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Cognitive Fatigability is Independent of Subjective Cognitive Fatigue and Mood in Multiple Sclerosis. Cogn Behav Neurol 2020; 33:113-121. [PMID: 32496296 DOI: 10.1097/wnn.0000000000000228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sustained cognitive testing is used to detect cognitive fatigability and is often considered a substitute for subjective cognitive fatigue (CF). However, the relationship between cognitive fatigability and subjective CF in people with multiple sclerosis (PwMS) remains undetermined. OBJECTIVE To explore potential associations between fatigability induced by sustained cognitive testing and subjective CF in PwMS. METHODS We gave 120 PwMS and 60 demographically matched, healthy individuals the Beck Depression Inventory-FastScreen (BDI-FS) to measure mood and the Modified Fatigue Impact Scale to measure CF. In addition, we used the Quotient ADHD Test, a sustained attention test, to measure cognitive fatigability. We also explored potential correlations between the individuals' performance on the sustained attention test and thalamic volume using recent MRI scans. RESULTS Forty-one (34.2%) of the PwMS exhibited cognitive fatigability. These 41 were found to be significantly older (P=0.006), had been diagnosed with the disease for longer (P=0.03), had higher scores (P<0.001) on the Expanded Disability Status Scale, and had reduced thalamic volume (P=0.04) compared with the 79 (65.8%) PwMS not exhibiting cognitive fatigability. The PwMS exhibiting cognitive fatigability scored similarly on the BDI-FS (P=0.21) and self-reported similar rates of CF (P=0.62) as the PwMS not exhibiting cognitive fatigability. CONCLUSION Cognitive fatigability induced by sustained cognitive testing is not an accurate clinical alternative to subjective CF. This study provides evidence to support cognitive fatigability and CF in PwMS as two distinct concepts.
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Chaves AR, Devasahayam AJ, Riemenschneider M, Pretty RW, Ploughman M. Walking Training Enhances Corticospinal Excitability in Progressive Multiple Sclerosis-A Pilot Study. Front Neurol 2020; 11:422. [PMID: 32581998 PMCID: PMC7287174 DOI: 10.3389/fneur.2020.00422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Inflammatory lesions and neurodegeneration lead to motor, cognitive, and sensory impairments in people with multiple sclerosis (MS). Accumulation of disability is at least partially due to diminished capacity for neuroplasticity within the central nervous system. Aerobic exercise is a potentially important intervention to enhance neuroplasticity since it causes upregulation of neurotrophins and enhances corticospinal excitability, which can be probed using single-pulse transcranial magnetic stimulation (TMS). Whether people with progressive MS who have accumulated substantial disability could benefit from walking rehabilitative training to enhance neuroplasticity is not known. Objective: We aimed to determine whether 10 weeks of task-specific walking training would affect corticospinal excitability over time (pre, post, and 3-month follow-up) among people with progressive MS who required walking aids. Results: Eight people with progressive MS (seven female; 29–74 years old) with an Expanded Disability Status Scale of 6–6.5 underwent harness-supported treadmill walking training in a temperature controlled room at 16°C (10 weeks; three times/week; 40 min at 40–65% heart rate reserve). After training, there was significantly higher corticospinal excitability in both brain hemispheres, reductions in TMS active motor thresholds, and increases in motor-evoked potential amplitudes and slope of the recruitment curve (REC). Decreased intracortical inhibition (shorter cortical silent period) after training was noted in the hemisphere corresponding to the stronger hand only. These effects were not sustained at follow-up. There was a significant relationship between increases in corticospinal excitability (REC, area under the curve) in the hemisphere corresponding to the stronger hand and lessening of both intensity and impact of fatigue on activities of daily living (Fatigue Severity Scale and Modified Fatigue Impact Scale, respectively). Conclusion: Our pilot results support that vigorous treadmill training can potentially improve neuroplastic potential and mitigate symptoms of the disease even among people who have accumulated substantial disability due to MS.
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Affiliation(s)
- Arthur R Chaves
- Recovery and Performance Laboratory, Faculty of Medicine, L. A. Miller Centre, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Augustine J Devasahayam
- Recovery and Performance Laboratory, Faculty of Medicine, L. A. Miller Centre, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Morten Riemenschneider
- Section for Sports Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ryan W Pretty
- Recovery and Performance Laboratory, Faculty of Medicine, L. A. Miller Centre, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, L. A. Miller Centre, Memorial University of Newfoundland, St. John's, NL, Canada
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Ashrafi A, Mohseni-Bandpei MA, Seydi M. The effect of tDCS on the fatigue in patients with multiple sclerosis: A systematic review of randomized controlled clinical trials. J Clin Neurosci 2020; 78:277-283. [PMID: 32389548 DOI: 10.1016/j.jocn.2020.04.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Fatigue is one of the most common disabling symptoms in patients with multiple sclerosis (MS) which is present in 75% of these patients and is usually associated with functional disabilities. According to the literature, there is no general agreement on the effectiveness of the existing treatments for fatigue in patients with MS. As transcranial direct current stimulation (tDCS) is a relatively new method in the treatment of fatigue symptoms in patients with MS, the purpose of this study was to systematically review published evidence conducted to assess the effects of tDCS on fatigue in patients with MS. MATERIAL & METHODS A thorough literature search of published articles was conducted from 1996 to 2019 in different databases including PubMed, Science Direct, OVID, Google Scholar, Cochrane Library, Scopus, Embase, ProQuest and web of science with keywords of "tDCS", "multiple Sclerosis" and "Fatigue". Results yielded 1017 studies, which after excluding articles based on duplication and title and abstract, 8 of them were selected for review in this study. RESULTS The results from the literature revealed that six studies indicated positive effects of tDCS stimulation on fatigue reduction. In four studies stimulation was over the right dorsolateral prefrontal cortex (DLPFC); in three studies stimulation placed over the whole body's primary somatosensory cortex (S1); and in one study stimulation applied over the posterior parietal cortex. In most studies, no serious side effects were reported. CONCLUSION Most studies revealed that tDCS can reduce the adverse effects of MS-related fatigue in particular cognitive type. As follow-ups were either absent or short period, as well as the application of treatment protocols and measurement instruments were different, it was very difficult to draw strong conclusion on the effects of tDCS in patients with MS. However, further large scale studies with long term follow-up are still recommended.
