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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Fu J, Chen X, Gu Y, Xie M, Zheng Q, Wang J, Zeng C, Li Y. Functional connectivity impairment of postcentral gyrus in relapsing-remitting multiple sclerosis with somatosensory disorder. Eur J Radiol 2019; 118:200-206. [PMID: 31439243 DOI: 10.1016/j.ejrad.2019.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/07/2019] [Accepted: 07/21/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To characterize the spatial patterns of functional connectivity(FC) changes of whole brain in RRMS with somatosensory disorder(RRMS-SS) and to investigate the correlation between abnormal FC and clinical scores. METHODS Twenty-six RRMS-SS patients and 23 healthy controls(HC) underwent resting-state functional magnetic resonance imaging(RS-fMRI) scanning. The clinical scores were collected including Expanded Disability Status Scores(EDSS), Disease Duration and Somatosensory Evaluation by the Fugl-Meyer sensory score(FMSS). With the voxel-wise methods, RS-fMRI data were analyzed using REST software, to assess the FC of the postcentral gyrus(PoCG). Correlation between clinical variables and the strength of FC was analyzed. RESULTS Compared with HC, the left postcentral-based FC showed decreased FC of the right cerebellum_8, lingual lobe and Rolandic operculum gyrus, and increased FC of the left middle frontal lobe. The right postcentral-based FC revealed decreased FC with the right Heschl's gyrus lobule, and increased FC with bilateral middle frontal lobe (p < 0.001, AlphaSim corrected). Correlation analysis revealed that the FC of altered brain regions was associated with FMSS, EDSS and disease duration. CONCLUSION The functional connectivity of PoCG at RS-fMRI has multi-network changes in patients with RRMS-SS. This suggests a complex pattern of abnormal connections between the somatosensory network regions and the whole brain. Moreover, the correlation between the FC and the FMSS, such as the left middle frontal lobe and the right PoCG, indicate that these two brain regions play an important role in RRMS-SS.
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Affiliation(s)
- Jialiang Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoya Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yao Gu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Min Xie
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiao Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jingjie Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Petracca M, Zaaraoui W, Cocozza S, Vancea R, Howard J, Heinig MM, Fleysher L, Oesingmann N, Ranjeva JP, Inglese M. An MRI evaluation of grey matter damage in African Americans with MS. Mult Scler Relat Disord 2018; 25:29-36. [PMID: 30029018 PMCID: PMC6214725 DOI: 10.1016/j.msard.2018.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/29/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Multiple sclerosis (MS) is less prevalent in African Americans (AAs) than Caucasians (CAs) but in the former the disease course tends to be more severe. In order to clarify the MRI correlates of disease severity in AAs, we performed a multimodal brain MRI study to comprehensively assess the extent of grey matter (GM) damage and the degree of functional adaptation to structural damage in AAs with MS. METHODS In this cross-sectional study, we characterized GM damage in terms of focal lesions and volume loss and functional adaptation during the execution of a simple motor task on a sample of 20 AAs and 20 CAs with MS and 20 healthy controls (CTRLs). RESULTS In AAs, we observed a wider range of EDSS scores than CAs, with multisystem involvement being more likely in AAs (p < 0.01). While no significant differences were detected in lesion loads and global brain volumes, AAs showed regional atrophy in the posterior lobules of cerebellum, temporo-occipital and frontal regions in comparison with CAs (p < 0.01), with cerebellar atrophy being the best metric in differentiating AAs from CAs (p = 0.007, AUC = 0.96 and p = 0.005, AUC = 0.96, respectively for right and left cerebellar clusters). In AAs, the functional analysis of cortical activations showed an increase in task-related activation of areas involved in high level processing and a decreased activation in the medial prefrontal cortex compared to CAs. INTERPRETATION In our study, the direct comparison of AAs and CAs points to cerebellar atrophy as the main difference between subgroups.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Neurosciences, Reproductive and Odonto-stomatological Sciences, University "Federico II", Naples, Italy
| | - Wafaa Zaaraoui
- Aix-Marseille Univ, CNRS, CRMBM UMR, 7339, Marseille, France
| | - Sirio Cocozza
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Roxana Vancea
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jonathan Howard
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Monika M Heinig
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jean-Philippe Ranjeva
- Aix-Marseille Univ, CNRS, CRMBM UMR, 7339, Marseille, France; UK Biobank, Stockport, Cheshire, SK3 0SA, UK
| | - Matilde Inglese
- Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, (DINOGMI) University of Genova and IRCCS AOU San Martino-IST, Genoa, Italy.
