The Role of the Cerebellum in Multiple Sclerosis
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In multiple sclerosis (MS), cerebellar signs and symptoms as well as cognitive dysfunction are frequent and contribute to clinical disability with only poor response to symptomatic treatment. The current consensus paper highlights the broad range of clinical signs and symptoms of MS patients, which relate to cerebellar dysfunction. There is considerable evidence of cerebellar involvement in MS based on clinical, histopathological as well as structural and functional magnetic resonance imaging (MRI) studies. The review of the recent literature, however, also demonstrates a high variability of results. These discrepancies are, at least partially, caused by the use of different techniques and substantial heterogeneity among the patient cohorts in terms of disease duration, number of patients, and progressive vs. relapsing disease courses. Moreover, the majority of studies were cross-sectional, providing little insight into the dynamics of cerebellar involvement in MS. Some links between the histopathological changes, the structural and functional abnormalities as captured by MRI, cerebellar dysfunction, and the clinical consequences are starting to emerge and warrant further study. A consensus is formed that this line of research will benefit from advances in neuroimaging techniques that allow to trace cerebellar involvement at higher resolution. Using a prospective study design, multimodal high-resolution cerebellar imaging is highly promising, particularly in patients who present with radiologically or clinically isolated syndromes or newly diagnosed MS.
KeywordsMultiple sclerosis Cerebellum Cognition Magnetic resonance imaging Demyelination
Conflict of Interest Statement
K.W. received funding from the Swiss National Science Foundation (PBSKP3_145838). Dr. Weier reports no conflict of interest.
B.B. serves as a consultant to Novartis, Sanofi-Aventis, and Biogen Idec. She is a senior editor of Multiple Sclerosis and Related Disorders.
A.C. reports no conflict of interest.
D.L.C discloses consulting for NeuroRx. He is co-founder of True Positive Medical Devices Inc.
A.M.D. has received speaker’s fee from Biogen Idec and Merck-Serono and congress fee to ECTRIMS 2010 covered by Merck-Serono, Denmark.
H.L. reports no conflict of interest
A.Q. reports no conflict of interest.
M.A.S. reports that he has received travel grants to different congresses and symposiums from Biogen Idec, Biologix, Novartis, Merck-Serono, and Cinnagen and also received research supports from Iranian MS Society, Cinnagen, Merck-Serono, and Novartis Iran.
H.S. has received honoraria as speaker from Lundbeck A/S, Valby, Denmark, Biogen Idec, Denmark A/S, Genzyme, Denmark and Merck-Serono, Denmark, honoraria as editor from Elsevier Publishers, Amsterdam, The Netherlands and Springer Publishing, Stuttgart, Germany, and travel support from MagVenture, Denmark.
T.S. has received no personal compensation for consultancy activities. His employer, the University Hospital Basel, received compensation for him serving on scientific advisory boards from Novartis, ATI, Allergan, Teva, Genzyme, and Biogen Idec. He has received research support from Novartis Switzerland, EFIC, and the Swiss MS Society.
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