Multipl sklerozlu hastalarda beyin atrofisi, kognisyon ve optik koherans tomografi ilişkisinin sağlıklı kontroller ile karşılaştırılması
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Date
2010
Authors
Yurtoğulları, Şükran Ç.
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda McDonald tanı kriterlerine göre kesin MS tanısı almış olan Uludağ Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı Multipl Skleroz Polikliniğinde izlenen Multipl Skleroz (MS) hastalığı tanılı 43 hasta ve 15 sağlıklı kontrol grubu alındı. MS'li olgular Relapsing Remiting (RRMS), Relapsing Remiting Optik Nörit (RRMS-ON) geçirmiş olgular ve Sekonder Progresif (SPMS) olmak üzre üç gruba ayrıldı ve TFT, Vit B12, folik asit değerleri incelendi. Hamilton depresyon testi ile depresyon varlığı dışlandı. Göz dibi muayeneleri yapıldı ve optik koherans tomografileri (OKT) çekildi. Olgulara uzman psikolog tarafından modifiye edilmiş Wechsler bellek ölçeği, Sözel bellek süreçleri testi, Görsel bellek testi, Mantıksal bellek testi, Dikkat testi, Çizgilerin yönünü belirleme testi, Raven testi (RSPM), Stroop, Benton yüz tanıma testi, Akıcılık testleri ve PASAT testi uygulandı. Tüm olguların otomatik segmentasyon yöntemi ile bilateral kranial subkortikal volümleri ölçüldü. Elde edilen volüm ülçümleri total intrakranial volüme oranlanarak beyin parankimal fraksiyonları hesaplandı. Çalışmaya toplam 58 (%65,5'i kadın, %34,5'i erkek) olgu alındı. Gruplar arasında atrofi açısından sol akkumbens, sol lateral ventrikül, sol talamus, sol kaudat, sol putamen, sol pallidum volümleri ile sağ lateral ventrikül, sağ talamus, sağ putamen, sağ pallidum, sağ hipocampus, sağ akkumbens, 3. ventrikül ve beyaz cevher hipointens volümleri açısından anlamlı fark saptandı. Derin gri cevher, meziyal temporal yapılar ve lateral ventrikül volümleri ile dikkat, akıcılık, sözel bellek süreçleri ve mantıksal bellek süreçleri testleri arasında anlamlı korelasyon mevcuttu. Optik nörit geçirsin yada geçirmesin tüm MS hastalarında SPMS grubunda daha kötü olmak üzre OKT skorları artmış olarak bulundu. Retinal sinir lifi kalınlığı (RSLK) ile beyin parankimal fraksiyonu arasında anlamlı korelasyon tesbit edildi. MS hastalarında yapılan beyin atrofisi ilgili çalışmalar ülkemizde elle çizme şeklinde yapılmakta, otomatik segmentasyon yöntemi henüz yaygın kullanılmamaktadır. Yaptığımız bu çalışma ile güvenilir ve ayrıntılı subkortikal ölçümler OKT sonuçları ve kognitif testlerler ile ilişkilendirilerek literatüre değerli ve güvenilir bilgiler sağlanmıştır.
Forty-three MS patients diagnosed according to McDonald's ctiteria and being followed up in the outpatient MS Unit of Neurology Department in Uludag University Medical Faculty and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as RRMS, Relapsing Remitting Optic Neuritis (RRMS-ON) and SPMS. Thyroid function tests, serum vitamine B12 and folic acid levels were measured in all the cases. Fundoscopy and OCT were done for all them. Hamilton depression test scores above 16 were included. An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test and Paced Auditory Serial Addition tests in all cases. Cranial subcortical volumes of the subjects were measured using an automatic segmentation method. Brain parenchymal fractions were calculated using the obtained volume measurements proportioning to the total intracranial volume. Fifty eight subjects (65,5% female, 34,5% male) were enrolled in the study. There were statistically significant differences between the patients and the control group in terms of volumes of the left accumbens, left lateral ventrikule, left thalamus, left caudate nucleus, left putamen, left pallidum, right lateral ventricule, right thalamus, right putamen, right pallidum, right hippocampus, right accumbens, third ventricule and the hypointense white matter. There was significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricule volumes and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, were increased, being worser especially in the SPMS group. Correlations between the retinal nerve fiber layer thickness and the brain parenchymal fractions of the patients were statistically significant. Manual methods instead of automatic segmentation method is being more commonly used in the studies with brain atrophy and MS in our country. Our study contributed to the literature by showing the correlations between the reliable and detailed subcortical measurements, OCT results and cognitive tests in MS patients.
Forty-three MS patients diagnosed according to McDonald's ctiteria and being followed up in the outpatient MS Unit of Neurology Department in Uludag University Medical Faculty and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as RRMS, Relapsing Remitting Optic Neuritis (RRMS-ON) and SPMS. Thyroid function tests, serum vitamine B12 and folic acid levels were measured in all the cases. Fundoscopy and OCT were done for all them. Hamilton depression test scores above 16 were included. An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test and Paced Auditory Serial Addition tests in all cases. Cranial subcortical volumes of the subjects were measured using an automatic segmentation method. Brain parenchymal fractions were calculated using the obtained volume measurements proportioning to the total intracranial volume. Fifty eight subjects (65,5% female, 34,5% male) were enrolled in the study. There were statistically significant differences between the patients and the control group in terms of volumes of the left accumbens, left lateral ventrikule, left thalamus, left caudate nucleus, left putamen, left pallidum, right lateral ventricule, right thalamus, right putamen, right pallidum, right hippocampus, right accumbens, third ventricule and the hypointense white matter. There was significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricule volumes and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, were increased, being worser especially in the SPMS group. Correlations between the retinal nerve fiber layer thickness and the brain parenchymal fractions of the patients were statistically significant. Manual methods instead of automatic segmentation method is being more commonly used in the studies with brain atrophy and MS in our country. Our study contributed to the literature by showing the correlations between the reliable and detailed subcortical measurements, OCT results and cognitive tests in MS patients.
Description
Keywords
Multipl skleroz, Beyin atrofisi, Kognisyon, Optik koherans tomografi, Multiple sclerosis, Brain atrophy, Cognition, Optic coherance tomography
Citation
Yurtoğulları, Ş. Ç. (2010). Multipl sklerozlu hastalarda beyin atrofisi, kognisyon ve optik koherans tomografi ilişkisinin sağlıklı kontroller ile karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.