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Patel KR, Tobyne S, Porter D, Bireley JD, Smith V, Klawiter E. Structural disconnection is responsible for increased functional connectivity in multiple sclerosis. Brain Struct Funct 2018; 223:2519-2526. [PMID: 29453522 DOI: 10.1007/s00429-018-1619-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023]
Abstract
Increased synchrony within neuroanatomical networks is often observed in neurophysiologic studies of human brain disease. Most often, this phenomenon is ascribed to a compensatory process in the face of injury, though evidence supporting such accounts is limited. Given the known dependence of resting-state functional connectivity (rsFC) on underlying structural connectivity (SC), we examine an alternative hypothesis: that topographical changes in SC, specifically particular patterns of disconnection, contribute to increased network rsFC. We obtain measures of rsFC using fMRI and SC using probabilistic tractography in 50 healthy and 28 multiple sclerosis subjects. Using a computational model of neuronal dynamics, we simulate BOLD using healthy subject SC to couple regions. We find that altering the model by introducing structural disconnection patterns observed in those multiple sclerosis subjects with high network rsFC generates simulations with high rsFC as well, suggesting that disconnection itself plays a role in producing high network functional connectivity. We then examine SC data in individuals. In multiple sclerosis subjects with high network rsFC, we find a preferential disconnection between the relevant network and wider system. We examine the significance of such network isolation by introducing random disconnection into the model. As observed empirically, simulated network rsFC increases with removal of connections bridging a community with the remainder of the brain. We thus show that structural disconnection known to occur in multiple sclerosis contributes to network rsFC changes in multiple sclerosis and further that community isolation is responsible for elevated network functional connectivity.
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Affiliation(s)
- Kevin R Patel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Sean Tobyne
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Daria Porter
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Victoria Smith
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Klawiter
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Yin P, Liu Y, Xiong H, Han Y, Sah SK, Zeng C, Wang J, Li Y. Structural abnormalities and altered regional brain activity in multiple sclerosis with simple spinal cord involvement. Br J Radiol 2017; 91:20150777. [PMID: 29227148 DOI: 10.1259/bjr.20150777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess the changes of the structural and functional abnormalities in multiple sclerosis with simple spinal cord involvement (MS-SSCI) by using resting-state functional MRI (RS-fMRI), voxel based morphology (VBM) and diffusion tensor tractography. METHODS The amplitude of low-frequency fluctuation (ALFF) of 22 patients with MS-SSCI and 22 healthy controls (HCs) matched for age, gender and education were compared by using RS-fMRI. We also compared the volume, fractional anisotropy (FA) and apparent diffusion coefficient of the brain regions in baseline brain activity by using VBM and diffusion tensor imaging. The relationships between the expanded disability states scale (EDSS) scores, changed parameters of structure and function were further explored. RESULTS (1) Compared with HCs, the ALFF of the bilateral hippocampus and right middle temporal gyrus in MS-SSCI decreased significantly. However, patients exhibited increased ALFF in the left middle frontal gyrus, left posterior cingulate gyrus and right middle occipital gyrus ( two-sample t-test, after AlphaSim correction, p < 0.01, voxel size > 40). The volume of right middle frontal gyrus reduced significantly (p < 0.01). The FA and ADC of right hippocampus, the FA of left hippocampus and right middle temporal gyrus were significantly different. (2) A significant correlation between EDSS scores and ALFF was noted only in the left posterior cingulate gyrus. CONCLUSION Our results detected structural and functional abnormalities in MS-SSCI and functional parameters were associated with clinical abnormalities. Multimodal imaging plays an important role in detecting structural and functional abnormalities in MS-SSCI. Advances in knowledge: This is the first time to apply RS-fMRI, VBM and diffusion tensor tractography to study the structural and functional abnormalities in MS-SSCI, and to explore its correlation with EDSS score.
