; P=0.001).
Case-Control (n=140)
Absolute Event Rate: 3.82% vs 3.31%
p-value: p=0.001
Normal-appearing white matter (NAWM) in established multiple sclerosis has been shown to be abnormal using a variety of magnetic resonance (MR) techniques, including proton MR spectroscopy ((1)H-MRS), although the stage at which these changes first appear is less clear. Using a 1.5 T scanner and single-voxel (1)H-MRS TR 3000 ms, TE 30 ms, point-resolved spectroscopy (PRESS) localization, we determined NAWM metabolite concentrations in 96 patients a mean of 19 weeks (range 12-28 weeks) after onset of a clinically isolated syndrome (CIS) suggestive of multiple sclerosis and in 44 healthy control subjects. Absolute concentrations of N-acetyl-aspartate, total creatine and phosphocreatine (Cr), choline-containing compounds, glutamate plus glutamine, and myo-inositol (Ins) were estimated automatically using the LCModel. Compared with control subjects, the concentration of Ins was elevated in CIS NAWM (mean 3.31 mM, SD 0.86 versus mean 3.82 mM, SD 1.06; P = 0.001). The increase in Ins was also seen in the patient subgroup with abnormal T2-weighted MRI (mean 3.88 mM, SD 1.10; P = 0.001) and in those who satisfied the McDonald criteria for multiple sclerosis (mean 4.04 mM, SD 1.31; P = 0.001). An increase in Cr was also observed in CIS NAWM (P = 0.023), but other metabolites did not significantly differ between the whole CIS group and control subjects. There was no significant correlation between NAWM Ins and T2 lesion load. The early increase in Ins may reflect a process of pathogenic importance in multiple sclerosis NAWM. Follow-up studies will investigate whether the increase in NAWM Ins is of prognostic importance for future relapses and disability.
Kryshani Fernando (Tue,) conducted a case-control in Clinically isolated syndrome (CIS) suggestive of multiple sclerosis (n=140). Clinically isolated syndrome (CIS) vs. Healthy control subjects was evaluated on Concentration of myo-inositol (Ins) in normal-appearing white matter (p=0.001). Patients with a clinically isolated syndrome had significantly elevated myo-inositol concentrations in normal-appearing white matter compared to healthy controls (3.82 vs 3.31 mM; P=0.001).