Benign multiple sclerosis: aspects of cognition and neuroimaging

Ton, Alyne Mendonça Marques; Vasconcelos, Claudia Cristina Ferreira; Alvarenga, Regina Maria Papais

doi:10.1590/0004-282X20170043

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REVIEW • Arq. Neuro-Psiquiatr. 75 (6) • June 2017 • https://doi.org/10.1590/0004-282X20170043 copy

Benign multiple sclerosis: aspects of cognition and neuroimaging

A esclerose múltipla benigna: aspectos cognitivos e de neuroimagem

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The existence of a benign multiple sclerosis (BMS) form is a controversial subject. Recent studies of these patients reveal different levels of cognitive impairment, despite the apparent preservation of motor function. The objective of this study was to review and analyze a number of publications that discuss the general aspects of this disease form, such as the definition criteria, prevalence, and clinical and neuroimaging markers. A systematic review of published data on BMS up to October 2015 was performed. Thirty-one published articles were analyzed. The estimated frequency of BMS varied between 6% and 73%. Cognitive impairment was recognized as affecting 17% to 47% of the subjects and presented significant correlation with neuroimaging, such as brain atrophy, increased lesion volume in T2 magnetic resonance assay, and regional grey matter atrophy. The current criteria overestimated the frequency of BMS and, for that reason, this highlights the importance of validating the diagnostic methods practiced.

multiple sclerosis; cognition; neuroimaging

Author	Year	Population (n)	Country	Definition	Frequency (%)	Frequency after

						5 years (%)	10 years (%)	20 years (%)
Hawkins & Mc Donell²	1999	131	Ireland	3	19.90	-	9.30	-
Thompson et al.³	1986	240	Ireland	3	42.00	-	-	-
Pittock et al.⁴	2004	162	Ireland	4	30.24	-	20.93	-
Glad et al.⁵	2010	138	Norway	2	14.50	-	-	-
				3	26.30	-	-	-
				4	40.80	-	-	-
McAlpine⁷	1954	241	London	1	32.36	25.72	-	-
Costelloe et al.¹¹	2008	355	Ireland	-	14.32	-	-	11.00
Correale et al.¹³	2012	342	Argentina	3	12.50	-	-	-
Sayao et al.²⁸	2007	169	England	3	-	-	-	52.10
Leray et al.²⁹	2013	374	France	2	57.70	-	12.01	2.63
Leray et al.²⁹	2013	374	France	3	73.90	-	18.53	5.03

Author	Year	Population (n)	Cognitive impairment (%)	Cognitive assessment
Pagani et al.⁶	2008	60 BMS	20	Nonspecified neuropsychological tests exploring memory, attention and frontal lobe cognitive domains
		35 SPMS
		21 healthy volunteers
Correale et al.¹³	2012	47 BMS	47	Neuropsychological battery containing PASAT- 3 seconds, DST, 7/24 SPART, WCST and VFD.
Correale et al.¹³	2012	299 NBMS	47
Bester et al.¹⁵	2013	26 BMS	38	Neuropsychological battery containing VFT, CVLT-II, SDMT, PASAT-3 seconds, D-KEFS and CWIT.
Bester et al.¹⁵	2013	24 healthy volunteers	38
Rovaris et a.l¹⁶	2008	62 BMS	19	Neuropsychological battery containing PASAT, TMT, CST, SST, DST, WLT, ROCF-recall, Token Test, VFT and WCST.
		32 SPMS
		19 healthy volunteers
Amato et al.¹⁷	2008	47 BMS	23	SRT, 10/36 SRT, PASAT, SDMT and WLG.
Mesaros et al.¹⁹	2009	54 BMS	17	Neuropsychological battery containg PASAT, TMT, AMT, DSP, SST, CST, WLG, ROCF-recall, Raven Test, Token Test, WCST and ROCF-copy.
Amato et al.²⁷	2006	163 BMS	45	SRT, 10/36 SRT, PASAT, SDMT, WLG and Stroop Test.
Amato et al.²⁷	2006	111 healthy volunteers	45	SRT, 10/36 SRT, PASAT, SDMT, WLG and Stroop Test.

Author	Year	Population (n)	Country	Neuroimages findings
Filippi et al.²¹	1995	13 BMS	Italy	Lower lesional charge (p = 0.03)
Filippi et al.²¹	1995	13 SPMS	Italy	-
De Stefano et al.²³	2008	50 BMS	Italy	Lesional and perilesional inferior MTr to the healthy controls (p < 0.0001) and bigger than the patients with RRMS
		50 RRMS		NAWM of MTr and cortical similar to the controls (p > 0.05) and bigger than the patients with RRMS (p < 0.0001)
		32 healthy volunteers		-
Gauthier et al.²⁴	2006	39 BMS	USA	Lower rate of brain atrophy (p = 0.02)
Gauthier et al.²⁴	2006	40 RRMS	USA	-
Strasser-Fuchs et al.²⁵	2007	13 BMS	England	No differences in relation to the lesional charge in T2 (p = 0.19)
Strasser-Fuchs et al.²⁵	2007	15 SPMS	England	-
Calabrese et al.³²	2009	48 BMS	Italy	Inferior number of intracortical lesions (p < 0.001)
Calabrese et al.³²	2009	96 RRMS	Italy	-

Author	Year	Population (n)	Country	Cognition and neuroimages
Pagani et al.⁶	2008	60 BMS	Italy	There’s no difference between the grey matter atrophy level and the patients with, or without, cognitive loss
		35 SPMS		-
		21 healthy volunteers		-
Carreole et al.¹³	2012	47 BMS	Argentina	BMS patients without a cognitive loss present less progression in the lesional charge related to others
Carreole et al.¹³	2012	299 BMS	Argentina	When compared to BMS patients with cognitive loss, there’s no difference
Rovaris et al.¹⁶	2008	62 BMS	London	BMS patients without a cognitive commitment were associated with a less lesional charge in T2 (p = 0.03), normalized brain volume (p = 0.006) and diffusion average of inferior grey matter in relation to SPMS controls (p = 0.03).
		32 SPMS		BMS patients without a cognitive commitment did not show differences in neuroimaging related to others
		19 healthy volunteers		-
Amato et al.¹⁷	2008	47 BMS	Italy	The cognitive commitment was associated with an increase in lesional charge in T1 (p = 0.001) and T2 (0.05).
Amato et al.¹⁷	2008		Italy	BMS patients with cognitive commitment presented with a pronounced cortical atrophy (p = 0.005) and a reduction of cortical MTr (p = 0.02)
Mesaros et al.¹⁹	2009	54 BMS	Italy	The cognitive commitment was associated with a greater lesional charge in the corpus callosum (p = 0.02) and diffusion average of superior NAWM to others (P = 0.02)
Bester et al.³²	2013	26 BMS	USA	The cognitive commitment was associated with an increase of lesional volume in T2 in the anterior thalamus region (p < 0.001)

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[1] Correspondence: Alyne Mendonça Marques Ton; Departamento de Neurologia da UNIRIO; Rua Mariz e Barros, 775; 20270-004 Rio de Janeiro RJ, Brasil; E-mail: lyne_msv@hotmail.com