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Affiliation(s)
- Ping Yin
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yi Liu
- 2 Department of Radiology, Peking University Hospital , Beijing , China
| | - Hua Xiong
- 3 Department of Radiology, Chongqing General Hospital , Chongqing , China
| | - Yongliang Han
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Shambhu Kumar Sah
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Chun Zeng
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jingjie Wang
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yongmei Li
- 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Peterson DS, Fling BW. How changes in brain activity and connectivity are associated with motor performance in people with MS. Neuroimage Clin 2017; 17:153-162. [PMID: 29071209 PMCID: PMC5651557 DOI: 10.1016/j.nicl.2017.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023]
Abstract
People with multiple sclerosis (MS) exhibit pronounced changes in brain structure, activity, and connectivity. While considerable work has begun to elucidate how these neural changes contribute to behavior, the heterogeneity of symptoms and diagnoses makes interpretation of findings and application to clinical practice challenging. In particular, whether MS related changes in brain activity or brain connectivity protect against or contribute to worsening motor symptoms is unclear. With the recent emergence of neuromodulatory techniques that can alter neural activity in specific brain regions, it is critical to establish whether localized brain activation patterns are contributing to (i.e. maladaptive) or protecting against (i.e. adaptive) progression of motor symptoms. In this manuscript, we consolidate recent findings regarding changes in supraspinal structure and activity in people with MS and how these changes may contribute to motor performance. Furthermore, we discuss a hypothesis suggesting that increased neural activity during movement may be either adaptive or maladaptive depending on where in the brain this increase is observed. Specifically, we outline preliminary evidence suggesting sensorimotor cortex activity in the ipsilateral cortices may be maladaptive in people with MS. We also discuss future work that could supply data to support or refute this hypothesis, thus improving our understanding of this important topic.
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Affiliation(s)
- Daniel S Peterson
- Arizona State University, Tempe, AZ, USA; Veterans Affairs Phoenix Medical Center Phoenix, AZ, USA.
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Hillary FG, Grafman JH. Injured Brains and Adaptive Networks: The Benefits and Costs of Hyperconnectivity. Trends Cogn Sci 2017; 21:385-401. [PMID: 28372878 PMCID: PMC6664441 DOI: 10.1016/j.tics.2017.03.003] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 01/15/2023]
Abstract
A common finding in human functional brain-imaging studies is that damage to neural systems paradoxically results in enhanced functional connectivity between network regions, a phenomenon commonly referred to as 'hyperconnectivity'. Here, we describe the various ways that hyperconnectivity operates to benefit a neural network following injury while simultaneously negotiating the trade-off between metabolic cost and communication efficiency. Hyperconnectivity may be optimally expressed by increasing connections through the most central and metabolically efficient regions (i.e., hubs). While adaptive in the short term, we propose that chronic hyperconnectivity may leave network hubs vulnerable to secondary pathological processes over the life span due to chronically elevated metabolic stress. We conclude by offering novel, testable hypotheses for advancing our understanding of the role of hyperconnectivity in systems-level brain plasticity in neurological disorders.
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Affiliation(s)
- Frank G Hillary
- Pennsylvania State University, University Park, PA, USA; Social Life and Engineering Sciences Imaging Center, University Park, PA, USA; Department of Neurology, Hershey Medical Center, Hershey, PA, USA.
| | - Jordan H Grafman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Zhong J, Nantes JC, Holmes SA, Gallant S, Narayanan S, Koski L. Abnormal functional connectivity and cortical integrity influence dominant hand motor disability in multiple sclerosis: a multimodal analysis. Hum Brain Mapp 2016; 37:4262-4275. [PMID: 27381089 DOI: 10.1002/hbm.23307] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 05/23/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023] Open
Abstract
