“Innovative imaging techniques such as functional MRI or diffusion tensor imaging occupy an important place in modern neurology today. With their help we can better understand diseases such as multiple sclerosis, dementia, amyotrophic lateral sclerosis or Alzheimer’s disease,” says Massimo Filippi, Milan,Italy, a committee member of the Annual Meeting of the European Neurological Society (ENS), which took place in Berlin between 19 and 23 June, 2010. Over 3,000 neurologists from around the world are meeting in Berlin.
The proven imaging techniques in neurology, also referred to as neuroimaging, include technologies such as functional magnetic resonance imaging (fMRI), diffusion tensor imaging or voxel based morphometry (VBM). These technologies provide precise images of the structure of the brain and allow doctors to observe the functional processes in the human brain, from cellular changes to processes activated when people act, think and feel. “We have to learn to understand the central nervous system. That is the only way we can gain insights into the development of diseases and improve treatments,” says Filippi.
Changes in white matter in the brain presage dementia
“We have gained interesting insights particularly in the area of early detection and diagnosis of dementia, multiple sclerosis, Parkinson’s, ALS and migraine,” says Filippi. As an example he mentions diagnosis of dementia at an early stage, a pattern of disease found also in patients with Alzheimer’s, and which affects around 35 million people worldwide. “We have discovered that the development of dementia in older people can be more precisely predicted on the basis of changes in white matter in the brain.”
Better assessment of primary progressive multiple sclerosis up to five years.
“When we know how damage is accumulated in the brain, we can respond better to diseases and intervene more selectively,” says Filippi. He and his research team presented a study investigating primary progressive multiple sclerosis (PPMS) at the ENS congress. PPMS presents one of the most severe courses of disease among MS, because the disease does not occur in phases, but instead the patient’s condition constantly deteriorates. Using diffusion tensor imaging, researchers have examined the grey matter in the brain of MS patients. It could be demonstrated that the extent of tissue damage in the thalamus predicted the accumulation of MS related disability five years after.
MS patients with fatigue suffer greater grey matter atrophy
In another study, scientists assessed “fatigue syndrome”, one of the most common symptoms of MS. These patients suffer continual exhaustion and thus significant loss of quality of life. Using a procedure known as voxel based morphometry (VBM), researchers were able to compare MS patients with and without fatigue and matched healthy volunteers. Significant differences were noted: MS patients with fatigue syndrome exhibited more severe grey matter atrophy in several frontal lobe areas of the left hemisphere, than the control groups.
Changes in the brain in migraine patients: a progressive disease?
Neuroimaging techniques don’t always provide indicators for better diagnosis, early detection or improved etiopathology. Sometimes the entire clinical picture has to be re-thought. Thus scientists now assume that migraine is a progressive disease. “We have been able to establish that the brain matter of migraine patients deteriorates with the duration of the disease,“ says Filippi. This assumption is based on a study comparing 82 migraine patients with different clinical characteristics. The results show that grey matter is affected in migraine patients according to the differing characteristics and duration of the disease.
Neuroimaging will continue in future to play an important role in research and treatment of neurological diseases. The goal is to improve techniques even further. Scientists are already focussing on a combination of functional MRI and EEG. They hope with this combination to gain new insights into how the human brain works.