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Abstract Details

MRI Predictors of Longitudinal Functional Decline in Amyotrophic Lateral Sclerosis
Neuromuscular and Clinical Neurophysiology (EMG)
S18 - Neuromuscular and Clinical Neurophysiology (EMG): Neuroimaging, Outcome Measures, and Biomarkers (1:12 PM-1:24 PM)
002
To explore longitudinally the progression of clinical and structural brain changes in patients with amyotrophic lateral sclerosis (ALS), and to assess magnetic resonance imaging (MRI) measures of brain damage as predictors of subsequent functional decline.
Considering the great heterogeneity of ALS, the identification of accurate prognostic predictors is important for both the clinical practice and the design of treatment trials.
50 ALS patients (mean age=59.8 ± 11.5 years) enrolled between 2010 and 2015 underwent clinical evaluation and 3T MRI scan at study entry, every 3 months for the first year, and every 6 months for the subsequent year, for a maximum of 2 years. MRI measures of grey matter cortical and subcortical volumes, as well as diffusion tensor (DT) metrics of microstructural damage along white matter (WM) tracts were obtained from structural brain MRI images. Voxel-wise regression models and nonlinear mixed-effects models with a logistic shape were used to test the relationship between clinical decline and the evolution of MRI features.

The rate of decline of the ALS Functional Rating Scale revised (ALSFRS-r) was significantly associated with the rate of fractional anisotropy (FA) decrease in the body of the corpus callosum (CC). Damage to the corticospinal tract (CST) and CC-body had a faster progression in patients with higher baseline ALSFRS-r scores and who were female. Baseline features associated with faster subsequent clinical progression were female sex and lower FA of the bulbo-pontine CST.

In this longitudinal study, we identified a significant association of measures of WM damage of the motor tracts with faster functional decline in ALS patients. Our data suggest that a multimodal approach including DT MRI measures of brain damage would provide an optimal method for an accurate stratification of ALS patients into prognostic classes.
Authors/Disclosures
Edoardo G. Spinelli, MD
PRESENTER 		Dr. Spinelli has nothing to disclose.
Federica Agosta (San Raffaele Scientific Institute) Federica Agosta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philips. Federica Agosta has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier INC.
No disclosure on file
No disclosure on file
Yuri Falzone Yuri Falzone has nothing to disclose.
No disclosure on file
Vincenzo Silani, MD, FAAN (University of Milan Medical School - IRCCS Istituto Auxologico Italiano) Dr. Silani has nothing to disclose.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit) Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.