Functional reorganization and structural damage occur in the brains of people with multiple sclerosis (MS) throughout the disease course. However, the relationship between resting-state functional connectivity (FC) reorganization in the sensorimotor network and motor disability in MS is not well understood. This study used resting-state fMRI, T1-weighted and T2-weighted, and magnetization transfer (MT) imaging to investigate the relationship between abnormal FC in the sensorimotor network and upper limb motor disability in people with MS, as well as the impact of disease-related structural abnormalities within this network. Specifically, the differences in FC of the left hemisphere hand motor region between MS participants with preserved (n = 17) and impaired (n = 26) right hand function, compared with healthy controls (n = 20) was investigated. Differences in brain atrophy and MT ratio measured at the global and regional levels were also investigated between the three groups. Motor preserved MS participants had stronger FC in structurally intact visual information processing regions relative to motor impaired MS participants. Motor impaired MS participants showed weaker FC in the sensorimotor and somatosensory association cortices and more severe structural damage throughout the brain compared with the other groups. Logistic regression analysis showed that regional MTR predicted motor disability beyond the impact of global atrophy whereas regional grey matter volume did not. More importantly, as the first multimodal analysis combining resting-state fMRI, T1-weighted, T2-weighted and MTR images in MS, we demonstrate how a combination of structural and functional changes may contribute to motor impairment or preservation in MS. Hum Brain Mapp 37:4262-4275, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jidan Zhong
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada
| | - Julia C Nantes
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Integrated Program in Neuroscience, McGill University, 3801 University Street, Room 141, Montreal, Quebec, H3A 2B4, Canada
| | - Scott A Holmes
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Integrated Program in Neuroscience, McGill University, 3801 University Street, Room 141, Montreal, Quebec, H3A 2B4, Canada
| | - Serge Gallant
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3H 2R9, Canada
| | - Lisa Koski
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, Quebec, H3H 2R9, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3H 2R9, Canada.,Department of Psychology, McGill University, Montreal, Quebec, H3H 2R9, Canada
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Zhuang Y, Zhou F, Gong H. Intrinsic functional plasticity of the sensorimotor network in relapsing-remitting multiple sclerosis: evidence from a centrality analysis. PLoS One 2015; 10:e0130524. [PMID: 26110420 PMCID: PMC4482320 DOI: 10.1371/journal.pone.0130524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/21/2015] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Advanced MRI studies have revealed regional alterations in the sensorimotor cortex of patients with relapsing-remitting multiple sclerosis (RRMS). However, the organizational features underlying the relapsing phase and the subsequent remitting phase have not been directly shown at the functional network or the connectome level. Therefore, this study aimed to characterize MS-related centrality disturbances of the sensorimotor network (SMN) and to assess network integrity and connectedness. Methods Thirty-four patients with clinically definite RRMS and well-matched healthy controls participated in the study. Twenty-three patients in the remitting phase underwent one resting-state functional MRI, and 11 patients in the relapsing-remitting phase underwent two different MRIs. We measured voxel-wise centrality metrics to determine direct (degree centrality, DC) and global (eigenvector centrality, EC) functional relationships across the entire SMN. Results In the relapsing phase, DC was significantly decreased in the bilateral primary motor and somatosensory cortex (M1/S1), left dorsal premotor (PMd), and operculum-integrated regions. However, DC was increased in the peripheral SMN areas. The decrease in DC in the bilateral M1/S1 was associated with the expanded disability status scale (EDSS) and total white matter lesion loads (TWMLLs), suggesting that this adaptive response is related to the extent of brain damage in the rapid-onset attack stage. During the remission process, these alterations in centrality were restored in the bilateral M1/S1 and peripheral SMN areas. In the remitting phase, DC was reduced in the premotor, supplementary motor, and operculum-integrated regions, reflecting an adaptive response due to brain atrophy. However, DC was enhanced in the right M1 and left parietal-integrated regions, indicating chronic reorganization. In both the relapsing and remitting phases, the changes in EC and DC were similar. Conclusions The alterations in centrality within the SMN indicate rapid plasticity and chronic reorganization with a biased impairment of specific functional areas in RRMS patients.
