1
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Bertoli M, Tataranni A, Porziani S, Pasqualetti P, Gianni E, Grifoni J, L’Abbate T, Armonaite K, Conti L, Cancelli A, Cottone C, Marinozzi F, Bini F, Cecconi F, Tecchio F. Effects on Corticospinal Tract Homology of Faremus Personalized Neuromodulation Relieving Fatigue in Multiple Sclerosis: A Proof-of-Concept Study. Brain Sci 2023; 13:brainsci13040574. [PMID: 37190539 DOI: 10.3390/brainsci13040574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives: Fatigue in multiple sclerosis (MS) is a frequent and invalidating symptom, which can be relieved by non-invasive neuromodulation, which presents only negligible side effects. A 5-day transcranial direct-current stimulation, 15 min per day, anodically targeting the somatosensory representation of the whole body against a larger occipital cathode was efficacious against MS fatigue (fatigue relief in multiple sclerosis, Faremus treatment). The present proof-of-concept study tested the working hypothesis that Faremus S1 neuromodulation modifies the homology of the dominant and non-dominant corticospinal (CST) circuit recruitment. Methods: CST homology was assessed via the Fréchet distance between the morphologies of motor potentials (MEPs) evoked by transcranial magnetic stimulation in the homologous left- and right-hand muscles of 10 fatigued MS patients before and after Faremus. Results: In the absence of any change in MEP features either as differences between the two body sides or as an effect of the treatment, Faremus changed in physiological direction the CST’s homology. Faremus effects on homology were more evident than recruitment changes within the dominant and non-dominant sides. Conclusions: The Faremus-related CST changes extend the relevance of the balance between hemispheric homologs to the homology between body sides. With this work, we contribute to the development of new network-sensitive measures that can provide new insights into the mechanisms of neuronal functional patterning underlying relevant symptoms.
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2
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Royer N, Coates K, Aboodarda SJ, Camdessanché JP, Millet GY. How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis? Front Neurol 2022; 13:983643. [DOI: 10.3389/fneur.2022.983643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Whereas fatigue is recognized to be the main complaint of patients with multiple sclerosis (PwMS), its etiology, and particularly the role of resistance to fatigability and its interplay with disability level, remains unclear. The purposes of this review were to (i) clarify the relationship between fatigue/disability and neuromuscular performance in PwMS and (ii) review the corticospinal and muscular mechanisms of voluntary muscle contraction that are altered by multiple sclerosis, and how they may be influenced by disability level or fatigue. Neuromuscular function at rest and during exercise are more susceptible to impairement, due to deficits in voluntary activation, when the disability is greater. Fatigue level is related to resistance to fatigability but not to neuromuscular function at rest. Neurophysiological parameters related to signal transmission such as central motor conduction time, motor evoked potentials amplitude and latency are affected by disability and fatigue levels but their relative role in the impaired production of torque remain unclear. Nonetheless, cortical reorganization represents the most likely explanation for the heightened fatigability during exercise for highly fatigued and/or disabled PwMS. Further research is needed to decipher how the fatigue and disability could influence fatigability for an ecological task, especially at the corticospinal level.
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3
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Franca T, Andrea C, Arianna P, Teresa L, Eugenia G, Massimo B, Luca P, Silvana Z, Alessandro G, Domenico L, Patrizio P, Massimiliano M, Maddalena FM. Home treatment against fatigue in multiple sclerosis by a personalized, bilateral whole-body somatosensory cortex stimulation. Mult Scler Relat Disord 2022; 63:103813. [DOI: 10.1016/j.msard.2022.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
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4
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Padalino M, Scardino C, Zito G, Cancelli A, Cottone C, Bertoli M, Gianni E, L'Abbate T, Trombetta E, Porcaro C, Bini F, Marinozzi F, Filippi MM, Tecchio F. Effects on Motor Control of Personalized Neuromodulation Against Multiple Sclerosis Fatigue. Brain Topogr 2021; 34:363-372. [PMID: 33656622 DOI: 10.1007/s10548-021-00820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
Fatigue is a hidden symptom of Multiple Sclerosis (MS) disease that nevertheless impacts severely on patients' everyday life. Evidence indicates the involvement of the sensorimotor network and its inter-nodes communication at the basis of this symptom. Two randomized controlled trials (RCTs) showed that the personalized neuromodulation called Fatigue Relief in Multiple Sclerosis (FaReMuS) efficaciously fights multiple sclerosis (MS) fatigue. By this Proof of Concept study, we tested whether FaReMuS reverts the alteration of the brain-muscular synchronization previously observed occurring with fatigue. The cortico muscular coherence (CMC) was studied in 11 patients before and after FaReMuS, a 5-day tDCS (1.5 mA, 15 min per day) anodal over the whole body's somatosensory representation (S1) via a personalized MRI-based electrode (35 cm2) against the occipital cathode (70 cm2). Before FaReMuS, the CMC was observed at a mean frequency of 31.5 ± 1.6 Hz (gamma-band) and positively correlated with the level of fatigue (p = .027). After FaReMuS, fatigue reduced in average of 28% ± 33% the baseline level, and the CMC frequency reduced to 26.6 ± 1.5 Hz (p = .022), thus forthcoming the physiological beta-band as observed in healthy people. The personalized S1 neuromodulation treatment, ameliorating the central-peripheral communication that subtends simple everyday movements, supports the appropriateness of neuromodulations aiming at increasing the parietal excitability in fighting MS fatigue. The relationship between central-peripheral features and fatigue profile strengthens a central more than peripheral origin of the symptom.
