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Lesion pattern in patients with multiple sclerosis and depression

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

T Supprian

Department of Psychiatry, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

J Thomae

Department of Psychiatry, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

M Warmuth-Metz

Division of Neuroradiology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

A Horowski

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

B Zeiler

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

T Magnus

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

P Rieckmann

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

G Becker

Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany

To assess if a specific lesion pattern or changes of the basal limbic system as seen in primary depression and depression associated with neurodegenerative disorders might be identified in depressive multiple sclerosis (MS) patients, we submitted 78 MS patients to a MRI examination consisting of a quantitative measurement of lesions and of hyperintense signals from the pontomesencephalic midline (raphe). Furthermore relaxometry of the pontomesencephalic midline, a transcranial ultrasound examination rating its echogenicity semiquantitatively and a standardized neurological, neuropsychiatric and neuropsychological assessment were obtained. Thirty-one patients fulfilled the DSM-IV criteria for depression. Depressed MS patients had a significantly larger temporal lesion load than non-depressed MS patients, especially on the right side. A trend of difference was detected for lesions of the right parietal lobe, the right frontal lobe, the cerebellum and the total lesion load. Neither hyperintense signals or relaxometry nor echogenicity of the region at the level of the pontomesencephalic midline were significantly different between the groups. We conclude that depression in MS patients is not associated with an alteration of the basal limbic system at the brainstem as seen in Parkinson's disease or unipolar depression but with an increased lesion load of the projection areas of the basal limbic system.

Key Words: depression • multiple sclerosis • MRI • transcranial ultrasound lesion distribution • basal limbic system

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