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January 08, 2013; 80 (2) Views & Reviews

The thalamus and multiple sclerosis

Modern views on pathologic, imaging, and clinical aspects

Alireza Minagar, Michael H. Barnett, Ralph H.B. Benedict, Daniel Pelletier, Istvan Pirko, Mohamad Ali Sahraian, Elliott Frohman, Robert Zivadinov
First published January 7, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31827b910b
Alireza Minagar
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Michael H. Barnett
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Ralph H.B. Benedict
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Daniel Pelletier
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Istvan Pirko
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Mohamad Ali Sahraian
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Elliott Frohman
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Robert Zivadinov
From the Department of Neurology (A.M.), Louisiana State University Health Sciences Center, Shreveport, LA; Department of Neurology (M.H.B.), Royal Prince Alfred Hospital, Sydney; Brain & Mind Research Institute (M.H.B.), University of Sydney, Australia; The Jacobs Neurological Institute (R.H.B.B., R.Z.) and Buffalo Neuroimaging Analysis Center, Department of Neurology (R.Z.), University at Buffalo, Buffalo, NY; Departments of Neurology and Diagnostic Radiology (D.P.), Yale University, New Haven, CT; Department of Neurology (I.P.), Mayo Clinic, Rochester, MN; Sina MS Research Center (M.A.S.), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (E.F.), UT Southwestern Medical Center, Dallas, TX.
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Citation
The thalamus and multiple sclerosis
Modern views on pathologic, imaging, and clinical aspects
Alireza Minagar, Michael H. Barnett, Ralph H.B. Benedict, Daniel Pelletier, Istvan Pirko, Mohamad Ali Sahraian, Elliott Frohman, Robert Zivadinov
Neurology Jan 2013, 80 (2) 210-219; DOI: 10.1212/WNL.0b013e31827b910b

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Abstract

The paired thalamic nuclei are gray matter (GM) structures on both sides of the third ventricle that play major roles in cortical activation, relaying sensory information to the higher cortical centers that influence cognition. Multiple sclerosis (MS) is an immune-mediated disease of the human CNS that affects both the white matter (WM) and GM. A number of clinical observations as well as recent neuropathologic and neuroimaging studies have clearly demonstrated extensive involvement of the thalamus, basal ganglia, and neocortex in patients with MS. Modern MRI techniques permit visualization of GM lesions and measurement of atrophy. These contemporary methods have fundamentally altered our understanding of the pathophysiologic nature of MS. Evidence confirms the contention that GM injury can be detected in the earliest phases of MS, and that iron deposition and atrophy of deep gray nuclei are closely related to the magnitude of inflammation. Extensive involvement of GM, and particularly of the thalamus, is associated with a wide range of clinical manifestations including cognitive decline, motor deficits, fatigue, painful syndromes, and ocular motility disturbances in patients with MS. In this review, we characterize the neuropathologic, neuroimaging, and clinical features of thalamic involvement in MS. Further, we underscore the contention that neuropathologic and neuroimaging correlative investigations of thalamic derangements in MS may elucidate not heretofore considered pathobiological underpinnings germane to understanding the ontogeny, magnitude, and progression of the disease process.

GLOSSARY

CIS=
clinically isolated inflammatory demyelinating syndrome;
DIR=
double inversion recovery;
DTI=
diffusion tensor imaging;
EDSS=
Expanded Disability Status Scale;
GM=
gray matter;
LGN=
lateral geniculate nucleus;
MS=
multiple sclerosis;
NAGM=
normal-appearing gray matter;
NAWM=
normal-appearing white matter;
SWI=
susceptibility-weighted imaging;
WM=
white matter

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 29, 2012.
  • Accepted August 6, 2012.
  • © 2013 American Academy of Neurology
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  • Article
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    • THALAMIC NEUROPATHOLOGY IN MS
    • NEUROIMAGING CHARACTERISTICS OF THALAMIC INVOLVEMENT IN MS
    • CLINICAL MANIFESTATIONS
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