Limits...
Pain and spinal cord imaging measures in children with demyelinating disease.

Barakat N, Gorman MP, Benson L, Becerra L, Borsook D - Neuroimage Clin (2015)

Bottom Line: Most of this research has focused on adult populations and patients with traumatic injuries.These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes.We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.

View Article: PubMed Central - PubMed

Affiliation: Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.

ABSTRACT
Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.

No MeSH data available.


Related in: MedlinePlus

MRI pathological features in myelitis. Sagittal T2-weighted images of (A) 13 year old female with NMO, (B) 10 year old female with transverse myelitis and (C) 10 year old female with MS. Arrows show lesion sites.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4588416&req=5

f0005: MRI pathological features in myelitis. Sagittal T2-weighted images of (A) 13 year old female with NMO, (B) 10 year old female with transverse myelitis and (C) 10 year old female with MS. Arrows show lesion sites.

Mentions: The typical pathological features of the disease process, as indicated by T2-weighted MRI (Fig. 1A–C), include cord enlargement and a focal increase in signal intensity. Some lesions may involve both transverse halves of the cord leading to the interruption of the spinal cord pathways (Choi et al., 1996). More pronounced changes in white matter than in gray matter were reported in one study (Misra et al., 1996) while another study reported both gray and white matter regions to be equally damaged in transverse myelitis (Krishnan et al., 2004).


Pain and spinal cord imaging measures in children with demyelinating disease.

Barakat N, Gorman MP, Benson L, Becerra L, Borsook D - Neuroimage Clin (2015)

MRI pathological features in myelitis. Sagittal T2-weighted images of (A) 13 year old female with NMO, (B) 10 year old female with transverse myelitis and (C) 10 year old female with MS. Arrows show lesion sites.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588416&req=5

f0005: MRI pathological features in myelitis. Sagittal T2-weighted images of (A) 13 year old female with NMO, (B) 10 year old female with transverse myelitis and (C) 10 year old female with MS. Arrows show lesion sites.
Mentions: The typical pathological features of the disease process, as indicated by T2-weighted MRI (Fig. 1A–C), include cord enlargement and a focal increase in signal intensity. Some lesions may involve both transverse halves of the cord leading to the interruption of the spinal cord pathways (Choi et al., 1996). More pronounced changes in white matter than in gray matter were reported in one study (Misra et al., 1996) while another study reported both gray and white matter regions to be equally damaged in transverse myelitis (Krishnan et al., 2004).

Bottom Line: Most of this research has focused on adult populations and patients with traumatic injuries.These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes.We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.

View Article: PubMed Central - PubMed

Affiliation: Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.

ABSTRACT
Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.

No MeSH data available.


Related in: MedlinePlus