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Affiliation(s)
- Ying Zhuang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Department of Oncology, the Second Hospital of Nanchang, Nanchang, Jiangxi Province, China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, China
- * E-mail:
| | - Honghan. Gong
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, China
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Pantano P, Petsas N, Tona F, Sbardella E. The Role of fMRI to Assess Plasticity of the Motor System in MS. Front Neurol 2015; 6:55. [PMID: 25852634 PMCID: PMC4360702 DOI: 10.3389/fneur.2015.00055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/27/2015] [Indexed: 01/07/2023] Open
Affiliation(s)
- Patrizia Pantano
- Department of Neurology and Psychiatry, Sapienza University of Rome , Rome , Italy ; IRCCS Neuromed , Pozzilli , Italy
| | - Nikolaos Petsas
- Department of Neurology and Psychiatry, Sapienza University of Rome , Rome , Italy
| | - Francesca Tona
- Department of Neurology and Psychiatry, Sapienza University of Rome , Rome , Italy
| | - Emilia Sbardella
- Department of Neurology and Psychiatry, Sapienza University of Rome , Rome , Italy
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11
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Russo M, Crupi D, Naro A, Avanzino L, Buccafusca M, Dattola V, Terranova C, Sottile F, Rizzo V, Ghilardi MF, Girlanda P, Bove M, Quartarone A. Fatigue in patients with multiple sclerosis: from movement preparation to motor execution. J Neurol Sci 2015; 351:52-57. [PMID: 25748966 DOI: 10.1016/j.jns.2015.02.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/09/2015] [Accepted: 02/17/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The neural mechanisms underlying fatigue in multiple sclerosis (MS) are still poorly understood. Cortico-cortical and cortico-subcortical circuitry abnormalities may play a central role in its pathogenesis. Our previous studies suggest that central fatigue may be related to an impairment of volition drive during movement preparation. OBJECTIVE We further explored the central mechanisms of fatigue at the premovement level in MS patients during a sustained motor task. METHODS In MS patients with (MS-F) and without (MS-NF) fatigue and age-matched healthy controls, we evaluated the motor cortex excitability and the premovement facilitation (PMF) through transcranial magnetic stimulation before and after 5min of sequenced finger-tapping movements at a fixed frequency of 2Hz. RESULTS In MS-F patients, the number of correct sequences performed and the ability to keep a fixed movement rate during the 5-min motor task were significantly decreased in comparison to the normal controls and MS-NF patients. Also, in MS-F patients, post-exercise PMF was significantly decreased. The PMF abnormalities were highly correlated with the performance decay. CONCLUSIONS PMF may be considered as a kind of servo-mechanism which could play a crucial role during sustained motor task in order to prevent motor performance disruption and to avoid motor exhaustion.
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Affiliation(s)
| | - Domenica Crupi
- Regional Epilepsy Centre "Bianchi Melacrino Morelli" Hospital, Reggio, Calabria, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Italy
| | | | | | | | - Fabrizio Sottile
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Vincenzo Rizzo
- Department of Neuroscience, University of Messina, Italy
| | - Maria Felice Ghilardi
- Department of Physiology, Pharmacology and Neuroscience, City University of New-York, Medical School, New York, USA
| | - Paolo Girlanda
- Department of Neuroscience, University of Messina, Italy
| | - Marco Bove
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Italy
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12
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Tewarie P, Schoonheim MM, Schouten DI, Polman CH, Balk LJ, Uitdehaag BMJ, Geurts JJG, Hillebrand A, Barkhof F, Stam CJ. Functional brain networks: linking thalamic atrophy to clinical disability in multiple sclerosis, a multimodal fMRI and MEG study. Hum Brain Mapp 2014; 36:603-18. [PMID: 25293505 DOI: 10.1002/hbm.22650] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/29/2014] [Indexed: 01/04/2023] Open
Abstract
Thalamic atrophy is known to be one of the most important predictors for clinical dysfunction in multiple sclerosis (MS). As the thalamus is highly connected to many cortical areas, this suggests that thalamic atrophy is associated with disruption of cortical functional networks. We investigated this thalamo-cortical system to explain the presence of physical and cognitive problems in MS. Functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) were performed in 86 MS patients and 21 healthy subjects. We computed cortical functional networks for fMRI and MEG by respectively the Pearson's correlation coefficient and the phase lag index using the same automated anatomical labeling atlas for both modalities. Thalamo-cortical functional connectivity was only estimated using fMRI. We computed conventional network metrics such as clustering coefficient and path length and analyzed the minimum spanning tree (MST), a subnetwork and backbone of the original network. MS patients showed reduced thalamic volumes and increased thalamo-cortical connectivity. MEG cortical functional networks showed a lower level of integration in MS in terms of the MST, whereas fMRI cortical networks did not differ between groups. Lower integration of MEG cortical functional networks was both related to thalamic atrophy as well as to increased thalamo-cortical functional connectivity in fMRI and to worse cognitive and clinical status. This study demonstrated for the first time that thalamic atrophy is associated with global disruption of cortical functional networks in MS and this global disruption of network activity was related to worse cognitive and clinical function in MS. Hum Brain Mapp 36:603-618, 2015. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Prejaas Tewarie
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Modeling of the hemodynamic responses in block design fMRI studies. J Cereb Blood Flow Metab 2014; 34:316-24. [PMID: 24252847 PMCID: PMC3915209 DOI: 10.1038/jcbfm.2013.200] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 11/08/2022]
Abstract
The hemodynamic response function (HRF) describes the local response of brain vasculature to functional activation. Accurate HRF modeling enables the investigation of cerebral blood flow regulation and improves our ability to interpret fMRI results. Block designs have been used extensively as fMRI paradigms because detection power is maximized; however, block designs are not optimal for HRF parameter estimation. Here we assessed the utility of block design fMRI data for HRF modeling. The trueness (relative deviation), precision (relative uncertainty), and identifiability (goodness-of-fit) of different HRF models were examined and test-retest reproducibility of HRF parameter estimates was assessed using computer simulations and fMRI data from 82 healthy young adult twins acquired on two occasions 3 to 4 months apart. The effects of systematically varying attributes of the block design paradigm were also examined. In our comparison of five HRF models, the model comprising the sum of two gamma functions with six free parameters had greatest parameter accuracy and identifiability. Hemodynamic response function height and time to peak were highly reproducible between studies and width was moderately reproducible but the reproducibility of onset time was low. This study established the feasibility and test-retest reliability of estimating HRF parameters using data from block design fMRI studies.