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Affiliation(s)
| | - Carla Scardino
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Giancarlo Zito
- Complex Operative Unit of Neurology, Emergency Department, San Camillo de Lellis Hospital, Viale Kennedy, Rieti, 02100, RI, Italy.,Diagnostic and Clinical Assessment Unit, Istituto di Ortofonologia, Via Salaria, 30, Rome, 00198, RM, Italy
| | | | | | - Massimo Bertoli
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Department of Imaging and Neuroscience and Clinical Sciences, University 'G. D'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Eugenia Gianni
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Camillo Porcaro
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK.,Department of Information Engineering, Università Politecnica Delle Marche, Ancona, Italy.,S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Maria Maddalena Filippi
- Complex Operative Unit of Neurology, Emergency Department, San Camillo de Lellis Hospital, Viale Kennedy, Rieti, 02100, RI, Italy
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5
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Mamoei S, Hvid LG, Boye Jensen H, Zijdewind I, Stenager E, Dalgas U. Neurophysiological impairments in multiple sclerosis-Central and peripheral motor pathways. Acta Neurol Scand 2020; 142:401-417. [PMID: 32474916 DOI: 10.1111/ane.13289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 12/27/2022]
Abstract
A systematic review of the literature was conducted comparing neurophysiological outcomes in persons with multiple sclerosis (PwMS) to healthy controls (HC), in studies of the central nervous system (CNS) function comprising motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) and in studies of the peripheral nervous system (PNS) function comprising electroneuronography (ENG) outcomes elicited by peripheral nerve stimulation. Studies comparing neuromuscular function, assessed during maximal voluntary contraction (MVC) of muscle, were included if they reported muscle strength along with muscle activation by use of electromyography (EMG) and/or interpolated twitch technique (ITT). Studies investigating CNS function showed prolonged central motor conduction times, asymmetry of nerve conduction motor pathways, and prolonged latencies in PwMS when compared to HC. Resting motor threshold, amplitude, and cortical silent periods showed conflicting results. CNS findings generally correlated with disabilities. Studies of PNS function showed near significant prolongation in motor latency of the median nerve, reduced nerve conduction velocities in the tibial and peroneal nerves, and decreased compound muscle action potential amplitudes of the tibial nerve in PwMS. ENG findings did not correlate with clinical severity of disabilities. Studies of neuromuscular function showed lower voluntary muscle activation and increased central fatigue in PwMS, whereas EMG showed divergent muscle activation (ie, EMG amplitude) during MVC. When comparing the existing literature on neurophysiological motor examinations in PwMS and HC, consistent and substantial impairments of CNS function were seen in PwMS, whereas impairments of the PNS were less pronounced and inconsistent. In addition, impairments in muscle activation were observed in PwMS.
