Week 6 - Safaa Mouline

At the MS clinicians meeting this week I learned about yet another disease that can present similarly to MS. Acute disseminated encephalomyelitis or ADEM. There was a patient whose MRIs they were analyzing who had cognitive issues and lesions throughout the brain, but the lesions did not look typical for MS; they were symmetrical and widespread, affecting both white and gray matter simultaneously, which is a pattern more consistent with ADEM than MS. Unlike MS, which tends to produce asymmetric lesions that accumulate over time, ADEM typically presents as a single monophasic episode with large confluent lesions that can look dramatic on MRI but may partially resolve over time. The clinicins decided it is best to monitor the patient (bring them back for a MRI in 4 weeks) to track the progression of the lesions and see whether a MS diagnoses is appropriate. 

Project-wise, using the estimated structural and functional connectivities, I tried to do some analysis grouping patients by age as a proxy for menopause status as a preliminary step since I don't have menopause data. However, without actual menopause status or hormonal data, age alone cannot distinguish post-menopausal women from perimenopausal women in the same age band. Additionally, the cross-sectional nature of the data means we cannot track how disability changes around the menopause transition within individuals. Statistically, EDSS increased with age in both men and women, suggesting the effect is driven by aging and disease duration rather than menopause specifically. There was a trending but non-significant interaction between sex and age (p = 0.082), showing that women might experience slightly steeper age-related disability accumulation, but this did not reach statistical significance. To properly investigate the role of menopause in MS progression, future work would benefit from longitudinal data with actual menopause status and hormonal measures such as estrogen and FSH levels. Fortunately, my clinician has a grant in review for a MS and menopause study, and so I could potentially get involved with that work if it goes through! 

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