The necessity of accurately and reliably measuring the brain’s white matter is crucial for monitoring patients with various pathologies, particularly multiple sclerosis (MS). Professor Damien Galanaud, a neuroradiologist at Assistance Publique Hopitaux de Paris – Hopital de la Pitié Salpêtrière, explains the importance of this measurement for assessing the diffuse damage to white matter, an aspect often overlooked by conventional monitoring methods.

When did you start introducing in your practice white matter measures as provided by Braintale? 

Pr. Damien Galanaud: As a co-founder of Braintale, I have been using this solution since it first became commercially available in 2021. Initially, it was very useful for me in cases of comas, especially for assisting in prognosis determination. Today, I also use it for monitoring patients with adrenoleukodystrophy, a rare neuro metabolic disease. Its physiopathology is very similar to multiple sclerosis, and so the next step will be to use it to monitor this much more common pathology.

What is the main pain point in MS patient monitoring?

Pr. Damien Galanaud: Measuring white matter using diffusion tensor MRI, as proposed by Braintale, offers significant advantages in two respects for monitoring MS patients.

First, current measurements are based essentially on the progression of the number of plaques and take very little account of diffuse white matter damage only currently assessed by evaluating cerebral atrophy, a very late marker of the disease. The advantage of precise, standardized measurement of white matter is to ensure that patients are well controlled, both by halting the increase in the number of plaques and by curbing diffuse damage even before the onset of atrophy.

The second benefit of this measurement is in monitoring progressive forms of MS, which have very few plaques but are primarily characterized by diffuse, degenerative white matter damages. Currently, we are at a loss with these patients, whose condition worsens without us being able to measure any significant change with conventional sequences.

In the first case, white matter measurement is truly complementary to the current approach. In the second case, it is a truly innovative, groundbreaking information that could change significantly how patients are being taken care of.

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How easy is it to assess white matter measure?

Pr. Damien Galanaud: White matter and its role in neuroinflammatory and neurodegenerative diseases are widely studied by researchers but its quantitative assessment remains challenging in clinical practice. Until now, standardized white matter quantification has not been integrated in the standard of care as no FDA/CE solution was available.  The power of machine calibration is key to obtain reliable and reproducible measures from one scan to another, thus enabling multi-scan analysis and, therefore, take appropriate decision from a medical standpoint. This equation is solved here!

On a more practical level, this measure is obtained through a standard diffusion tensor MRI examination, which does not involve any supplementary exam as already included in the patient’s journey – either in clinical trials or in the patient care. It does not add some extra time for the doctor or the patient. It’s an easy sequence to add to the standard protocol, making it a powerful, reliable, and efficient tool.