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Affiliation(s)
- Sepehr Mamoei
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Denmark/MS‐Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg) Department of Neurology University Hospital of Southern Jutland Sønderborg Denmark
| | - Lars G. Hvid
- Exercise Biology Department of Public Health Aarhus University Aarhus C Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Department of Neurology Kolding Sygehus Kolding Denmark
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems UMCG University of Groningen Groningen The Netherlands
| | - Egon Stenager
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Denmark/MS‐Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg) Department of Neurology University Hospital of Southern Jutland Sønderborg Denmark
| | - Ulrik Dalgas
- Exercise Biology Department of Public Health Aarhus University Aarhus C Denmark
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Coates KD, Aboodarda SJ, Krüger RL, Martin T, Metz LM, Jarvis SE, Millet GY. Multiple sclerosis-related fatigue: the role of impaired corticospinal responses and heightened exercise fatigability. J Neurophysiol 2020; 124:1131-1143. [PMID: 32877296 DOI: 10.1152/jn.00165.2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
It is unclear whether motor fatigability and perceived fatigue share a common pathophysiology in people with multiple sclerosis (PwMS). This cross-sectional investigation explored the relationship between the mechanisms of motor fatigability from cycling and fatigue severity in PwMS. Thirteen highly fatigued (HF) and thirteen nonfatigued (LF) PwMS and thirteen healthy controls (CON) completed a step test until volitional exhaustion on an innovative cycle ergometer. Neuromuscular evaluations involving femoral nerve electrical stimulation and transcranial magnetic stimulation were performed every 3 min throughout cycling. One-way ANOVA at baseline and exhaustion uncovered evidence of consistently smaller motor evoked potential (MEP) amplitudes (P = 0.011) and prolonged MEP latencies (P = 0.041) in HF as well as a greater decline in maximal voluntary contraction force (HF: 63 ± 13%; LF: 75 ± 13%; CON: 73 ± 11% of pre; P = 0.037) and potentiated twitch force (HF: 35 ± 13%; LF: 50 ± 16%; CON: 47 ± 17% of pre; P = 0.049) in HF at volitional exhaustion. Hierarchical regression determined that fatigue severity on the Fatigue Severity Scale was predicted by prolonged MEP latencies (change in r2 = 0.389), elevated peripheral muscle fatigability (change in r2 = 0.183), and depressive symptoms (change in r2 = 0.213). These findings indicate that MS-related fatigue is distinguished by disrupted corticospinal responsiveness, which could suggest progressive pathology, but fatigability from whole body exercise and depressive symptoms also influence perceptions of fatigue in PwMS.NEW & NOTEWORTHY The etiology of fatigability from whole body exercise was examined for the first time to accurately elucidate the relationship between fatigue and fatigability in multiple sclerosis (MS). Compromised corticospinal responsiveness predicted fatigue severity, providing a novel, objective indicator of fatigue in MS. Although the impaired corticomotor transmission did not aggravate muscle activation in this group of people with multiple sclerosis (PwMS) of lower disability, heightened muscle fatigability was seen to contribute to perceptions of fatigue in PwMS.
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Affiliation(s)
- Kyla D Coates
- Neuromuscular Fatigue Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Saied Jalal Aboodarda
- Neuromuscular Fatigue Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Renata L Krüger
- Neuromuscular Fatigue Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tristan Martin
- Neuromuscular Fatigue Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Unité Mixte de Recherche-S 1075 Comete Moblites: Vieillissement Pathologies Santé, Institut National de la Santé et de la Recherche Médicale, Normandy University, Caen, France
| | - Luanne M Metz
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott E Jarvis
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guillaume Y Millet
- Neuromuscular Fatigue Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Inter-University Laboratory of Human Movement Biology, Jean Monnet University-Saint-Etienne, University of Lyon, Saint-Etienne, France.,Institut Universitaire de France, Paris, France
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7
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Bertoli M, Tecchio F. Fatigue in multiple sclerosis: Does the functional or structural damage prevail? Mult Scler 2020; 26:1809-1815. [DOI: 10.1177/1352458520912175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Fatigue in multiple sclerosis (MS) is a highly invalidating symptom, lacking efficacious drugs. This topical review aims at assessing the signs in the literature of functional versus structural damage prevalence at the origin of MS fatigue by focusing on papers that assessed the two counterparts in the same patients, paying attention that the fatigue levels do not correlate with clinical severity. We summarize and discuss evidence of increased levels of fatigue occurring together with the alterations of functional connectivity at multiple levels, in the absence of any relationship with lesion load and local atrophy of the involved structures. Specifically, neuronal communication mainly altered in the corticomuscular synchronizations, between hemispheric homologs and in the resting-state networks involved in emotion (cingulate cortex) and effort-reward balance (striatum and inferior parietal lobule). Finally, given the functional prevalence in neuronal network alterations at the origin of fatigue in MS, we highlight the relevance of developing treatments aiming at compensating the neuronal electric communication dysfunctions.
