DTI detects water diffusion abnormalities in the thalamus that correlate with an extremity pain episode in a patient with multiple sclerosis
In context of a pilot examination for a clinical trial study a 38-year-old female patient with early MS, diagnosed according to revised McDonald criteria (), was admitted for MRI at 10 different time points (average inter-scan interval = 25.6 days +/− 13.1 days SD, total interval = 230 days), after obtaining written informed consent. The background of the pilot study was to examine the reproducibility of DTI parameters on MS patients. The patient presented with a first relapse of sensory symptoms of the left body side in 2011 and was diagnosed with relapsing remitting multiple sclerosis (RRMS) in 2012 according to McDonald criteria. At that time she showed dissemination in space () and time in addition to oligoclonal bands, 6 lymphocytes/μl and intrathecal IgG production. This first relapse was contralateral (left) to the episode of central pain and sensory symptoms of the relapse described in the following. She was treated with immunomodulation (interferon ß 1a, once weekly i.m.) after the first relapse, and when she entered the series of DTI scans her expanded disability status scale (EDSS) was 2.0. Within the series of imaging scans she developed an episode of central pain and abnormal somatosensory and thermal sensations on the right hand side of her body. These symptoms occurred and disappeared simultaneously. Since this combination of symptoms developed over 2 days and remained for > 24 h we considered this episode as a relapse according to the international accepted definition of MS relapses. In addition, sensory symptoms and central pain very well responded to steroid therapy.