Authors
Bolomatov N.V.1, Shulzhenko E.A.2, Masaleva I.O.2, Molchanov I.P.2
1 Pirogov National Medical and Surgical Center, Moscow
2 Kursk State Medical University, Kursk
Abstract
Introduction. Multiple sclerosis (MS) is characterized by its course in patients of different genders. The described neurodegenerative and proinflammatory phenotypes of MS have different representation in men and women. The diversity of views on the influence of the location, size of demyelination foci and the degree of disability in patients with multiple sclerosis determines the importance of assessing these parameters by gender.
The aim of the study was to analyze gender characteristics in the location of demyelination zones, the relationship between morphological and quantitative features of focal changes and disability in patients with multiple sclerosis.
Materials and methods. A prospective analysis of magnetic resonance imaging data was performed in 103 patients (women – 54, men – 49; average age – 39±11.7) with relapsing-remitting multiple sclerosis during the period of persistent remission, who received outpatient care at the Kursk Regional Multidisciplinary Clinical Hospital in 2017-2024 using the consent criteria and correlation analysis.
Results. The presence of periventricular foci of demyelination in 72.2% of cases was recorded in women, while in men this figure was 97.9%, the differences are significant (p<0.05). In the corpus callosum, demyelination foci were more often observed in men than in women – 46.2% versus 65.3% (p<0.05). In the cervical spine, the demyelinating process was more pronounced in men (79.6%) compared to women (40.7%), which is statistically significant (p<0.05). When assessing the severity of demyelination in the cerebellum, it was found that in men the proportion of foci was 46.9%, while in women this figure was 29.6% (p<0.05). Correlation analysis using the Spearman criterion revealed a reliable effect of the number of foci on EDSS in the male population (p<0.05). Correlation analysis revealed a moderate positive relationship between the sizes (min/max) and the disability indices of the connection in female patients (ρ = 0.397; p<0.05). Conclusion. In men, foci are localized more often periventricularly, in the cerebellum, corpus callosum and cervical spinal cord compared to women, which is comparable with the degree of disability. Women have a lesser degree of demyelinating process and a more favorable prognosis according to EDSS.
Keywords: multiple sclerosis, MRI, neuroradiology, gender.
References
1. Hauser SL, Cree BAC. Treatment of Multiple Sclerosis: A Review. Am J Med. 2020; 133(12): 1380-1390.e2. doi: 10.1016/j.amjmed.2020.05.049.
2. Faissner S, Plemel JR, Gold R, et al. Progressive multiple sclerosis: from pathophysiology to therapeutic strategies. Nat Rev Drug Discov. 2019; 18(12): 905-922. doi: 10.1038/s41573-019-0035-2.
3. Correale J, Gaitán MI, Ysrraelit MC, et al. Progressive multiple sclerosis: from pathogenic mechanisms to treatment. Brain. 2017; 140(3): 527-546. doi: 10.1093/brain/aww258.
4. Wingerchuk DM, Carter JL. Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies. Mayo Clin Proc. 2014; 89(2): 225-40. doi: 10.1016/j.mayocp.2013.11.002.
5. Fujita S, Yokoyama K, Hagiwara A, et al. 3D Quantitative Synthetic MRI in the Evaluation of Multiple Sclerosis Lesions. AJNR Am J Neuroradiol. 2021; 42(3): 471-478. doi: 10.3174/ajnr.A6930.
6. Ward M, Goldman MD. Epidemiology and Pathophysiology of Multiple Sclerosis. Continuum (Minneap Minn). 2022; 28(4): 988-1005. doi: 10.1212/CON.0000000000001136.
7. Hartmann A, Noro F, Bahia PRV, et al. The clinical-radiological paradox in multiple sclerosis: myth or truth? O paradoxo clínico radiológico na esclerose múltipla: mito ou verdade? Arq Neuropsiquiatr. 2023; 81(1): 55-61. doi: 10.1055/s-0042-1758457.
8. Cohen AB, Neema M, Arora A, et al. The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis. J Neuroimaging. 2012; 22(2): 122-128. doi: 10.1111/j.1552-6569.2011.00589.x.
9. Zeydan B, Kantarci OH. Impact of Age on Multiple Sclerosis Disease Activity and Progression. Curr Neurol Neurosci. 2020; 20(7): 24. doi: 10.1007/s11910-020-01046-2.
10. Degraeve B, Sequeira H, Mecheri H, et al. Corpus callosum damage to account for cognitive, affective, and social-cognitive dysfunctions in multiple sclerosis: A model of callosal disconnection syndrome? Mult Scler. 2023; 29(2): 160-168. doi: 10.1177/13524585221091067.
11. Fritz NE, Edwards EM, Ye C, et al. Cerebellar Contributions to Motor and Cognitive Control in Multiple Sclerosis. Arch Phys Med Rehabil. 2022; 103(8): 1592-1599. doi: 10.1016/j.apmr.2021.12.010.