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Affiliation(s)
- Massimo Bertoli
- LET’S – ISTC – CNR, Catholic University of the Sacred Heart, Rome, Italy
| | - Franca Tecchio
- LET’S – ISTC – CNR, Catholic University of the Sacred Heart, Rome, Italy
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8
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Cortical neurodynamics changes mediate the efficacy of a personalized neuromodulation against multiple sclerosis fatigue. Sci Rep 2019; 9:18213. [PMID: 31796805 PMCID: PMC6890667 DOI: 10.1038/s41598-019-54595-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
The people with multiple sclerosis (MS) often report that fatigue restricts their life. Nowadays, pharmacological treatments are poorly effective accompanied by relevant side effects. A 5-day transcranial direct current stimulation (tDCS) targeting the somatosensory representation of the whole body (S1) delivered through an electrode personalized based on the brain MRI was efficacious against MS fatigue (FaReMuS treatment). This proof of principle study tested whether possible changes of the functional organization of the primary sensorimotor network induced by FaReMuS partly explained the effected fatigue amelioration. We measured the brain activity at rest through electroencephalography equipped with a Functional Source Separation algorithm and we assessed the neurodynamics state of the primary somatosensory (S1) and motor (M1) cortices via the Fractal Dimension and their functional connectivity via the Mutual Information. The dynamics of the neuronal electric activity, more distorted in S1 than M1 before treatment, as well as the network connectivity, altered maximally between left and right M1 homologs, reverted to normal after FaReMuS. The intervention-related changes explained 48% of variance of fatigue reduction in the regression model. A personalized neuromodulation tuned in on specific anatomo-functional features of the impaired regions can be effective against fatigue.
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9
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Liu M, Fan S, Xu Y, Cui L. Non-invasive brain stimulation for fatigue in multiple sclerosis patients: A systematic review and meta-analysis. Mult Scler Relat Disord 2019; 36:101375. [PMID: 31491597 DOI: 10.1016/j.msard.2019.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/05/2019] [Accepted: 08/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND To investigate the efficacy and safety of non-invasive brain stimulation for fatigue in multiple sclerosis patients. METHODS We searched MEDLINE, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang databases up to October 25, 2018 (PROSPERO registration number: CRD42018112823). Randomized or pseudo-randomized, sham-controlled clinical trials evaluating the effect of non-invasive brain stimulation (NIBS) such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), transcranial random noise stimulation (tRNS), transcranial alternating current stimulation (tACS), cranial electrotherapy stimulation, and reduced impedance non-invasive cortical electrostimulation were included. Two authors independently performed data extraction and risk of bias assessment according to Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The primary outcome was fatigue scores before and after stimulation and the secondary outcome was adverse events. RESULTS Data from cross-over and parallel group studies were pooled using a generic inverse-variance approach. A total of 14 studies (11 for tDCS, 2 for TMS, and 1 for tRNS) recruiting 207 patients were included in the systematic review and meta-analysis. No eligible tACS, cranial electrotherapy stimulation or reduced impedance non-invasive cortical electrostimulation studies were found. Short-term and long-term treatment effects were significant for tDCS, whereas TMS and tRNS were not superior to sham stimulation. The available evidence supported the effectiveness of the 1.5 mA subgroup and bilateral S1 subgroup of tDCS. Adverse events were minor and transient but comparable between real and sham stimulation. CONCLUSIONS tDCS is a safe and effective treatment for fatigue in MS patients. However, further studies are required to confirm our results in a large-scale population and to investigate the effectiveness of other NIBS subtypes.
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Affiliation(s)
- Mange Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yan Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
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10
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Mordillo-Mateos L, Soto-Leon V, Torres-Pareja M, Peinado-Palomino D, Mendoza-Laiz N, Alonso-Bonilla C, Dileone M, Rotondi M, Aguilar J, Oliviero A. Fatigue in Multiple Sclerosis: General and Perceived Fatigue Does Not Depend on Corticospinal Tract Dysfunction. Front Neurol 2019; 10:339. [PMID: 31024433 PMCID: PMC6465550 DOI: 10.3389/fneur.2019.00339] [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: 05/11/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an autoimmune disorder of the CNS in which inflammation, demyelination, and axonal damage of the central nervous system coexist. Fatigue is one of the most disabling symptoms in MS and little is known about the neurophysiological mechanisms involved. Methods: To give more mechanistic insight of fatigue in MS, we studied a cohort of 17 MS patients and a group of 16 age-matched healthy controls. Baseline Fatigue Severity Scales and Fatigue Rating were obtained from both groups to check the level of fatigue and to perform statistical correlations with fatigue-induced neurophysiologic changes. To induce fatigue we used a handgrip task. During the fatiguing task, we evaluated fatigue state (using a dynamometer) and after the task we evaluated the Borg Rating of Perceived Exertion Scale. Transcranial magnetic stimulation and peripheral electric stimulation were used to assess corticospinal tract and peripheral system functions before and after the task. Results: Clinically significant fatigue and central motor conduction time were greater in patients than in controls, while motor cortex excitability was decreased and maximal handgrip strength reduced in patients. Interestingly, fatigue state was positively correlated to perceived fatigue in controls but not in patients. Furthermore, in the presence of similar fatigue state over time, controls showed a significant fatigue-related reduction in motor evoked potential (a putative marker of central fatigue) whereas this effect was not seen in patients. Conclusions: in MS patients the pathogenesis of fatigue seems not driven by the mechanisms directly related to corticospinal function (that characterize fatigue in controls) but seems probably due to other "central abnormalities" upstream to primary motor cortex.