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Engström M, Flensner G, Landtblom AM, Ek AC, Karlsson T. Thalamo-striato-cortical determinants to fatigue in multiple sclerosis. Brain Behav 2013; 3:715-28. [PMID: 24363974 PMCID: PMC3868176 DOI: 10.1002/brb3.181] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue. METHODS MS participants with self-reported fatigue were examined by functional magnetic resonance imaging (fMRI) during the performance of a complex working memory task. In this task, cognitive effort was challenged by a parametric design, which modeled the cerebral responses at increasing cognitive demands. In order to explore the theory of central fatigue in MS we also analyzed the cerebral responses by adding perceived fatigue scores as covariates in the analysis and by calculating the functional connectivity between regions in the thalamo-striatocortical network. The main findings were that MS participants elicited altered brain responses in the thalamo-striato-cortical network, and that brain activation in the left posterior parietal cortex and the right substantia nigra was positively correlated to perceived fatigue ratings. MS participants had stronger cortical-to-cortical and subcortical-to-subcortical connections, whereas they had weaker cortical-to-subcortical connections. CONCLUSIONS The findings of the present study indicate that the thalamo-striato-cortical network is involved in the pathophysiology of fatigue in MS, and provide support for the theory of central fatigue. However, due to the limited number of participants and the somewhat heterogeneous sample of MS participants, these results have to be regarded as tentative, though they might serve as a basis for future studies.
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Affiliation(s)
- Maria Engström
- Radiology, Department of Medical and Health Sciences, Linköping University Linköping, Sweden ; Center for Medical Image Science and Visualization (CMIV), Linköping University Linköping, Sweden
| | - Gullvi Flensner
- Nursing Science, Department of Medical and Health Sciences, Linköping University Linköping, Sweden ; Department of Nursing, Health and Culture, University West Trollhättan, Sweden
| | - Anne-Marie Landtblom
- Center for Medical Image Science and Visualization (CMIV), Linköping University Linköping, Sweden ; Neuroscience, Department of Clinical and Experimental Medicine (IKE), Department of Neurology, Linköping University, County Council of Östergötland Linköping, Sweden
| | - Anna-Christina Ek
- Nursing Science, Department of Medical and Health Sciences, Linköping University Linköping, Sweden
| | - Thomas Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University Linköping, Sweden ; Department of Behavioural Science and Learning, Linköping University Linköping, Sweden
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Guo S, Yu Y, Zhang J, Feng J. A reversal coarse-grained analysis with application to an altered functional circuit in depression. Brain Behav 2013; 3:637-48. [PMID: 24363967 PMCID: PMC3868169 DOI: 10.1002/brb3.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 08/09/2013] [Accepted: 08/14/2013] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION When studying brain function using functional magnetic resonance imaging (fMRI) data containing tens of thousands of voxels, a coarse-grained approach - dividing the whole brain into regions of interest - is applied frequently to investigate the organization of the functional network on a relatively coarse scale. However, a coarse-grained scheme may average out the fine details over small spatial scales, thus rendering it difficult to identify the exact locations of functional abnormalities. METHODS A novel and general approach to reverse the coarse-grained approach by locating the exact sources of the functional abnormalities is proposed. RESULTS Thirty-nine patients with major depressive disorder (MDD) and 37 matched healthy controls are studied. A circuit comprising the left superior frontal gyrus (SFGdor), right insula (INS), and right putamen (PUT) exhibit the greatest changes between the patients with MDD and controls. A reversal coarse-grained analysis is applied to this circuit to determine the exact location of functional abnormalities. CONCLUSIONS The voxel-wise time series extracted from the reversal coarse-grained analysis (source) had several advantages over the original coarse-grained approach: (1) presence of a larger and detectable amplitude of fluctuations, which indicates that neuronal activities in the source are more synchronized; (2) identification of more significant differences between patients and controls in terms of the functional connectivity associated with the sources; and (3) marked improvement in performing discrimination tasks. A software package for pattern classification between controls and patients is available in Supporting Information.
