Axonal injury or loss in the internal capsule and motor impairment in multiple sclerosis

被引:86
作者
Lee, MA
Blamire, AM
Pendlebury, S
Ho, KH
Mills, KR
Styles, P
Palace, J
Matthews, PM [1 ]
机构
[1] John Radcliffe Hosp, Ctr Funct Magnet Resonance Imaging Brain, Oxford OX3 9DU, England
[2] John Radcliffe Hosp, MRC, Magnet Resonance Spect Unit, Oxford OX3 9DU, England
[3] Radcliffe Infirm, Dept Clin Neurol, Oxford OX2 6HE, England
[4] Radcliffe Infirm, Dept Neurophysiol, Oxford OX2 6HE, England
关键词
D O I
10.1001/archneur.57.1.65
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To test the hypothesis that axonal damage extending into primarily normal-appearing white matter is clinically important by comparing the concentrations of N-acetylaspartate (NAA) bilaterally within the internal capsule with lateralization of motor impairment in patients with multiple sclerosis (MS) and persistent asymmetrical motor deficit. Design: We performed magnetic resonance spectroscopy and T2-weighted imaging of the internal capsule, calculated central motor conduction times, and related these results to measures of motor function asymmetry in 12 patients with MS. Results: Levels of NAA from normal-appearing white matter of the internal capsule in patients with MS were significantly lower than those in control subjects (P = .05). Side-to-side differences in NAA levels were also significantly greater in patients with MS than in controls (P = .01). There was a correlation between asymmetry in motor function for the left and right limbs and asymmetry of internal capsule NAA concentrations (r = 0.60; P = .04). This correlation seemed slightly stronger when tests specifically of arm and hand motor asymmetry were considered alone. Central motor conduction times were abnormal in most patients with MS and showed a side-to-side difference that also correlated with asymmetry in motor function. Conclusion: Our demonstration of a graded association between NAA concentrations within primarily normal-appearing white matter of a specific tract and functional impairments referable to that tract suggests that axonal pathology distant from macroscopic lesions might be an important determinant of disability in MS.
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页码:65 / 70
页数:6
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