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Affiliation(s)
- Laura Mordillo-Mateos
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Vanesa Soto-Leon
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Marta Torres-Pareja
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain.,Facultad de Ciencias del Deporte, University of Castilla La Mancha, Toledo, Spain
| | - Diego Peinado-Palomino
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain.,Facultad de Ciencias del Deporte, University of Castilla La Mancha, Toledo, Spain
| | | | - Carlos Alonso-Bonilla
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Michele Dileone
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, IRCCS Scientific Clinical Institutes Maugeri, University of Pavia, Pavia, Italy
| | - Juan Aguilar
- Experimental Neurophysiology, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
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11
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Cancelli A, Cottone C, Giordani A, Migliore S, Lupoi D, Porcaro C, Mirabella M, Rossini PM, Filippi MM, Tecchio F. Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis. Mult Scler 2017; 24:1366-1374. [PMID: 28756744 DOI: 10.1177/1352458517720528] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The patients suffering from multiple sclerosis (MS) often consider fatigue the most debilitating symptom they experience, but conventional medicine currently offers poorly efficacious therapies. OBJECTIVE We executed a replication study of an innovative approach for relieving MS fatigue. METHODS According to the sample size estimate, we recruited 10 fatigued MS patients who received 5-day transcranial direct current stimulation (tDCS) in a randomized, double-blind, Sham-controlled, crossover study, with modified Fatigue Impact Scale (mFIS) score reduction at the end of the treatment as primary outcome. A personalized anodal electrode, shaped on the magnetic resonance imaging (MRI)-derived individual cortical folding, targeted the bilateral whole-body primary somatosensory cortex (S1) with an occipital cathode. RESULTS The amelioration of fatigue symptoms after Real stimulation (40% of baseline) was significantly larger than after Sham stimulation (14%, p = 0.012). Anodal whole body S1 induced a significant fatigue reduction in mildly disabled MS patients when the fatigue-related symptoms severely hampered their quality of life. CONCLUSION This second result in an independent group of patients supports the idea that neuromodulation interventions that properly select a personalized target might be a suitable non-pharmacological treatment for MS fatigue.
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Affiliation(s)
- Andrea Cancelli
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Carlo Cottone
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Alessandro Giordani
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy/Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy
| | - Simone Migliore
- Clinical Psychology Service, University Campus Bio-Medico, Rome, Italy/LIRH Foundation, Rome, Italy
| | - Domenico Lupoi
- Neuroscience and Imaging, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Camillo Porcaro
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Massimiliano Mirabella
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Paolo Maria Rossini
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | | | - Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
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12
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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: 51] [Impact Index Per Article: 7.3] [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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13
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Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: A scoping review. J Neurol Sci 2017; 373:307-320. [PMID: 28131211 DOI: 10.1016/j.jns.2017.01.002] [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] [Received: 07/27/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fatigue is one of the most common and most disabling symptoms of multiple sclerosis (MS). It is a multidimensional and complex symptom with multifaceted origins, involving both central and peripheral fatigue mechanisms. Exercise has proven to be safe for people with MS, with cumulating evidence supporting significant reductions in fatigue. However, the potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in MS remain elusive. OBJECTIVES The objectives were, in PwMS (1) to update the knowledge on the pathophysiology underlying primary and secondary fatigue, and (2) to discuss potential pathophysiological pathways that can explain the positive effects of exercise on MS fatigue. METHODS A comprehensive literature search of six databases (PubMed, Embase, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to 1) enroll participants with definite MS according to defined criteria, 2) assess explicit pathophysiological mechanisms related to MS fatigue, 3) be available in English, Danish or French, and 4) had undergone peer-review. RESULTS A total of 234 studies fulfilled the inclusion criteria. Primary MS fatigue mainly originated from a dysfunction of central nervous system neuronal circuits secondary to increased inflammation, reduced glucose metabolism, brain atrophy and diffuse demyelination and axonal lesions. Secondary MS fatigue was linked with sleep disturbances, depression, cognitive impairments, and deconditioning. Cardiovascular, immunologic, neuroendocrine, and neurotrophic changes associated with exercise may alleviate primary MS fatigue while exercise may improve secondary MS fatigue through symptomatic improvement of deconditioning, sleep disorders, and depression. CONCLUSIONS >30 primary and secondary pathophysiological fatigue pathways were identified underlining the multidimensionality and complexity of MS fatigue. Though the underlying key cellular and molecular cascades still have to be fully elucidated, exercise holds the potential to alleviate MS fatigue, through both primary and secondary fatigue pathways.
