The following is a summary of “Dimethyl fumarate preserves brainstem and cervical spinal cord integrity in radiologically isolated syndrome,” published in the July 2024 issue of Neurology by Okuda et al.

A new study shows dimethyl fumarate (DMF) delayed the start of nervous system demyelination symptoms and reduced brain lesions in people with radiologically isolated syndrome (RIS).

Researchers conducted a retrospective study to explore the effect of DMF on volumetric measures, including the whole brain, thalamic and subcortical gray matter volumes, brainstem, upper cervical spine three-dimensional (3D) volumes, and surface characteristics.

They conducted standardized 3T MRIs, including 3D isotropic T1-weighted gradient echo images, at baseline and end-of-study as per the ARISE study protocol. The data were analyzed using Structural Image Evaluation Using Normalization of Atrophy (SIENA), FreeSurfer v7.3, and an in-house pipeline for 3D conformational metrics. Rates of change in brain structures and 3D surface and volume changes in specific areas were analyzed using multivariate mixed models for repeated measures.

The results showed that among 64 subjects of RIS (DMF: 30, placebo: 34), no significant difference was seen in whole brain, thalamic, or subcortical gray matter volumes between treated and untreated patients with RIS. A significant difference was observed in dorsal pons curvature, with the DMF group having a lower least squares mean change of -4.46 (standard estimate (SE): 3.77) than placebo [6.94 (3.71)] (P=0.036). In individuals who experienced a first clinical event, a more significant reduction in medulla-upper cervical spinal cord volume (P=0.044) and a decrease in surface curvature at the dorsal medulla (P=0.009), but not at the dorsal pons (P=0.443), was observed.

Investigators concluded that the benefits of disease-modifying therapy in RIS may go beyond what conventional volumetric measures can detect, potentially impacting CNS structures affected by neurodegeneration.

Source: link.springer.com/article/10.1007/s00415-024-12514-x