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Affiliation(s)
- Shuixia Guo
- College of Mathematics and Computer Science, Key Laboratory of High Performance Computing and Stochastic Information Processing (Ministry of Education of China), Hunan Normal University Changsha, Hunan, China
| | - Yun Yu
- College of Mathematics and Computer Science, Key Laboratory of High Performance Computing and Stochastic Information Processing (Ministry of Education of China), Hunan Normal University Changsha, Hunan, China
| | - Jie Zhang
- Centre for Computational Systems Biology, School of Mathematical Sciences, Fudan University Shanghai, China
| | - Jianfeng Feng
- Centre for Computational Systems Biology, School of Mathematical Sciences, Fudan University Shanghai, China ; Department of Computer Science, University of Warwick Coventry, U.K
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Janssen AL, Boster A, Patterson BA, Abduljalil A, Prakash RS. Resting-state functional connectivity in multiple sclerosis: an examination of group differences and individual differences. Neuropsychologia 2013; 51:2918-29. [PMID: 23973635 DOI: 10.1016/j.neuropsychologia.2013.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 01/12/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative, inflammatory disease of the central nervous system, resulting in physical and cognitive disturbances. The goal of the current study was to examine the association between network integrity and composite measures of cognition and disease severity in individuals with relapsing-remitting MS (RRMS), relative to healthy controls. All participants underwent a neuropsychological and neuroimaging session, where resting-state data was collected. Independent component analysis and dual regression were employed to examine network integrity in individuals with MS, relative to healthy controls. The MS sample exhibited less connectivity in the motor and visual networks, relative to healthy controls, after controlling for group differences in gray matter volume. However, no alterations were observed in the frontoparietal, executive control, or default-mode networks, despite previous evidence of altered neuronal patterns during tasks of exogenous processing. Whole-brain, voxel-wise regression analyses with disease severity and processing speed composites were also performed to elucidate the brain-behavior relationship with neuronal network integrity. Individuals with higher levels of disease severity demonstrated reduced intra-network connectivity of the motor network, and the executive control network, while higher disease burden was associated with greater inter-network connectivity between the medial visual network and areas involved in visuomotor learning. Our findings underscore the importance of examining resting-state oscillations in this population, both as a biomarker of disease progression and a potential target for therapeutic intervention.
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Affiliation(s)
- Alisha L Janssen
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, United States
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Abnormalities of resting state functional connectivity are related to sustained attention deficits in MS. PLoS One 2012; 7:e42862. [PMID: 22912754 PMCID: PMC3422320 DOI: 10.1371/journal.pone.0042862] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 07/13/2012] [Indexed: 01/08/2023] Open
Abstract
Objectives Resting state (RS) functional MRI recently identified default network abnormalities related to cognitive impairment in MS. fMRI can also be used to map functional connectivity (FC) while the brain is at rest and not adhered to a specific task. Given the importance of the anterior cingulate cortex (ACC) for higher executive functioning in MS, we here used the ACC as seed-point to test for differences and similarities in RS-FC related to sustained attention between MS patients and controls. Design Block-design rest phases of 3 Tesla fMRI data were analyzed to assess RS-FC in 31 patients (10 clinically isolated syndromes, 16 relapsing-remitting, 5 secondary progressive MS) and 31 age- and gender matched healthy controls (HC). Participants underwent extensive cognitive testing. Observations In both groups, signal changes in several brain areas demonstrated significant correlation with RS-activity in the ACC. These comprised the posterior cingulate cortex (PCC), insular cortices, the right caudate, right middle temporal gyrus, angular gyri, the right hippocampus, and the cerebellum. Compared to HC, patients showed increased FC between the ACC and the left angular gyrus, left PCC, and right postcentral gyrus. Better cognitive performance in the patients was associated with increased FC to the cerebellum, middle temporal gyrus, occipital pole, and the angular gyrus. Conclusion We provide evidence for adaptive changes in RS-FC in MS patients compared to HC in a sustained attention network. These results extend and partly mirror findings of task-related fMRI, suggesting FC may increase our understanding of cognitive dysfunction in MS.