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Sleep and fatigue in multiple sclerosis: A questionnaire-based, cross-sectional, cohort study. J Neurol Sci 2017; 372:387-392. [DOI: 10.1016/j.jns.2016.10.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 09/28/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022]
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Grape HE, Solbrække KN, Kirkevold M, Mengshoel AM. Tiredness and fatigue during processes of illness and recovery: A qualitative study of women recovered from fibromyalgia syndrome. Physiother Theory Pract 2016; 33:31-40. [PMID: 27898261 DOI: 10.1080/09593985.2016.1247933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fibromyalgia syndrome (FMS), a chronic musculoskeletal pain condition, is often accompanied by fatigue. In this study, inspired by narrative approaches to health and illness, we explore how women who have regained their health after FMS describe tiredness along a storyline from before they fell ill, through their illness, recovery process, and present-day health. The data derive from qualitative interviews with eight Norwegian women who previously suffered from FMS but who no longer had the condition at the time of interview. We undertook a narrative analysis to understand the complexity of the stories about tiredness and fatigue and on this basis identified a storyline based on four sub-narratives: 1) Alarming but ignored tiredness (before illness); 2) paralyzing fatigue (during illness); 3) making sense of fatigue (recovery process); and 4) integrating tiredness into life (today). The findings highlight participants' different understandings and meanings of tiredness and fatigue and the ways in which these link past, present, and future. Significantly, a clear distinction between tiredness and fatigue was not always found. Overall, the storyline that emerges from the narratives is about balancing tiredness/fatigue with everyday life, and how this unfolds in different ways across the span of FMS, from falling ill to recovering and regaining health.
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Affiliation(s)
- Hedda Eik Grape
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Kari Nyheim Solbrække
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Marit Kirkevold
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Anne Marit Mengshoel
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
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Zijdewind I, Prak RF, Wolkorte R. Fatigue and Fatigability in Persons With Multiple Sclerosis. Exerc Sport Sci Rev 2016; 44:123-8. [DOI: 10.1249/jes.0000000000000088] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Vecchio F, Miraglia F, Porcaro C, Cottone C, Cancelli A, Rossini PM, Tecchio F. Electroencephalography-Derived Sensory and Motor Network Topology in Multiple Sclerosis Fatigue. Neurorehabil Neural Repair 2016; 31:56-64. [DOI: 10.1177/1545968316656055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
People with multiple sclerosis (MS) frequently complain of excessive fatigue, which is the most disabling symptom for half of them. While the few drugs used to treat MS fatigue are of limited utility, we recently observed the efficacy of a personalized neuromodulation treatment. Here, we aim at strengthening knowledge of the brain network changes that occur when MS fatigue increases, using graph theory. We collected electroencephalographic (EEG; 23 or 64 channels) data in resting state with eyes open in 27 relapsing-remitting (RR) patients with mild MS (EDSS ≤2), suffering a wide range of fatigue as scored by the modified Fatigue Impact Scale (mFIS) (2-69, within a total range 0-84). To estimate graph theory small-world index (SW), we calculated the lagged linear coherence between EEG cortical eLORETA sources, in the standard frequency bands delta (2-4 Hz), theta (4-8 Hz), alpha1 (8-10.5 Hz), alpha2 (10.5-13 Hz), beta1 (13-20 Hz), beta2 (20-30 Hz), and gamma (30-45 Hz). We calculated the SW of these undirected and weighted networks separately in the four left and right frontal (motor) and parieto-occipito-temporal (sensory) brain networks. A correlative analysis demonstrated increased fatigue symptoms along with the SW specifically in the Sensory network of the left dominant hemisphere in the beta1 band (Pearson’s r = 0.404, P = .020). Our study indicates a specific involvement of the dominant-hemisphere sensory network in MS fatigue. It suggests that compensatory neuromodulation interventions could enhance efficacy in relieving this debilitating symptom by targeting this area.