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Affiliation(s)
- Atefe Ashrafi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation sciences, Tehran, Iran
| | | | - Mahsa Seydi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation sciences, Tehran, Iran
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Mortezanejad M, Ehsani F, Masoudian N, Zoghi M, Jaberzadeh S. Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial. Clin Rehabil 2020; 34:1103-1111. [PMID: 32397748 DOI: 10.1177/0269215520921506] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the effects of anodal trans-cranial direct current stimulation (a-tDCS) over primary motor and dorsolateral prefrontal cortices on Fatigue Severity Scale and its lasting effect on fatigue reduction and improvement in quality of life in patients with multiple sclerosis. DESIGN A randomized, double-blinded, sham-controlled parallel clinical trial study. SETTING Neurological physiotherapy clinics. SUBJECTS Thirty-nine participants were randomly assigned to three groups: dorsolateral prefrontal cortex a-tDCS, primary motor a-tDCS (experimental groups) and sham a-tDCS. Finally, 36 participants completed the whole study (n = 12 in each group). INTERVENTIONS Participants in the experimental groups received six-session a-tDCS (1.5 mA, 20 minutes) during two weeks (three sessions per week). The sham group received six sessions of 20-minute sham stimulation. MAIN MEASURES The Fatigue Severity Scale and quality of life were assessed before, immediately and four weeks after the intervention. RESULTS Findings indicated a significant reduction in the Fatigue Severity Scale and a significant increase in the quality of life in both experimental groups, immediately after the intervention (P < 0.001), while Fatigue Severity Scale and quality of life changes were not significant in the sham a-tDCS group (P > 0.05). In addition, improvement of the variables remained four weeks after the intervention in dorsolateral prefrontal cortex a-tDCS (mean differences (95% confidence interval): 0.03 (-0.63 to 0.68) as compared to primary motor (-0.62 (-0.11 to -1.14) and sham a-tDCS groups (-0.47 (-1.37 to 0.43)). CONCLUSION Both primary motor and dorsolateral prefrontal cortex a-tDCS as compared to sham intervention can immediately improve fatigue and quality of life. However, the effects last up to four weeks only by the dorsolateral prefrontal cortex a-tDCS.
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Affiliation(s)
- Marzieh Mortezanejad
- Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran
| | - Nooshin Masoudian
- Neurology Ward, Department of Internal Medicine, Kosar Hospital, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Capone F, Motolese F, Falato E, Rossi M, Di Lazzaro V. The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue. Front Neurol 2020; 11:251. [PMID: 32425869 PMCID: PMC7212459 DOI: 10.3389/fneur.2020.00251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a very common symptom among people with multiple sclerosis (MS), but its management in clinical practice is limited by the lack of clear evidence about the pathogenic mechanisms, objective tools for diagnosis, and effective pharmacological treatments. In this scenario, neurophysiology could play a decisive role, thanks to its ability to provide objective measures and to explore the peripheral and the central structures of the nervous system. We hereby review and discuss current evidence about the potential role of neurophysiology in the management of MS-related fatigue. In the first part, we describe the use of neurophysiological techniques for exploring the pathogenic mechanisms of fatigue. In the second part, we review the potential application of neurophysiology for monitoring the response to pharmacological therapies. Finally, we show data about the therapeutic implications of neurophysiological techniques based on non-invasive brain stimulation.
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Affiliation(s)
- Fioravante Capone
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Francesco Motolese
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Emma Falato
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Mariagrazia Rossi
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.,NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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Chalah MA, Grigorescu C, Padberg F, Kümpfel T, Palm U, Ayache SS. Bifrontal transcranial direct current stimulation modulates fatigue in multiple sclerosis: a randomized sham-controlled study. J Neural Transm (Vienna) 2020; 127:953-961. [PMID: 32161992 DOI: 10.1007/s00702-020-02166-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/29/2020] [Indexed: 12/16/2022]
Abstract
Fatigue is a frequent and debilitating symptom in patients with central nervous system diseases. Up to 90% of patients with multiple sclerosis (MS) suffer from fatigue that drastically affects the quality of life. MS patients also complain of anxiety and depressive symptoms and these three manifestations tend to cluster together in this clinical population. The objective of this work was to assess the effects of transcranial direct stimulation (tDCS), a noninvasive brain stimulation technique, on fatigue as well as anxiety and depressive symptoms. Eleven fatigued MS patients randomly received two blocks (active and sham tDCS) of five consecutive daily sessions of bifrontal tDCS (anode/cathode over the left/right prefrontal cortices, respectively) in a crossover manner, separated by a 3-week washout interval. Evaluation took place at day 1, day 5 (right after each block) and 1 week later. Active but not sham tDCS resulted in a significant improvement of fatigue at day 5 (p < 0.05), an effect that seems to last at least 1 week following the stimulation (p = 0.05). Active tDCS also significantly improved anxiety symptoms, but the effect emerged 1 week later (p < 0.05). No significant effects were obtained regarding depression (p > 0.05). Bifrontal tDCS seems to modulate fatigue in PwMS. The observed anxiolytic effects could constitute delayed after effects of tDCS or might be mediated by fatigue improvement. These findings merit to be addressed in large-scale controlled trials.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique, Hôpitaux de Paris, 94010, Créteil, France
| | - Christina Grigorescu
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Tania Kümpfel
- Institute for Clinical Neuroimmunology, Klinikum der Universität München, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique, Hôpitaux de Paris, 94010, Créteil, France.
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57
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Chalah MA, Kauv P, Palm U, Lefaucheur JP, Hodel J, Créange A, Ayache SS. Deciphering the neural underpinnings of alexithymia in multiple sclerosis. Neurosci Lett 2020; 725:134894. [PMID: 32147502 DOI: 10.1016/j.neulet.2020.134894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Alexithymia is a personality construct that could occur in up to 53 % of patients with multiple sclerosis (MS). It entails difficulties in identifying and describing one's feelings and an externally oriented thinking. The current work aims to assess the neural underpinnings of alexithymia in this population. METHODS Forty-five patients with MS filled in the Toronto Alexithymia Scale (n = 17 with high alexithymia and n = 28 with low alexithymia). Brain magnetic resonance imaging was obtained for each patient and a morphometry algorithm (MorphoBox) was applied to calculate regional brain volumes. All patients underwent a clinical and neuropsychological evaluation which included measures for anxiety, depression, fatigue, daytime sleepiness, and basic and social cognition. RESULTS Compared to patients with low alexithymia, patients with high alexithymia had significantly higher fatigue and depression ratings, and lower empathy scores. In addition, they had lower volumes of corpus callosum, deep white matter, pallidum bilaterally, and left thalamus. In the whole cohort, alexithymia scores were inversely correlated with gray matter (thalamus and pallidum bilaterally) and white matter volumes (corpus callosum and bilateral deep white matter) after controlling for covariates (ps<0.05). CONCLUSION This study offers insights on the neuropsychological and neural substrates of alexithymia in MS. The current findings are consistent with alexithymia reports in other clinical populations, and suggest an association between alexithymia and atrophy of thalami, pallidum, corpus callosum and deep white matter in MS. Further research is needed to enhance the understanding of alexithymia mechanisms in this clinical context.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Paul Kauv
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neuroradiologie, Hôpital Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Jérôme Hodel
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neuroradiologie, Hôpital Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
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The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability. Brain Sci 2019; 10:brainsci10010012. [PMID: 31878058 PMCID: PMC7017217 DOI: 10.3390/brainsci10010012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) modulates cortical excitability and affects a variety of outcomes. tDCS at intensities ≤2 mA is well-tolerated, but the tolerability and efficacy of tDCS at intensities >2 mA merits systematic investigation. The study objective was to determine the tolerability and effects of 4 mA tDCS on leg muscle fatigability. Thirty-one young, healthy adults underwent two randomly ordered tDCS conditions (sham, 4 mA) applied before and during an isokinetic fatigue test of the knee extensors and flexors. Subjects reported the severity of the sensations felt from tDCS. Primary outcomes were sensation tolerability and the fatigue index of the knee extensors and flexors. A repeated-measures ANOVA determined statistical significance (p < 0.05). Sensation severity at 4 mA tDCS was not substantially different than sham. However, two subjects reported a moderate–severe headache, which dissipated soon after the stimulation ended. The left knee flexors had significantly greater fatigability with 4 mA tDCS compared with sham (p = 0.018). tDCS at 4 mA was well-tolerated by young, healthy subjects and increased left knee flexor fatigability. Exploration of higher intensity tDCS (>2 mA) to determine the potential benefits of increasing intensity, especially in clinical populations with decreased brain activity/excitability, is warranted.
