q-Space Myelin Map imaging for longitudinal analysis of demyelination and remyelination in multiple sclerosis patients treated with fingolimod: A preliminary study

Abstract Background Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models. Objective To analyze feasibility of a novel q -space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MS patients. Methods Treatment outcomes of 24 consecutive MS patients treated with FTY were analyzed. A longitudinal analysis of q -space Myelin Map imaging was performed in a subset of these patients. Results During the treatment course (average of 16.1 months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state (“optimal responders”). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q -space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions. Conclusion FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q -Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MS patients.