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Affiliation(s)
| | | | - Camillo Porcaro
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
- Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Cottone
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
| | - Andrea Cancelli
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
- Catholic University, Rome, Italy
| | | | - Franca Tecchio
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
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L’étude de l’excitabilité corticale par TMS comme biomarqueur de la sclérose en plaques. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Collett J, Meaney A, Howells K, Dawes H. Acute recovery from exercise in people with multiple sclerosis: an exploratory study on the effect of exercise intensities. Disabil Rehabil 2016; 39:551-558. [DOI: 10.3109/09638288.2016.1152604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Johnny Collett
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Andy Meaney
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Ken Howells
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Movement Science Group, Oxford Brookes University, Oxford, UK
- Department of Clinical Neurology, University of Oxford, Oxford, UK
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Neurophysiological Correlates of Central Fatigue in Healthy Subjects and Multiple Sclerosis Patients before and after Treatment with Amantadine. Neural Plast 2015; 2015:616242. [PMID: 26236509 PMCID: PMC4506817 DOI: 10.1155/2015/616242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/17/2015] [Indexed: 01/05/2023] Open
Abstract
In ten healthy subjects and in ten patients suffering from Multiple Sclerosis (MS), we investigated the cortical functional changes induced by a standard fatiguing repetitive tapping task. The Cortical Silent Period (CSP), an intracortical, mainly GABAB-mediated inhibitory phenomenon, was recorded by two different hand muscles, one acting as prime mover of the fatiguing index-thumb tapping task (First Dorsal Interosseous, FDI) and the other one not involved in the task but sharing largely overlapping central, spinal, and peripheral innervation (Abductor Digiti Minimi, ADM). At baseline, the CSP was shorter in patients than in controls. As fatigue developed, CSP changes involved both the “fatigued” FDI and the “unfatigued” ADM muscles, suggesting a cortical spread of central fatigue mechanisms. Chronic therapy with amantadine annulled differences in CSP duration between controls and patients, possibly through restoration of more physiological levels of intracortical inhibition in the motor cortex. These inhibitory changes correlated with the improvement of fatigue scales. The CSP may represent a suitable marker of neurophysiological mechanisms accounting for central fatigue generation either in controls or in MS patients, involving corticospinal neural pools supplying not only the fatigued muscle but also adjacent muscles sharing an overlapping cortical representation.
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Tecchio F, Cancelli A, Cottone C, Ferrucci R, Vergari M, Zito G, Pasqualetti P, Filippi MM, Ghazaryan A, Lupoi D, Smits FM, Giordani A, Migliore S, Porcaro C, Salustri C, Rossini PM, Priori A. Brain Plasticity Effects of Neuromodulation Against Multiple Sclerosis Fatigue. Front Neurol 2015; 6:141. [PMID: 26191036 PMCID: PMC4490242 DOI: 10.3389/fneur.2015.00141] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022] Open
Abstract
Rationale We recently reported on the efficacy of a personalized transcranial direct current stimulation (tDCS) treatment in reducing multiple sclerosis (MS) fatigue. The result supports the notion that interventions targeted at modifying abnormal excitability within the sensorimotor network could represent valid non-pharmacological treatments. Objective The present work aimed at assessing whether the mentioned intervention also induces changes in the excitability of sensorimotor cortical areas. Method Two separate groups of fatigued MS patients were given a 5-day tDCS treatments targeting, respectively, the whole body somatosensory areas (S1wb) and the hand sensorimotor areas (SM1hand). The study had a double blind, sham-controlled, randomized, cross-over (Real vs. Sham) design. Before and after each treatment, we measured fatigue levels (by the modified fatigue impact scale, mFIS), motor evoked potentials (MEPs) in response to transcranial magnetic stimulation and somatosensory evoked potentials (SEPs) in response to median nerve stimulation. We took MEPs and SEPs as measures of the excitability of the primary motor area (M1) and the primary somatosensory area (S1), respectively. Results The Real S1wb treatment produced a 27% reduction of the mFIS baseline level, while the SM1hand treatment showed no difference between Real and Sham stimulations. M1 excitability increased on average 6% of the baseline in the S1wb group and 40% in the SM1hand group. Observed SEP changes were not significant and we found no association between M1 excitability changes and mFIS decrease. Conclusion The tDCS treatment was more effective against MS fatigue when the electrode was focused on the bilateral whole body somatosensory area. Changes in S1 and M1 excitability did not correlate with symptoms amelioration. Significance The neuromodulation treatment that proved effective against MS fatigue induced only minor variations of the motor cortex excitability, not enough to explain the beneficial effects of the intervention.