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Specogna I, Casagrande F, Lorusso A, Catalan M, Gorian A, Zugna L, Longo R, Zorzon M, Naccarato M, Pizzolato G, Ukmar M, Cova MA. Functional MRI during the execution of a motor task in patients with multiple sclerosis and fatigue. Radiol Med 2012; 117:1398-407. [PMID: 22729506 DOI: 10.1007/s11547-012-0845-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 09/30/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was undertaken to assess cortical activation during execution of a motor task in patients with multiple sclerosis (MS) and fatigue. MATERIALS AND METHODS We enrolled 24 right-handed patients affected by relapsing-remitting MS and mild disability (12 with and 12 without fatigue) and 15 healthy volunteers. Magnetic resonance imaging (MRI) examination (1.5 T) was performed with conventional sequences and an echoplanar imaging (EPI) sequence for functional MRI (fMRI). The motor task consisted of sequential finger tapping performed with the right hand. Statistical maps of motor activation were obtained. Comparison between the two subgroups of patients and between patients and controls was performed with analysis of variance (ANOVA) statistical analysis (p<0.05). RESULTS Compared with controls, patients without fatigue showed greater activation of the primary sensorimotor cortex bilaterally, of the right supplementary motor cortex, of the left premotor cortex, of the left cerebellum and of the superior parietal lobule bilaterally. Compared with patients without fatigue, patients with fatigue demonstrated greater activation of the right premotor area, of the putamen and the dorsolateral prefrontal cortex. CONCLUSIONS Patients with fatigue have greater activation of the motor-attentional network when performing a simple motor task.
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Affiliation(s)
- I Specogna
- U.C.O. di Radiologia, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Azienda Ospedaliero-Universitaria AOUTS, Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
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Horakova D, Kalincik T, Dusankova JB, Dolezal O. Clinical correlates of grey matter pathology in multiple sclerosis. BMC Neurol 2012; 12:10. [PMID: 22397707 PMCID: PMC3311149 DOI: 10.1186/1471-2377-12-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 03/07/2012] [Indexed: 12/26/2022] Open
Abstract
Traditionally, multiple sclerosis has been viewed as a disease predominantly affecting white matter. However, this view has lately been subject to numerous changes, as new evidence of anatomical and histological changes as well as of molecular targets within the grey matter has arisen. This advance was driven mainly by novel imaging techniques, however, these have not yet been implemented in routine clinical practice. The changes in the grey matter are related to physical and cognitive disability seen in individuals with multiple sclerosis. Furthermore, damage to several grey matter structures can be associated with impairment of specific functions. Therefore, we conclude that grey matter damage - global and regional - has the potential to become a marker of disease activity, complementary to the currently used magnetic resonance markers (global brain atrophy and T2 hyperintense lesions). Furthermore, it may improve the prediction of the future disease course and response to therapy in individual patients and may also become a reliable additional surrogate marker of treatment effect.
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Affiliation(s)
- Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
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Increased functional connectivity indicates the severity of cognitive impairment in multiple sclerosis. Proc Natl Acad Sci U S A 2011; 108:19066-71. [PMID: 22065778 DOI: 10.1073/pnas.1110024108] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Correlations in spontaneous brain activity provide powerful access to large-scale organizational principles of the CNS. However, making inferences about cognitive processes requires a detailed understanding of the link between these couplings and the structural integrity of the CNS. We studied the impact of multiple sclerosis, which leads to the severe disintegration of the central white matter, on functional connectivity patterns in spontaneous cortical activity. Using a data driven approach based on the strength of a salient pattern of cognitive pathology, we identified distinct networks that exhibit increases in functional connectivity despite the presence of strong and diffuse reductions of the central white-matter integrity. The default mode network emerged as a core target of these connectivity modulations, showing enhanced functional coupling in bilateral inferior parietal cortex, posterior cingulate, and medial prefrontal cortex. These findings imply a complex and diverging relation of anatomical and functional connectivity in early multiple sclerosis and, thus, add an important observation for understanding how cognitive abilities and CNS integrity may be reflected in the intrinsic covariance of functional signals.
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