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59
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Fatigue and Affective Manifestations in Multiple Sclerosis-A Cluster Approach. Brain Sci 2019; 10:brainsci10010010. [PMID: 31877878 PMCID: PMC7017318 DOI: 10.3390/brainsci10010010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
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Ng X, Sadeghian M, Heales S, Hargreaves IP. Assessment of Mitochondrial Dysfunction in Experimental Autoimmune Encephalomyelitis (EAE) Models of Multiple Sclerosis. Int J Mol Sci 2019; 20:ijms20204975. [PMID: 31600882 PMCID: PMC6829485 DOI: 10.3390/ijms20204975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 01/03/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) that involves the autoreactive T-cell attack on axonal myelin sheath. Lesions or plaques formed as a result of repeated damage and repair mechanisms lead to impaired relay of electrical impulses along the nerve, manifesting as clinical symptoms of MS. Evidence from studies in experimental autoimmune encephalomyelitis (EAE) models of MS strongly suggests that mitochondrial dysfunction presents at the onset of disease and throughout the disease course. The aim of this study was to determine if mitochondrial dysfunction occurs before clinical symptoms arise, and whether this is confined to the CNS. EAE was induced in C57B/L6 mice, and citrate synthase and mitochondrial respiratory chain (MRC) complex I–IV activities were assayed at presymptomatic (3 or 10 days post first immunisation (3 or 10 DPI)) and asymptomatic (17 days post first immunisation (17 DPI) time-points in central nervous system (CNS; spinal cord) and peripheral (liver and jaw muscle) tissues. Samples from animals immunised with myelin oligodendrocyte glycoprotein (MOG) as EAE models were compared with control animals immunised with adjuvant (ADJ) only. Significant changes in MOG compared to control ADJ animals in MRC complex I activity occurred only at presymptomatic stages, with an increase in the spinal cord at 10 DPI (87.9%), an increase at 3 DPI (25.6%) and decrease at 10 DPI (22.3%) in the jaw muscle, and an increase in the liver at 10 DPI (71.5%). MRC complex II/III activity changes occurred at presymptomatic and the asymptomatic stages of the disease, with a decrease occurring in the spinal cord at 3 DPI (87.6%) and an increase at 17 DPI (36.7%), increase in the jaw muscle at 10 DPI (25.4%), and an increase at 3 DPI (75.2%) and decrease at 17 DPI (95.7%) in the liver. Citrate synthase activity was also significantly decreased at 10 DPI (27.3%) in the liver. No significant changes were observed in complex IV across all three tissues assayed. Our findings reveal evidence that mitochondrial dysfunction is present at the asymptomatic stages in the EAE model of MS, and that the changes in MRC enzyme activities are tissue-specific and are not confined to the CNS.
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Affiliation(s)
- Xiulin Ng
- UCL Institute of Neurology, Queen Square, University College London, London WC1N 3BG, UK.
- University Medical Center, 79106 Freiburg im Breisgau, Germany.
| | - Mona Sadeghian
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London WC1N 3BG, UK.
- Global Clinical Development, Actelion, High Wycombe HP12 4DP, UK.
| | - Simon Heales
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
- Neurometabolic Unit, National Hospital, London WC1N 3BG, UK.
| | - Iain P Hargreaves
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
- Neurometabolic Unit, National Hospital, London WC1N 3BG, UK.
- School of Pharmacy and Biomolecular Sciences, Byrom Street, Liverpool John Moores University, Liverpool L3 3AF, UK.
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Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A, Stephan KE. Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:642-651. [PMID: 30683707 PMCID: PMC6581095 DOI: 10.1136/jnnp-2018-320050] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
Fatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error with limited success, probably due to the presence of multiple different underlying mechanisms. Recent neuroscientific advances offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. However, development of these tools for differential diagnosis will require guidance by pathophysiological and cognitive theories that propose mechanisms which can be assessed in individual patients. This article provides an overview of contemporary pathophysiological theories of fatigue in MS and discusses how the mechanisms they propose may become measurable with emerging technologies and thus lay a foundation for future personalised treatments.
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Affiliation(s)
- Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland .,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Cao Tri Do
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Gabor Stefanics
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research (SNS), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Andreas Lutterotti
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Müller
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Max Planck Institute for Metabolism Research, Cologne, Germany
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Abdollahi F, Tayebi Myaneh Z, Rashvand F. The Relationship between Perception of Illness and Health-related Behaviors in Patients with Multiple Sclerosis. ACTA ACUST UNITED AC 2019. [DOI: 10.29252/jhc.21.2.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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63
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Salemi G, Vazzoler G, Ragonese P, Bianchi A, Cosentino G, Croce G, Gangitano M, Portera E, Realmuto S, Fierro B, Brighina F. Application of tRNS to improve multiple sclerosis fatigue: a pilot, single-blind, sham-controlled study. J Neural Transm (Vienna) 2019; 126:795-799. [PMID: 31054015 DOI: 10.1007/s00702-019-02006-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Abstract
We evaluated the effects of transcranial random noise stimulation (tRNS) on fatigue in 17 subjects with relapsing-remitting multiple sclerosis with low physical disability. Two different patient groups underwent real or sham stimulation for 10 days, targeting the primary motor cortex of the dominant side or contralateral to the most compromised limb. In the 'real group', beneficial effects were observed using the Modified Fatigue Impact Scale (p = 0.04; physical subscale: p = 0.03), the subscales 'change in health' (p = 0.006) and 'role limitations due to physical problems' (p = 0.001) of the Multiple Sclerosis Quality of Life-54, and by assessing the patient impression of perceived fatigue (p = 0.005).
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Affiliation(s)
- Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Giulia Vazzoler
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
| | - Alessia Bianchi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Giuseppe Cosentino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Croce
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Erika Portera
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Sabrina Realmuto
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Brigida Fierro
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
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64
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Cognitive Fatigue in Multiple Sclerosis: An Objective Approach to Diagnosis and Treatment by Transcranial Electrical Stimulation. Brain Sci 2019; 9:brainsci9050100. [PMID: 31052593 PMCID: PMC6562441 DOI: 10.3390/brainsci9050100] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 01/03/2023] Open
Abstract
Cognitive fatigue is one of the most frequent symptoms in multiple sclerosis (MS), associated with significant impairment in daily functioning and quality of life. Despite its clinical significance, progress in understanding and treating fatigue is still limited. This limitation is already caused by an inconsistent and heterogeneous terminology and assessment of fatigue. In this review, we integrate previous literature on fatigue and propose a unified schema aiming to clarify the fatigue taxonomy. With special focus on cognitive fatigue, we survey the significance of objective behavioral and electrophysiological fatigue parameters and discuss the controversial literature on the relationship between subjective and objective fatigue assessment. As MS-related cognitive fatigue drastically affects quality of life, the development of efficient therapeutic approaches for overcoming cognitive fatigue is of high clinical relevance. In this regard, the reliable and valid assessment of the individual fatigue level by objective parameters is essential for systematic treatment evaluation and optimization. Transcranial electrical stimulation (tES) may offer a unique opportunity to manipulate maladaptive neural activity underlying MS fatigue. Therefore, we discuss evidence for the therapeutic potential of tES on cognitive fatigue in people with MS.