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Affiliation(s)
- Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy
| | - Andrea Cancelli
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy
| | - Carlo Cottone
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
| | - Maurizio Vergari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
| | - Giancarlo Zito
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Patrizio Pasqualetti
- Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | | | - Anna Ghazaryan
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Domenico Lupoi
- AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | | | - Alessandro Giordani
- Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Simone Migliore
- University of Campus Biomedico, Psychology Service , Rome , Italy
| | - Camillo Porcaro
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Institute of Neuroscience, Medical School, Newcastle University , Newcastle upon Tyne , UK
| | - Carlo Salustri
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy
| | - Paolo M Rossini
- Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy
| | - Alberto Priori
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
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Makashay MJ, Cannard KR, Solomon NP. Speech-related fatigue and fatigability in Parkinson's disease. CLINICAL LINGUISTICS & PHONETICS 2015; 29:27-45. [PMID: 25152085 PMCID: PMC4337875 DOI: 10.3109/02699206.2014.951901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study tested the assumption that speech is more susceptible to fatigue than normal in persons with dysarthria. After 1 h of speech-like exercises, participants with Parkinson's disease (PD) were expected to report increased perceptions of fatigue and demonstrate fatigability by producing less precise speech with corresponding acoustic changes compared to neurologically normal participants. Twelve adults with idiopathic PD and 13 neurologically normal adults produced sentences with multiple lingual targets before and after six 10-min blocks of fast syllable or word productions. Both groups reported increasing self-perceived fatigue over time, but trained listeners failed to detect systematic differences in articulatory precision or speech naturalness between sentences produced before and after speech-related exercises. Similarly, few systematic acoustic differences occurred. These findings do not support the hypothesis that dysarthric speakers are particularly susceptible to speech-related fatigue; instead, speech articulation generally appears to be resistant to fatigue induced by an hour of moderate functional exercises.
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Affiliation(s)
- Matthew J. Makashay
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kevin R. Cannard
- Neurology Department, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nancy Pearl Solomon
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Hofstadt-van Oy U, Keune PM, Muenssinger J, Hagenburger D, Oschmann P. Normative data and long-term test-retest reliability of the triple stimulation technique (TST) in multiple sclerosis. Clin Neurophysiol 2014; 126:356-64. [PMID: 25027641 DOI: 10.1016/j.clinph.2014.05.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Transcranial magnetic stimulation is useful for the assessment of cortico-spinal tract integrity in multiple sclerosis (MS). An advanced approach is the triple stimulation technique (TST), utilizing a combination of central and peripheral stimuli, reducing individual response variability. Although TST measures have been implemented in longitudinal studies, basic methodological data on temporal properties of abnormal TST values in MS are sparse. METHODS Normative TST data were obtained from 48 healthy participants. Longitudinal measures were derived from 17 MS-patients (relapsing-remitting: N=10; clinically isolated syndrome: N=7) prior to, three and twelve months following therapy initiation. Intraclass correlations were used to examine test-retest reliability. Complementary, patient ambulation and cognition were assessed. RESULTS Patient TST parameters were abnormal, involving excellent test-retest reliability and stable mean values. Cognitive and motor performance improved. CONCLUSIONS Results are the first to show that abnormal TST values in MS, reflecting diagnostic utility, are highly reliable in a long-term follow-up. Methodological properties are adequate for a longitudinal implementation of TST. Parameters were insensitive to alterations in cognitive/motor functioning. Sensitivity may be verified in subgroups with different treatment regimes. SIGNIFICANCE Results provide new normative data, support diagnostic utility of TST measures in MS, and confirm their long-term robustness.
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Affiliation(s)
| | - P M Keune
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany; Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
| | - J Muenssinger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - D Hagenburger
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - P Oschmann
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
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Tecchio F, Cancelli A, Cottone C, Zito G, Pasqualetti P, Ghazaryan A, Rossini PM, Filippi MM. Multiple sclerosis fatigue relief by bilateral somatosensory cortex neuromodulation. J Neurol 2014; 261:1552-8. [PMID: 24854634 DOI: 10.1007/s00415-014-7377-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis-related fatigue is highly common and often refractory to medical therapy. Ten fatigued multiple sclerosis patients received two blocks of 5-day anodal bilateral primary somatosensory areas transcranial direct current stimulation in a randomized, double-blind sham-controlled, cross-over study. The real neuromodulation by a personalized electrode, shaped on the MR-derived primary somatosensory cortical strip, reduced fatigue in all patients, by 26 % in average (p = 0.002), which did not change after sham (p = 0.901). Anodal tDCS over bilateral somatosensory areas was able to relief fatigue in mildly disabled MS patients, when the fatigue-related symptoms severely hamper their quality of life. These small-scale study results support the concept that interventions modifying the sensorimotor network activity balances could be a suitable non-pharmacological treatment for multiple sclerosis fatigue.
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Affiliation(s)
- Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S)-ISTC-CNR, Department of Clinical Neuroscience, Fatebenefratelli Hospital, Isola Tiberina, 00186, Rome, Italy,
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