• Eloy Martinez-Heras, Elisabeth Solana, Francesc Vivó, Elisabet Lopez-Soley, Alberto Calvi, Salut Alba-Arbalat, Menno M Schoonheim, Eva M Strijbis, Hugo Vrenken, Frederik Barkhof, Maria A Rocca, Massimo Filippi, Elisabetta Pagani, Sergiu Groppa, Vinzenz Fleischer, Robert A Dineen, Barbara Bellenberg, Carsten Lukas, Deborah Pareto, Alex Rovira, Jaume Sastre-Garriga, Sara Collorone, Ferran Prados, Ahmed Toosy, Olga Ciccarelli, Albert Saiz, Yolanda Blanco, and Sara Llufriu.
• Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
• J. Neurol. Neurosurg. Psychiatr. 2023 Nov 1; 94 (11): 916923916-923.

BackgroundWe aimed to describe the severity of the changes in brain diffusion-based connectivity as multiple sclerosis (MS) progresses and the microstructural characteristics of these networks that are associated with distinct MS phenotypes.MethodsClinical information and brain MRIs were collected from 221 healthy individuals and 823 people with MS at 8 MAGNIMS centres. The patients were divided into four clinical phenotypes: clinically isolated syndrome, relapsing-remitting, secondary progressive and primary progressive. Advanced tractography methods were used to obtain connectivity matrices. Then, differences in whole-brain and nodal graph-derived measures, and in the fractional anisotropy of connections between groups were analysed. Support vector machine algorithms were used to classify groups.ResultsClinically isolated syndrome and relapsing-remitting patients shared similar network changes relative to controls. However, most global and local network properties differed in secondary progressive patients compared with the other groups, with lower fractional anisotropy in most connections. Primary progressive participants had fewer differences in global and local graph measures compared with clinically isolated syndrome and relapsing-remitting patients, and reductions in fractional anisotropy were only evident for a few connections. The accuracy of support vector machine to discriminate patients from healthy controls based on connection was 81%, and ranged between 64% and 74% in distinguishing among the clinical phenotypes.ConclusionsIn conclusion, brain connectivity is disrupted in MS and has differential patterns according to the phenotype. Secondary progressive is associated with more widespread changes in connectivity. Additionally, classification tasks can distinguish between MS types, with subcortical connections being the most important factor.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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