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65
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Berra E, Bergamaschi R, De Icco R, Dagna C, Perrotta A, Rovaris M, Grasso MG, Anastasio MG, Pinardi G, Martello F, Tamburin S, Sandrini G, Tassorelli C. The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment. Front Hum Neurosci 2019; 13:31. [PMID: 30809137 PMCID: PMC6379270 DOI: 10.3389/fnhum.2019.00031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/21/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Central neuropathic pain represents one of the most common symptoms in multiple sclerosis (MS) and it seriously affects quality of life. Spinal mechanisms may contribute to the pathogenesis of neuropathic pain in MS. Converging evidence from animal models and neurophysiological and clinical studies in humans suggests a potential effect of transcranial direct current stimulation (tc-DCS) on neuropathic pain. Spinal application of DCS, i.e., transcutaneous spinal DCS (ts-DCS), may modulate nociception through inhibition of spinal reflexes. Therefore, ts-DCS could represents an effective, safe and well-tolerated treatment for neuropathic pain in MS, a largely unexplored topic. This study is a pilot randomized double-blind sham-controlled trial to evaluate the efficacy of ts-DCS on central neuropathic pain in MS patients. Methods: Thirty-three MS patients with central neuropathic pain were enrolled and randomly assigned to two groups in a double-blind sham-controlled design: anodal ts-DCS group (n = 19, 10 daily 20-min sessions, 2 mA) or sham ts-DCS group (n = 14, 10 daily 20-min sessions, 0 mA). The following clinical outcomes were evaluated before ts-DCS treatment (T0), after 10 days of treatment (T1) and 1 month after the end of treatment (T2): neuropathic pain symptoms inventory (NPSI), Ashworth Scale (AS) for spasticity and Fatigue Severity Scale (FSS). A subgroup of patients treated with anodal ts-DCS (n = 12) and sham ts-DCS (n = 11) also underwent a parallel neurophysiological study of the nociceptive withdrawal reflex (NWR) and the NWR temporal summation threshold (TST), two objective markers of pain processing at spinal level. Results: Anodal ts-DCS group showed a significant improvement in NPSI at T1, which persisted at T2, while we did not detect any significant change in AS and FSS. Sham ts-DCS group did not show any significant change in clinical scales. We observed a non-significant trend towards an inhibition of NWR responses in the anodal ts-DCS group at T1 and T2 when compared to baseline. Conclusions: Anodal ts-DCS seems to have an early and persisting (i.e., 1 month after treatment) clinical efficacy on central neuropathic pain in MS patients, probably through modulation of spinal nociception. Clinical Trial Registration:www.ClinicalTrials.gov, identifier #NCT02331654.
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Affiliation(s)
- Eliana Berra
- Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Roberto Bergamaschi
- Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, Italy.,Multiple Sclerosis Center, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlotta Dagna
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Marco Rovaris
- Neurorehabilitation Unit and Multiple Sclerosis Center, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Rehabilitation Hospital Santa Lucia Foundation, Rome, Italy
| | | | - Giovanna Pinardi
- Neurorehabilitation Unit and Multiple Sclerosis Center, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Federico Martello
- Multiple Sclerosis Unit, Rehabilitation Hospital Santa Lucia Foundation, Rome, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giorgio Sandrini
- Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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66
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Chalah MA, Kauv P, Créange A, Hodel J, Lefaucheur JP, Ayache SS. Neurophysiological, radiological and neuropsychological evaluation of fatigue in multiple sclerosis. Mult Scler Relat Disord 2019; 28:145-152. [DOI: 10.1016/j.msard.2018.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
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67
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Sakkas GK, Giannaki CD, Karatzaferi C, Manconi M. Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:4. [DOI: 10.1007/s11940-019-0544-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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68
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Zare L, Baharvand H, Javan M. Trichostatin A Promotes the Conversion of Astrocytes to Oligodendrocyte Progenitors in a Defined Culture Medium. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:286-295. [PMID: 31089363 PMCID: PMC6487402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The generation of oligodendrocyte progenitor cells (OPCs) offers tremendous opportunities for cell replacement therapy in demyelinating diseases such as multiple sclerosis (MS) and spinal cord injury. Recently, the prospect of reprogramming terminally differentiated adult cells towards another mature somatic cell or progenitor cells without an intermediate pluripotent state has been of interest. Trichostatin A is a histone deacetylase inhibitor which opens the chromatin and facilitates the transcription of silence genes. In this study, we have treated human astrocytes line U87 and primary culture of mouse astrocytes with TSA for 12 h, prior their transfer to OPC induction medium. Then we evaluated the morphology and the fate of the treated astrocytes at post-treatment days. Both cell lines acquired OPC morphology and expressed OPC specific markers. Following transfer to differentiation medium, U87-derived iOPCs differentiated to oligodendrocyte like cells and expressed PLP as a mature oligodendrocyte marker. Our results introduced TSA as an inducer for production of OPCs from astrocytes and could be considered a potential way for the treatment of demyelinating diseases.
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Affiliation(s)
- Leila Zare
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Hossein Baharvand
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.,Department of Developmental Biology, University of Science and Culture, ACECR, Tehran, Iran.
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.,Department of Brain and Cognitive Sciences Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.,Corresponding author: E-mail:
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69
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Andreasen AK, Iversen P, Marstrand L, Siersma V, Siebner HR, Sellebjerg F. Structural and cognitive correlates of fatigue in progressive multiple sclerosis. Neurol Res 2018; 41:168-176. [PMID: 30513278 DOI: 10.1080/01616412.2018.1547813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue in multiple sclerosis (MS) is a debilitating symptom and experienced by most patients. In recent studies investigating this phenomenon, the majority of patients had a relapsing-remitting disease course. METHODS Patients with progressive MS participating in one of three treatment trials during a period from 2010 to 2014 were included. Fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions (FSMC) and patients were further examined with a cognitive test battery, including Symbol Digit Modalities Test (SDMT), and 3 T MRI with subsequent quantitative analyses of 13 cortical regions of interest, deep grey matter and lesion volume. RESULTS Twenty-two patients were enrolled. The thickness of the pre-central gyrus correlated significantly with motor fatigue. We found only a non-significant trend towards a correlation between cognitive fatigue and the thickness of the pre-central gyrus, the parietal inferior supra-marginal gyrus and the opercular part of the inferior frontal gyrus. 36% of participants had impaired processing speed and 9% had normal function on all tests. The scores on the FSMC-cognitive scale were related to performance on SDMT. CONCLUSION In this exploratory study of patients with progressive MS, fatigue was related to processing speed. Motor fatigue was also related to the cortical thickness of the primary motor cortex and there was a trend towards a relationship between cognitive fatigue and the thickness of cortical areas involved in attentional processes. Additional studies are needed to further elucidate the relationship between regional cortical atrophy, cognitive functioning and the perception of fatigue. ABBREVIATIONS FSMC: Motor and Cognitive Functions; MS: Multiple Sclerosis; SDMT: Symbol Digit Modalities Test; MRI: Magnetic Resonance Imaging; RRMS: Relapsing-Remitting Disease Course; EDSS: Kurtzke Expanded Disability Status Scale; FLAIR: Fluid Attenuated Inversion Recovery; NAWM: Normal-Appearing White Matter; CGM: Cortical Grey Matter; CTh: Cortical Thickness; ROIs: Regions of Interest; Raven: Raven Progressive Matrices; TM A: Trail Making A; TM B: Trail Making B; Rey: Rey Complex Figure; Similarities: WAIS III Similarities; Stroop: Stroop Colour Naming Test; BDI: Becks Depression Inventory II.
