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Purpose: In multiple sclerosis (MS), chronic active/smoldering white matter lesions presenting with hypointense rims on susceptibility-weighted imaging (SWI) of the brain have been recognized as an important radiological feature. The aim of this work was to study the prevalence of paramagnetic rim lesions (RLs) in MS patients in a clinical setting and to assess differences in demographic and clinical variables regarding the presence of RLs., Methods: All 3 T brain magnetic resonance (MR) studies performed in MS patients between July 2020 and January 2021 were reviewed. In all patients, RLs were assessed on three-dimensional (3D) SWI images and the T2 FLAIR lesion load volume was assessed. Demographic, laboratory (oligoclonal bands in CSF), and clinical data, including functional status with Expanded Disability Status Scale (EDSS), were retrieved from the clinical files., Results: Of the 192 patients, 113 (59%) presented with at least 1 RL. In the RL-positive group, the mean RL count was 4.81 ranging from 1 to 37. There was no significant difference in the number of RLs between the different types of MS (p = 0.858). Regarding the presence of RLs, there were no significant differences based on gender (p = 0.083), disease duration (p = 0.520), treatment regime (p = 0.326), EDSS score (p = 0.103), and the associated T2 FLAIR lesion load volume., Conclusion: SWI RLs were frequently detected in our cohort regardless of the MS type, T2 FLAIR lesion load volume, demographic features, disease duration, or clinical score. Our results suggest that RLs are not associated with more severe forms of the disease. Today, RLs can be seen on 3 T 3D SWI, although this is not a clinical standard sequence yet. Therefore, it should be considered an additional helpful MR sequence in the diagnostic workup of MS, although more studies are warranted to establish the role of RLs as prognostic markers., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background/objectives: Fluoxetine and prucalopride might change phosphocreatine (PCr) levels via the cAMP-PKA pathway, an interesting target in the neurodegenerative mechanisms of MS., Methods: We conducted a two-center double-blind, placebo-controlled, randomized trial including 48 relapsing-remitting MS patients. Patients were randomized to receive placebo (n = 13), fluoxetine (n = 15), or prucalopride (n = 14) for 6 weeks. Proton ( 1 H) and phosphorus ( 31 P) magnetic resonance spectroscopy (MRS) as well as volumetric and perfusion MR imaging were performed at weeks 0, 2, and 6. Clinical and cognitive testing were evaluated at weeks 0 and 6., Results: No significant changes were observed for both 31 P and 1 H MRS indices. We found a significant effect on white matter volume and a trend towards an increase in grey matter and whole brain volume in the fluoxetine group at week 2; however, these effects were not sustained at week 6 for white matter and whole brain volume. Fluoxetine and prucalopride showed a positive effect on 9-HPT, depression, and fatigue scores., Conclusion: Both fluoxetine and prucalopride had a symptomatic effect on upper limb function, fatigue, and depression, but this should be interpreted with caution. No effect of treatment was found on 31 P and 1 H MRS parameters, suggesting that these molecules do not influence the PCr metabolism.

We report two cases of primary progressive multiple sclerosis (PPMS) included in the INFORMS cohort, experiencing a relapse related to a single MRI gadolinium-enhancing lesion 3 months after fingolimod withdrawal. These two patients share similarities with relapsing-remitting multiple sclerosis cases described in the same situation, suggesting that the initiating process of the active demyelinating plaques is also present in PPMS, even without relapses, but may be triggered as fingolimod is withdrawn. Although the results of the INFORMS study suggest that fingolimod may not slow down the progression, some PPMS patients might still benefit from a disease-modifying treatment.