The role of spinal cord reserve in multiple sclerosis

Abstract

The current thesis builds on the first formal attempt to define the concept of spinal cord reserve in multiple sclerosis (MS) through a comprehensive analysis of the cervical canal area (CCaA) as a surrogate marker, drawing on the established concept of brain reserve. For this purpose, we first developed and validated a methodology based on the Spinal Cord Toolbox to obtain reproducible measures of the CCaA from brain and cervical cord sagittal 3D T1-weighted images. Secondly, we applied the pipeline on a multicentre cohort of well-characterized people with MS and healthy controls to examine CCaA differences among groups and MS phenotypes. Our findings revealed that patients with progressive MS exhibited a smaller CCaA, suggesting that reduced spinal cord reserve might be a characteristic of the progressive MS phenotype. Additionally, we identified a significant association between CCaA and disability progression, supporting the potential existence of a spinal cord reserve. Lastly, we assessed the effectiveness of our methodology in estimating CCaA using the most commonly employed magnetic ressonance sequences in clinical practice. The ultimate goal of this thesis was to validate the CCaA as a reliable marker for spinal cord reserve, thereby advancing the understanding of disability progression in MS through three consecutive and complementary projects.

Date of Award	3 Dec 2024
Original language	English
Supervisor	Jaume Sastre Garriga (Director) & Deborah Pareto Onghena (Director)