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Affiliation(s)
- Anne Katrine Andreasen
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Pernille Iversen
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Lisbet Marstrand
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Volkert Siersma
- c The Research Unit for General Practice and Section of General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Hartwig Roman Siebner
- b Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Finn Sellebjerg
- a Danish Multiple Sclerosis Centre (DMSC), Department of Neurology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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70
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Ayache SS, Chalah MA. The place of transcranial direct current stimulation in the management of multiple sclerosis-related symptoms. Neurodegener Dis Manag 2018; 8:411-422. [PMID: 30451080 DOI: 10.2217/nmt-2018-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, characterized by chronic inflammation, demyelination, synaptopathy and neurodegeneration. Patients may exhibit sensory, motor, cognitive, emotional and behavioral symptoms throughout their disease process. Nowadays, the challenge is to find optimal treatment for MS symptoms, especially that available pharmacological interventions are faced by modest therapeutic outcomes and numerous side effects. Thus, finding alternative strategies might be of help in this context. The aim of this report is to visit the effects of transcranial direct current stimulation - a noninvasive brain stimulation technique - in the context of MS symptoms, namely fatigue, cognitive deficits, psychiatric complaints, neuropathic pain and some sensorimotor manifestations.
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Affiliation(s)
- Samar S Ayache
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France.,EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.,Neurology Division, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Moussa A Chalah
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France.,EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
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71
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Moral Judgment: An Overlooked Deficient Domain in Multiple Sclerosis? Behav Sci (Basel) 2018; 8:bs8110105. [PMID: 30453483 PMCID: PMC6262463 DOI: 10.3390/bs8110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system through which patients can suffer from sensory, motor, cerebellar, emotional, and cognitive symptoms. Although cognitive and behavioral dysfunctions are frequently encountered in MS patients, they have previously received little attention. Among the most frequently impaired cognitive domains are attention, information processing speed, and working memory, which have been extensively addressed in this population. However, less emphasis has been placed on other domains like moral judgment. The latter is a complex cognitive sphere that implies the individuals’ ability to judge others’ actions and relies on numerous affective and cognitive processes. Moral cognition is crucial for healthy and adequate interpersonal relationships, and its alteration might have drastic impacts on patients’ quality of life. This work aims to analyze the studies that have addressed moral cognition in MS. Only three works have previously addressed moral judgement in this clinical population compared to healthy controls, and none included neuroimaging or physiological measures. Although scarce, the available data suggest a complex pattern of moral judgments that deviate from normal response. This finding was accompanied by socio-emotional and cognitive deficits. Only preliminary data are available on moral cognition in MS, and its neurobiological foundations are still needing to be explored. Future studies would benefit from combining moral cognitive measures with comprehensive neuropsychological batteries and neuroimaging/neurophysiological modalities (e.g., functional magnetic resonance imaging, tractography, evoked potentials, electroencephalography) aiming to decipher the neural underpinning of moral judgement deficits and subsequently conceive potential interventions in MS patients.
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72
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Polachini CRN, Spanevello RM, Schetinger MRC, Morsch VM. Cholinergic and purinergic systems: A key to multiple sclerosis? J Neurol Sci 2018; 392:8-21. [DOI: 10.1016/j.jns.2018.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/21/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022]
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73
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Transcranial direct current stimulation: A glimmer of hope for multiple sclerosis fatigue? J Clin Neurosci 2018; 55:10-12. [PMID: 29914773 DOI: 10.1016/j.jocn.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/04/2018] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a neurological disease of the central nervous system characterized by inflammation, demyelination and neurodegeneration. Throughout the disease process, patients may complain of a panel of sensory, motor, cognitive and behavioral symptoms. Fatigue is a debilitating manifestation of central nervous system diseases with physical, cognitive and psychosocial dimensions. In MS, fatigue could be very frequent concerning up to 90% of patients and may have a drastic impact on their quality of life. Based on neuroimaging studies, a 'cortico-striato-thalamo-cortical' loop seems to underlie this symptom. Despite the availability of pharmacological molecules, the majority of them fail to bring satisfactory outcomes mainly because of the numerous related side-effects. Therefore, finding a safe, easy to implement, and effective alternative therapy is highly needed. These properties appear to match those of noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). tDCS consists of placing two electrodes over cortical sites, such as those that take part in MS fatigue loop. Here, tDCS protocols targeting MS fatigue are revisited. Their short and long-term effects are discussed. The majority of the available protocols have applied 5 consecutive daily 20-min sessions of anodal tDCS over specific cortical sites and yielded beneficial effects on MS fatigue. Finally, the recent emergence of remotely supervised tDCS protocols are also tackled in this work aiming to address the future possibility of translating the current research data into routine clinical practice. This may lead to optimize patients' care and improve their quality of life.
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74
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Chalah MA, Ayache SS. Is there a link between inflammation and fatigue in multiple sclerosis? J Inflamm Res 2018; 11:253-264. [PMID: 29922081 PMCID: PMC5995280 DOI: 10.2147/jir.s167199] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Among autoimmune diseases of the central nervous system stands multiple sclerosis (MS), which is characterized by demyelination, synaptopathy, and neurodegeneration. MS fatigue can affect up to 90% of patients and be very disabling, with a drastic impact on their quality of life. To date, the evaluation of MS fatigue has relied mainly on subjective scales, and actual therapeutic interventions are challenged by modest efficacy and numerous undesirable effects. Therefore, finding biomarkers of MS fatigue might help in optimizing evaluation and treatment strategies. The main objective here was to assess the relationship between MS fatigue and inflammatory or other immunomediated markers. Methods Research was conducted according to PRISMA guidelines. Computerized databases (ie, PubMed/Medline and Scopus) were consulted till February 2018 aiming to identify articles that addressed inflammation and MS fatigue. Studies in English and French published at any time were considered. Results A total of 27 studies matched the research criteria. Inconsistency existed regarding the relationship between fatigue and the orexin A system, hypothalamus–pituitary–adrenal axis, and cerebrospinal fluid inflammatory markers. As for peripheral markers, although there was scarcity in the available data, serum proinflammatory cytokines (ie, IL6, TNFα, and IFNγ) seem to be associated with MS fatigue. Finally, no link was found between MS fatigue and T-cell populations (ie, CD3+CD4+ T lymphocytes, regulatory T cells) or other peripheral markers of inflammation (ie, CRP, erythrocyte-sedimentation rate, soluble ICAM1). Conclusion Future large-scale studies would benefit from comparing the relationship between fatigue and immune measures in patients with different disease phenotypes with and without disease-modifying drugs. With the subjective nature of fatigue scales, finding objective biomarkers for fatigue would be of great help.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Neurology Division, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
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75
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Chalah MA, Ayache SS. Cognitive behavioral therapies and multiple sclerosis fatigue: A review of literature. J Clin Neurosci 2018; 52:1-4. [DOI: 10.1016/j.jocn.2018.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/11/2018] [Indexed: 01/02/2023]
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76
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Palm U, Chalah MA, Créange A, Lefaucheur JP, Ayache SS. The evaluation of depression in multiple sclerosis using the newly proposed Multiple Sclerosis Depression Rating Scale. Encephale 2018; 44:565-567. [PMID: 29463384 DOI: 10.1016/j.encep.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Fatigue and depression are frequent symptoms in multiple sclerosis (MS). Both are overlapping and shadowing each other and may impair the quality of life. For detection of depression symptoms in MS, the Multiple Sclerosis Depression Rating Scale (MSDRS) has been proposed recently. Here, we compare the performance of MSDRS in MS patients with and without fatigue to that of established rating scales, i.e. Hospital Anxiety and Depression Scale and Beck Depression Inventory. Twenty-nine MS patients were screened for fatigue and depression symptoms. Patients with fatigue showed significantly higher depression scores compared to patients without fatigue, whereas the number of depressed patients did not differ between the two groups. MSDRS seems to have higher sensitivity to detect severe depression than established rating scales. However, one should keep in mind that such a finding might be due to an increase in false positive cases when using MSDRS. Implementing this scale in future studies might be of help to enhance the understanding of its potential utility.
