Exploratory analysis of the association between total T2 lesion volume on brain MRI and resilience in young Patients with Multiple Sclerosis

INTRODUCTION: Multiple Sclerosis is a neurological disorder that affects mostly young adults potentially causing disability due to involvement of motor, sensory, visual and cognitive functions. Frequently patients with multiple sclerosis presents psychological symptoms such as depression and anxiety. Receiving a diagnosis of multiple sclerosis, especially when it happens during young age, represent a challenge for which each individual must face relevant emotional distress. The way in which each person copes to disease seems to be strongly related with resilience. Determinants of resilience include a host of biological, psychological, social, and cultural factors that interact with one another to determine how one respond to stressful experiences. The links between disease-specific variables at diagnosis, resilience, and psychological adjustment of multiple sclerosis patients remain largely unexplored, especially in young adults. AIM OF THE STUDY: to explore the hypothesis that psychological adaptation to multiple sclerosis might be driven not only from personal, social and cognitive factors but also from mechanisms that are intrinsic to the disease process. The primary endpoint of the study was to analyze the correlation between psychological resilience and total T2 lesion volume on brain MRI – i.e. a reliable biomarker of disease severity – in a cohort of young patients newly diagnosed with multiple sclerosis. MATERIALS AND METHODS: we identified eligible patients from an ongoing observational study at University of Verona in which several clinical, psychological, MRI and laboratory measures are collected cross - sectionally in patients with multiple sclerosis aged 18-45 years at enrolment, which occurs in the first two years after diagnosis according to inclusion criteria. For MRI segmentation and lesion volume calculation we used the brain MRI scans obtained from routine investigation for diagnosis or clinical assessment (1.5 or 3 T depending on the machine available at the Center where diagnosis was formulated) within 6 months prior and one month after enrolment. The analysis of total T2 lesion volume (TLV) was made using software open-source ITK-SNAP with semiautomatic segmentation. In order to measure resilience, the Connor-Davidson Resilience Scale (CD – RISC25) was used. The statistical analysis included a descriptive analysis of demographical, psychological and clinical characteristics of participants. A non-parametric approach was applied to compare groups, by using the Kruskal-Wallis test. An explorative correlation analysis was conducted to check possible relationship among variables. RESULTS: our sample consists of 51 consecutive patients, 33 females and 18 males with a mean age of 33.3 years. 88,23% of patients have relapsing-remitting multiple sclerosis and 74,5% a low level of disability (EDSS ≤ 2). The mean T2 lesion volume found was 4.32 cm3 (range 0,21 – 24,79). For resilience (the maximum score on the CD-RISC is 100), the mean value in our sample resulted 65,13 (CI 60,65 – 69,61). Considering data about Quality of Life using the MSQoL- 54 scale, the mean score for physical health resulted 61,48 (CI 58.87 – 64.08) while the mean score for mental health resulted 51,13 (CI 48,22 – 54,03). Other two single scores were calculated; the mean for change in health was 50,19 (CI 45,24 – 55,14); for sexual satisfaction it was 76,73 (CI 70,71 – 82,75). Correlation analysis did not show a significant correlation between T2 total lesion volume and resilience. Despite none of the performed correlation analyses showed statistically significant results, a moderate correlation between resilience and age and between resilience and time from onset of symptoms was numerically observed; a weak inverse correlation was found between EDSS score and resilience. In addition, there was a numerical correlation between resilience and the physical health subscore of MSQoL-54, particularly in the relapsing-remitting multiple sclerosis patients subgroup. CONCLUSION: with reference to the primary outcome, the exploratory analysis we performed in our study showed that total T2 lesion volume on brain MRI of young patients with multiple sclerosis is not significantly associated with resilience. Overall, no significant findings were observed for any of analyzed variables, however some of association examined are worthy of attention. The time that took place between onset of disease and enrollment seems to have a potential moderate correlation with resilience. Among sociodemographic data we have found a possible moderate correlation between resilience and age and also with physical health score in the MSQoL. Also the score regarding physical health on MSQoL numerically shows a moderate correlation with resilience. Our findings show that resilience of young patients with multiple sclerosis, although not statistically associated with disease burden assessed as T2 lesion load on brain MRI, is possibly connected to demographic variables, physical wellbeing, disease duration and possibly disability accumulation in the early stages of the disease. Therefore, all these features deserve to be furtherly examined as possible determinants of resilience, with the ultimate goal of improving quality of life of people with multiple sclerosis.