Multiple Sclerosis is the most frequent acquired neurological disease affecting young adults (1/1000 habitants in France)  and leading to impairment. This project focusses on physical impairment and especially on the ability to walk. Early and well adapted treatment is essential in patients presenting aggressive forms of MS.

Several studies, whether epidemiolgic or based on brain MRI, have shown that several factors where likely to announce aggressive development of the disease, such as age, number of focal lesions on baseline MRI, clinical activity.

However, this factors only partially explain physical impairment progression, preventing their use at the individual level.

Spinal cord is often affected in MS, as demonstrated in postmortem or imaging studies. Yet, early radiological depiction of spinal cord relapses is not always correlated with clinical symptoms. Preliminary data, on reduced number of patients, and only investigating the cervical spinal cord have shown that diffuse spinal cord affection, observed via diffusion or magnetisation transfer imaging, would be correlated with physical impairment as evaluated by the EDSS score. Besides, the role of early spinal cord affection (first two years) in the evolution of physical impairment remains unknown.

In the EMISEP project (Clinical Trials link) started in 2014, we propose to adress these different issues and perfom a longitudinal study, including RRMS patients in the first year of the disease. Our goal is to show that diffuse and focal lesions detected spinal cord MRI in the first 2 years can be used to predict disease evolution and physical impairment at 5 years.

EMISEP Study group – Participating centers (Neurologists – Radiologists – MR Physicist)

CHU de Rennes (Gilles Edan, Anne Kerbrat, Emmanuelle LePage, Laure Michel – Jean-Christophe Ferré – Elise Bannier) – Principal investigators – Coordinating center

CHU de Montpellier (Pierre Labauge, Xavier Ayrignac, Clarisse Carra-Dallière – Nicolas Menjot de Champfleur – Emmanuelle Le Bars)

CHU de Marseille (Jean Pelletier, Bertrand Audoin, Audrey Rico, Adil Maarouf – Frédérique Chapon – Virginie Callot)

CHU de Strasbourg (Jérôme de Seze, Nicolas Collongues – Jean-Louis Dietemann, Stéphane Kremer – Paulo Loureiro de Sousa)

CHU de Lyon (Françoise Durand-Dubief – François Cotton)

CHU de Toulouse (David Brassat, Michel Clanet, Damien Biotti – Fabrice Bonneville, Manuela Kamsu, Isabelle Berry)

CHU de Clermont-Ferrand (Pierre Clavelou – Betty Jean)

CHU de Nîmes (Eric Thouvenot – Nicolas Menjot de Champfleur)

People involved in the Visages Team and at CHU Rennes

– Researchers : Elise Bannier (Research Engineer), Christian Barillot (Visages Team leader), Emmanuel Caruyer (Researcher),  Benoit Combes (Post Doc), Olivier Commowick (Researcher), Haykel Snoussi (PhD Student),

– Medical Doctors : Gilles Edan (Neurologist), Anne Kerbrat (Neurologist), Jean-Christophe Ferré (Radiologist), Laureline Monteau (Radiologist), Gabrielle Rojat (Radiologist), Raphaël Chouteau (Neurologist)

Study details

Inclusion criteria

RRMS as defined by Mac Donald révised criteria in 2010. First symtoms < 1 year. T2 relapses > 9 on baseline MRI EDSS < 3. Patients aged between 18 and 40 ans, having signed the IRB form and affiliated to the french healthcare system.

Follow-up

Clinical follow up –       Relapses, treatment –       EDSS –       25-foot timed-walked test, 6-minute walk –       nine-hole peg test –       Auto-questionnaire QUALIVEEN –       ASIA score. Spinal Cord MRI  follow up : –       Spinal cord MRI at baseline, 12, 36 and 60 months. Sagittal T2 TSE and sagittal STIR Axial T2 GRE on C1-C3 and C4-C7 3D T1 EG with and without magnetisation transfer Sagittal diffusion imaging –       to measure the following parameters Focal lesions (amount, size, localisation) Atrophy Diffuse lesions (extracted from diffusion and MT imaging) Brain MRI (3 Tesla) at baseline and at 12, 24, 36 et 60 months as part of the clinical routine OFSEP follow-up MRI protocol including 3D T1 pre-gd T2 FLAIR 30 directions Diffusion 3D T1 post gadolinium

Publications using EMISEP data