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Affiliation(s)
- U Palm
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Department of Psychiatry, Psychotherapy and Psychosomatics, Ludwig-Maximilian University, Geschwister-Scholl Platz 1, 80539 Munich, Germany
| | - M A Chalah
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - A Créange
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de neurologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - J-P Lefaucheur
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - S S Ayache
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France; Lebanese American University Medical Center, Rizk hospital (LAUMC-RH), Zahar street, Beirut, Lebanon.
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77
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Electrophysiological and behavioral effects of frontal transcranial direct current stimulation on cognitive fatigue in multiple sclerosis. J Neurol 2018; 265:607-617. [DOI: 10.1007/s00415-018-8754-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 12/23/2022]
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78
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Stampanoni Bassi M, Gilio L, Buttari F, Maffei P, Marfia GA, Restivo DA, Centonze D, Iezzi E. Remodeling Functional Connectivity in Multiple Sclerosis: A Challenging Therapeutic Approach. Front Neurosci 2017; 11:710. [PMID: 29321723 PMCID: PMC5733539 DOI: 10.3389/fnins.2017.00710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Neurons in the central nervous system are organized in functional units interconnected to form complex networks. Acute and chronic brain damage disrupts brain connectivity producing neurological signs and/or symptoms. In several neurological diseases, particularly in Multiple Sclerosis (MS), structural imaging studies cannot always demonstrate a clear association between lesion site and clinical disability, originating the "clinico-radiological paradox." The discrepancy between structural damage and disability can be explained by a complex network perspective. Both brain networks architecture and synaptic plasticity may play important roles in modulating brain networks efficiency after brain damage. In particular, long-term potentiation (LTP) may occur in surviving neurons to compensate network disconnection. In MS, inflammatory cytokines dramatically interfere with synaptic transmission and plasticity. Importantly, in addition to acute and chronic structural damage, inflammation could contribute to reduce brain networks efficiency in MS leading to worse clinical recovery after a relapse and worse disease progression. These evidence suggest that removing inflammation should represent the main therapeutic target in MS; moreover, as synaptic plasticity is particularly altered by inflammation, specific strategies aimed at promoting LTP mechanisms could be effective for enhancing clinical recovery. Modulation of plasticity with different non-invasive brain stimulation (NIBS) techniques has been used to promote recovery of MS symptoms. Better knowledge of features inducing brain disconnection in MS is crucial to design specific strategies to promote recovery and use NIBS with an increasingly tailored approach.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Luana Gilio
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Pierpaolo Maffei
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Diego Centonze
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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79
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Chalah MA, Ayache SS. Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 2017; 104:31-47. [DOI: 10.1016/j.neuropsychologia.2017.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 02/07/2023]
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80
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Ayache SS, Chalah MA. Cortical excitability changes: A mirror to the natural history of multiple sclerosis? Neurophysiol Clin 2017; 47:221-223. [DOI: 10.1016/j.neucli.2017.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/05/2017] [Indexed: 01/07/2023] Open
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81
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Long term effects of prefrontal tDCS on multiple sclerosis fatigue: A case study. Brain Stimul 2017; 10:1001-1002. [PMID: 28551319 DOI: 10.1016/j.brs.2017.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/20/2022] Open
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82
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Neuromuscular fatigue during exercise: Methodological considerations, etiology and potential role in chronic fatigue. Neurophysiol Clin 2017; 47:95-110. [PMID: 28434551 DOI: 10.1016/j.neucli.2017.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The term fatigue is used to describe a distressing and persistent symptom of physical and/or mental tiredness in certain clinical populations, with distinct but ultimately complex, multifactorial and heterogenous pathophysiology. Chronic fatigue impacts on quality of life, reduces the capacity to perform activities of daily living, and is typically measured using subjective self-report tools. Fatigue also refers to an acute reduction in the ability to produce maximal force or power due to exercise. The classical measurement of exercise-induced fatigue involves neuromuscular assessments before and after a fatiguing task. The limitations and alternatives to this approach are reviewed in this paper in relation to the lower limb and whole-body exercise, given the functional relevance to locomotion, rehabilitation and activities of daily living. It is suggested that under some circumstances, alterations in the central and/or peripheral mechanisms of fatigue during exercise may be related to the sensations of chronic fatigue. As such, the neurophysiological correlates of exercise-induced fatigue are briefly examined in two clinical examples where chronic fatigue is common: cancer survivors and people with multiple sclerosis. This review highlights the relationship between objective measures of fatigability with whole-body exercise and perceptions of fatigue as a priority for future research, given the importance of exercise in relieving symptoms of chronic fatigue and/or overall disease management. As chronic fatigue is likely to be specific to the individual and unlikely to be due to a simple biological or psychosocial explanation, tailored exercise programmes are a potential target for therapeutic intervention.
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83
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Ayache SS, Chalah MA. Fatigue in multiple sclerosis – Insights into evaluation and management. Neurophysiol Clin 2017; 47:139-171. [DOI: 10.1016/j.neucli.2017.02.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/15/2017] [Indexed: 12/20/2022] Open
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84
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85
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Furber KL, Van Agten M, Evans C, Haddadi A, Doucette JR, Nazarali AJ. Advances in the treatment of relapsing-remitting multiple sclerosis: the role of pegylated interferon β-1a. Degener Neurol Neuromuscul Dis 2017; 7:47-60. [PMID: 30050377 PMCID: PMC6053102 DOI: 10.2147/dnnd.s71986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive, neurodegenerative disease with unpredictable phases of relapse and remission. The cause of MS is unknown, but the pathology is characterized by infiltration of auto-reactive immune cells into the central nervous system (CNS) resulting in widespread neuroinflammation and neurodegeneration. Immunomodulatory-based therapies emerged in the 1990s and have been a cornerstone of disease management ever since. Interferon β (IFNβ) was the first biologic approved after demonstrating decreased relapse rates, disease activity and progression of disability in clinical trials. However, frequent dosing schedules have limited patient acceptance for long-term therapy. Pegylation, the process by which molecules of polyethylene glycol are covalently linked to a compound, has been utilized to increase the half-life of IFNβ and decrease the frequency of administration required. To date, there has been one clinical trial evaluating the efficacy of pegylated IFN. The purpose of this article is to provide an overview of the role of IFN in the treatment of MS and evaluate the available evidence for pegylated IFN therapy in MS.
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Affiliation(s)
- Kendra L Furber
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Marina Van Agten
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Charity Evans
- College of Pharmacy and Nutrition, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
| | | | - J Ronald Doucette
- Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital, .,Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Adil J Nazarali
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
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Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system, representing the primary cause of non-traumatic disability in young adults. Cognitive dysfunction can affect patients at any time during the disease process and might alter the six core functional domains. Social cognition is a multi-component construct that includes the theory of mind, empathy and social perception of emotions from facial, bodily and vocal cues. Deficits in this cognitive faculty might have a drastic impact on interpersonal relationships and quality of life (QoL). Although exhaustive data exist for non-social cognitive functions in MS, only a little attention has been paid for social cognition. The objectives of the present work are to reappraise the definition and anatomy of social cognition and evaluate the integrity of this domain across MS studies. We will put special emphasis on neuropsychological and neuroimaging studies concerning social cognitive performance in MS. METHODS Studies were selected in conformity with PRISMA guidelines. We looked for computerized databases (PubMed, Medline, and Scopus) that index peer-reviewed journals to identify published reports in English and French languages that mention social cognition and multiple sclerosis, regardless of publication year. We combined keywords as follows: (facial emotion or facial expression or emotional facial expressions or theory of mind or social cognition or empathy or affective prosody) AND multiple sclerosis AND (MRI or functional MRI or positron emission tomography or functional imaging or structural imaging). We also scanned references from articles aiming to get additional relevant studies. RESULTS In total, 26 studies matched the abovementioned criteria (26 neuropsychological studies including five neuroimaging studies). Available data support the presence of social cognitive deficits even at early stages of MS. The increase in disease burden along with the "multiple disconnection syndrome" resulting from gray and white matters pathology might exceed the "threshold for cerebral tolerance" and can manifest as deficits in social cognition. Admitting the impact of the latter on patients' social functioning, a thorough screening for such deficits is crucial to improving patients' QoL. (JINS, 2017, 23, 266-286).
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La fatigue dans la sclérose en plaques : la place de la Stimulation transcrânienne à courant continu (tDCS). Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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88
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Severijns D, Zijdewind I, Dalgas U, Lamers I, Lismont C, Feys P. The Assessment of Motor Fatigability in Persons With Multiple Sclerosis: A Systematic Review. Neurorehabil Neural Repair 2017; 31:413-431. [DOI: 10.1177/1545968317690831] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background. Persons with multiple sclerosis (PwMS) are often characterized by increased motor fatigability, which is a performance change on an objectively measured criterion after any type of voluntary muscle contractions. This review summarizes the existing literature to determine which protocols and outcome measures are best to detect or study motor fatigability and the underlying mechanisms in MS. Methods. Two electronic databases, PubMed and Web of Science, were searched for relevant articles published until August 2016 with a combination of multiple sclerosis, fatigability, muscle fatigue, and motor fatigue. Results. A total of 48 articles were retained for data extraction. A variety of fatigability protocols were reported; protocols showed differences in type (isometric vs concentric), duration (15 to 180 s), and number of contractions (fixed or until exhaustion). Also, 12 articles reported motor fatigability during functional movements, predominantly assessed by changes in walking speed; 11 studies evaluated the mechanisms underlying motor fatigability, using additional electrical nerve or transcranial magnetic stimulation. Three articles reported psychometrics of the outcomes. Conclusions. The disparity of protocols and outcome measures to study different aspects of motor fatigability in PwMS impedes direct comparison between data. Most protocols use maximal single-joint isometric contractions, with the advantage of high standardization. Because there is no head-to-head comparison of the different protocols and only limited information on psychometric properties of outcomes, there is currently no gold standard to assess motor fatigability. The disability level, disease phenotype, and studied limb may influence the assessment of motor fatigability in PwMS.
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Affiliation(s)
- Deborah Severijns
- REVAL - Rehabilitation Research Research Center—BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge Zijdewind
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ulrik Dalgas
- Department Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Ilse Lamers
- REVAL - Rehabilitation Research Research Center—BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Caroline Lismont
- REVAL - Rehabilitation Research Research Center—BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- REVAL - Rehabilitation Research Research Center—BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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89
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Dulamea AO. Role of Oligodendrocyte Dysfunction in Demyelination, Remyelination and Neurodegeneration in Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 958:91-127. [PMID: 28093710 DOI: 10.1007/978-3-319-47861-6_7] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oligodendrocytes (OLs) are the myelinating cells of the central nervous system (CNS) during development and throughout adulthood. They result from a complex and well controlled process of activation, proliferation, migration and differentiation of oligodendrocyte progenitor cells (OPCs) from the germinative niches of the CNS. In multiple sclerosis (MS), the complex pathological process produces dysfunction and apoptosis of OLs leading to demyelination and neurodegeneration. This review attempts to describe the patterns of demyelination in MS, the steps involved in oligodendrogenesis and myelination in healthy CNS, the different pathways leading to OLs and myelin loss in MS, as well as principles involved in restoration of myelin sheaths. Environmental factors and their impact on OLs and pathological mechanisms of MS are also discussed. Finally, we will present evidence about the potential therapeutic targets in re-myelination processes that can be accessed in order to develop regenerative therapies for MS.
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Affiliation(s)
- Adriana Octaviana Dulamea
- Neurology Clinic, University of Medicine and Pharmacy "Carol Davila", Fundeni Clinical Institute, Building A, Neurology Clinic, Room 201, 022328, Bucharest, Romania.
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90
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Lencioni T, Jonsdottir J, Cattaneo D, Crippa A, Gervasoni E, Rovaris M, Bizzi E, Ferrarin M. Are Modular Activations Altered in Lower Limb Muscles of Persons with Multiple Sclerosis during Walking? Evidence from Muscle Synergies and Biomechanical Analysis. Front Hum Neurosci 2016; 10:620. [PMID: 28018193 PMCID: PMC5145858 DOI: 10.3389/fnhum.2016.00620] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
Background: Persons with Multiple Sclerosis frequently have gait deficits that lead to diminished activities of daily living. Identification of motoneuron activity patterns may elucidate new insight into impaired locomotor coordination and underlying neural systems. The aim of the present study was to investigate muscle synergies, identified by motor modules and their activation profiles, in persons with Multiple Sclerosis (PwMS) during walking compared to those of healthy subjects (HS), as well as, exploring relationship of muscle synergies with walking ability of PwMS. Methods: Seventeen PwMS walked at their natural speed while 12 HS walked at slower than their natural speeds in order to provide normative gait values at matched speeds (spatio-temporal, kinematic, and kinetic parameters and electromyography signals). Non-negative matrix factorization was used to identify muscle synergies from eight muscles. Pearson's correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in module activations, each module's activation timing was integrated over 100% of gait cycle and the activation percentage was computed in six phases. Results: Fifty-nine% of PwMS and 58% of HS had 4 modules while the remaining of both populations had 3 modules. Module 2 (related to soleus, medial, and lateral gastrocnemius primarily involved in mid and terminal stance) and Module 3 (related to tibialis anterior and rectus femoris primarily involved in early stance, and early and late swing) were comparable across all subjects regardless of synergies number. PwMS had shorter stride length, longer double support phase and push off deficit with respect to HS (p < 0.05). The alterations of activation timing profiles of specific modules in PwMS were associated with their walking deficits (e.g., the reduction of Module 2 activation percentage index in terminal stance, PwMS 35.55 ± 13.23 vs. HS 50.51 ± 9.13% p < 0.05, and the push off deficit, PwMS 0.181 ± 0.136 vs. HS 0.291 ± 0.062 w/kg p < 0.05). Conclusion: During gait PwMS have synergies numbers similar to healthy persons. Their neurological deficit alters modular control through modifications of the timing activation profiles rather than module composition. These changes were associated with their main walking impairment, muscle weakness, and prolonged double support.
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Affiliation(s)
- Tiziana Lencioni
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi Onlus Milan, Italy
| | - Johanna Jonsdottir
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, LaRiCE Milan, Italy
| | - Davide Cattaneo
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, LaRiCE Milan, Italy
| | - Alessandro Crippa
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, LaRiCE Milan, Italy
| | - Elisa Gervasoni
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, LaRiCE Milan, Italy
| | - Marco Rovaris
- Department of Multiple Sclerosis, IRCCS Fondazione Don Carlo Gnocchi Onlus Milan, Italy
| | - Emilio Bizzi
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology Cambridge, MA, USA
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi Onlus Milan, Italy
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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1034] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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Hanken K, Bosse M, Möhrke K, Eling P, Kastrup A, Antal A, Hildebrandt H. Counteracting Fatigue in Multiple Sclerosis with Right Parietal Anodal Transcranial Direct Current Stimulation. Front Neurol 2016; 7:154. [PMID: 27708612 PMCID: PMC5030283 DOI: 10.3389/fneur.2016.00154] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 12/20/2022] Open
Abstract
Background Fatigue in multiple sclerosis (MS) patients appears to correlate with vigilance decrement as reflected in an increase in reaction time (RT) and errors with prolonged time-on-task. Objectives The aim of this study was to investigate whether anodal transcranial direct current stimulation (tDCS) over the right parietal or frontal cortex counteracts fatigue-associated vigilance decrement and subjective fatigue. Methods In study I, a randomized double-blind placebo-controlled study, anodal tDCS (1.5 mA) was delivered to the right parietal cortex or the right frontal cortex of 52 healthy participants during the first 20 min of a 40-min lasting visual vigilance task. Study II, also a randomized double-blind placebo-controlled study, investigated the effect of anodal tDCS (1.5 mA) over the right parietal cortex in 46 MS patients experiencing cognitive fatigue. tDCS was delivered for 20 min before patients performed a 20-min lasting visual vigilance task. Results Study I showed that right parietal stimulation, but not right frontal stimulation, counteracts the increase in RT associated with vigilance decrement. Hence, only right parietal stimulation was applied to the MS patients in study II. Stimulation had a significant effect on vigilance decrement in mildly to moderately cognitively fatigued MS patients. Vigilance testing significantly increased the feeling of fatigue independent of stimulation. Conclusion Anodal tDCS over the right parietal cortex can counteract the increase in RTs during vigilance performance, but not the increase in subjective fatigue. This finding is compatible with our model of fatigue in MS, suggesting a dissociation between the feeling and the behavioral characteristics of fatigue.
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Affiliation(s)
- Katrin Hanken
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Mona Bosse
- Department of Psychology, Carl von Ossietzky University Oldenburg , Oldenburg , Germany
| | - Kim Möhrke
- Department of Chemistry, Carl von Ossietzky University Oldenburg , Oldenburg , Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen , Nijmegen , Netherlands
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost , Bremen , Germany
| | - Andrea Antal
- University Medical Center, Georg-August University Göttingen , Göttingen , Germany
| | - Helmut Hildebrandt
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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93
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Chalah MA, Mhalla A, Créange A, Lefaucheur JP, Ayache SS. L’effet de la stimulation transcrânienne à Courant Continu (tDCS) sur la fatigue dans la sclerose en plaques. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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94
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Ayache SS, Chalah MA, Palm U, Créange A, Lefaucheur JP. L’effet de la stimulation transcrânienne à Courant Continu (tDCS) sur la douleur, l’attention, et l’humeur dans la sclérose en plaques. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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95
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Ayache SS, Palm U, Chalah MA, Al-Ani T, Brignol A, Abdellaoui M, Dimitri D, Sorel M, Créange A, Lefaucheur JP. Prefrontal tDCS Decreases Pain in Patients with Multiple Sclerosis. Front Neurosci 2016; 10:147. [PMID: 27092048 PMCID: PMC4824778 DOI: 10.3389/fnins.2016.00147] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/21/2016] [Indexed: 01/17/2023] Open
Abstract
Background: In the last few years, transcranial direct current stimulation (tDCS) has emerged as an appealing therapeutic option to improve brain functions. Promising data support the role of prefrontal tDCS in augmenting cognitive performance and ameliorating several neuropsychiatric symptoms, namely pain, fatigue, mood disturbances, and attentional impairment. Such symptoms are commonly encountered in patients with multiple sclerosis (MS). Objective: The main objective of the current work was to evaluate the tDCS effects over the left dorsolateral prefrontal cortex (DLPFC) on pain in MS patients.Our secondary outcomes were to study its influence on attention, fatigue, and mood. Materials and Methods: Sixteen MS patients with chronic neuropathic pain were enrolled in a randomized, sham-controlled, and cross-over study.Patients randomly received two anodal tDCS blocks (active or sham), each consisting of three consecutive daily tDCS sessions, and held apart by 3 weeks. Evaluations took place before and after each block. To evaluate pain, we used the Brief Pain Inventory (BPI) and the Visual Analog Scale (VAS). Attention was assessed using neurophysiological parameters and the Attention Network Test (ANT). Changes in mood and fatigue were measured using various scales. Results: Compared to sham, active tDCS yielded significant analgesic effects according to VAS and BPI global scales.There were no effects of any block on mood, fatigue, or attention. Conclusion: Based on our results, anodal tDCS over the left DLPFC appears to act in a selective manner and would ameliorate specific symptoms, particularly neuropathic pain. Analgesia might have occurred through the modulation of the emotional pain network. Attention, mood, and fatigue were not improved in this work. This could be partly attributed to the short protocol duration, the small sample size, and the heterogeneity of our MS cohort. Future large-scale studies can benefit from comparing the tDCS effects over different cortical sites, changing the stimulation montage, prolonging the duration of protocol, and coupling tDCS with neuroimaging techniques for a better understanding of its possible mechanism of action.
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Affiliation(s)
- Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France; Neurology Division, Lebanese American University Medical Center - Rizk HospitalBeirut, Lebanon
| | - Ulrich Palm
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-UniversityMunich, Germany
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
| | - Tarik Al-Ani
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France
| | - Arnaud Brignol
- Département d'Informatique et de Recherche Opérationnelle, Université de Montréal Montréal, QC, Canada
| | - Mohamed Abdellaoui
- Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Dalia Dimitri
- Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Marc Sorel
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
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