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Cordani C, Preziosa P, Valsasina P, Meani A, Pagani E, Morozumi T, Rocca MA, Filippi M. MRI of Transcallosal White Matter Helps to Predict Motor Impairment in Multiple Sclerosis. Radiology 2021; 302:639-649. [PMID: 34846201 DOI: 10.1148/radiol.2021210922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Altered callosal integrity has been associated with motor deficits in patients with multiple sclerosis (MS), but its contribution to disability has, to the knowledge of the authors, not been investigated by using multiparametric MRI approaches. Purpose To investigate structural and functional interhemispheric MRI substrates of global disability at different milestones and upper limb motor impairment in MS. Materials and Methods In this cross-sectional study, healthy control patients and patients with MS (between January 1, 2008, and December 31, 2016) were retrospectively selected from our hospital database. Clinical assessment included Expanded Disability Status Scale (EDSS), nine-hole peg test, and digital finger tapping test. By using structural and resting-state functional MRI sequences, probabilistic tractography of hand corticospinal tract fibers, and transcallosal fibers between hand-motor cortices (hereafter, referred to as hand-M1), supplementary motor areas (SMAs), premotor cortices (PMCs), and voxel-mirror homotopic connectivity (VMHC) were analyzed. Random forest analyses identified the MRI predictors of clinical disability at different milestones (EDSS scores of 3.0, 4.0, 6.0) and upper limb motor impairment (nine-hole peg test and finger tapping test z scores < healthy control patients 5th percentile). Results One-hundred thirty healthy control patients (median age, 39 years; interquartile range, 31-50 years; 70 women) and 340 patients with MS (median age, 43 years; interquartile range, 33-51 years; 213 women) were studied. EDSS 3.0 predictors (n = 159) were global measures of atrophy and lesions together with damage measures of corticospinal tracts and transcallosal fibers between PMCs and SMAs (accuracy, 86%; P = .001-.01). For EDSS 4.0 (n = 131), similar predictors were found in addition to damage in transcallosal fibers between hand-M1 (accuracy, 89%; P = .001-.049). No MRI predictors were found for EDSS 6.0 (n = 70). Nine-hole peg test (right, n = 161; left, n = 166) and finger tapping test (right, n = 117; left, n = 111) impairments were predicted by damage in transcallosal fibers between SMAs and PMCs (accuracy range, 69%-77%; P = .001-.049). VMHC abnormalities did not explain clinical outcomes. Conclusion Structural, not functional, abnormalities at MRI in transcallosal premotor and motor white matter fibers predicted severity of global disability and upper limb motor impairment in patients with multiple sclerosis. The informative role of such predictors appeared less evident at higher disability levels. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Barkhof and Pontillo in this issue.
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Affiliation(s)
- Claudio Cordani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Paolo Preziosa
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Paola Valsasina
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Alessandro Meani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Tetsu Morozumi
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Maria Assunta Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
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Chaves AR, Snow NJ, Alcock LR, Ploughman M. Probing the Brain-Body Connection Using Transcranial Magnetic Stimulation (TMS): Validating a Promising Tool to Provide Biomarkers of Neuroplasticity and Central Nervous System Function. Brain Sci 2021; 11:384. [PMID: 33803028 PMCID: PMC8002717 DOI: 10.3390/brainsci11030384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/18/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method used to investigate neurophysiological integrity of the human neuromotor system. We describe in detail, the methodology of a single pulse TMS protocol that was performed in a large cohort of people (n = 110) with multiple sclerosis (MS). The aim was to establish and validate a core-set of TMS variables that predicted typical MS clinical outcomes: walking speed, hand dexterity, fatigue, and cognitive processing speed. We provide a brief and simple methodological pipeline to examine excitatory and inhibitory corticospinal mechanisms in MS that map to clinical status. Delayed and longer ipsilateral silent period (a measure of transcallosal inhibition; the influence of one brain hemisphere's activity over the other), longer cortical silent period (suggestive of greater corticospinal inhibition via GABA) and higher resting motor threshold (lower corticospinal excitability) most strongly related to clinical outcomes, especially when measured in the hemisphere corresponding to the weaker hand. Greater interhemispheric asymmetry (imbalance between hemispheres) correlated with poorer performance in the greatest number of clinical outcomes. We also show, not surprisingly, that TMS variables related more strongly to motor outcomes than non-motor outcomes. As it was validated in a large sample of patients with varying severities of central nervous system dysfunction, the protocol described herein can be used by investigators and clinicians alike to investigate the role of TMS as a biomarker in MS and other central nervous system disorders.
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Affiliation(s)
| | | | | | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1A 1E5, Canada; (A.R.C.); (N.J.S.); (L.R.A.)
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3
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Stampanoni Bassi M, Buttari F, Gilio L, De Paolis N, Fresegna D, Centonze D, Iezzi E. Inflammation and Corticospinal Functioning in Multiple Sclerosis: A TMS Perspective. Front Neurol 2020; 11:566. [PMID: 32733354 PMCID: PMC7358546 DOI: 10.3389/fneur.2020.00566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) has been employed in multiple sclerosis (MS) to assess the integrity of the corticospinal tract and the corpus callosum and to explore some physiological properties of the motor cortex. Specific alterations of TMS measures have been strongly associated to different pathophysiological mechanisms, particularly to demyelination and neuronal loss. Moreover, TMS has contributed to investigate the neurophysiological basis of MS symptoms, particularly those not completely explained by conventional structural damage, such as fatigue. However, variability existing between studies suggests that alternative mechanisms should be involved. Knowledge of MS pathophysiology has been enriched by experimental studies in animal models (i.e., experimental autoimmune encephalomyelitis) demonstrating that inflammation alters synaptic transmission, promoting hyperexcitability and neuronal damage. Accordingly, TMS studies have demonstrated an imbalance between cortical excitation and inhibition in MS. In particular, cerebrospinal fluid concentrations of different proinflammatory and anti-inflammatory molecules have been associated to corticospinal hyperexcitability, highlighting that inflammatory synaptopathy may represent a key pathophysiological mechanism in MS. In this perspective article, we discuss whether corticospinal excitability alterations assessed with TMS in MS patients could be useful to explain the pathophysiological correlates and their relationships with specific MS clinical characteristics and symptoms. Furthermore, we discuss evidence indicating that, in MS patients, inflammatory synaptopathy could be present since the early phases, could specifically characterize relapses, and could progressively increase during the disease course.
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Affiliation(s)
| | - Fabio Buttari
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Luana Gilio
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Nicla De Paolis
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Fresegna
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
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4
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Acute Phase Neuronal Activity for the Prognosis of Stroke Recovery. Neural Plast 2019; 2019:1971875. [PMID: 31611914 PMCID: PMC6755296 DOI: 10.1155/2019/1971875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
Strokes causing similar lesions and clinical states can be followed by diverse regains of neurological functions, indicating that the clinical recovery can depend on individual modulating factors. A promising line to disclose these factors, to finally open new therapeutic strategies, is to search for individual indices of recovery prognosis. Here, we pursued on strengthening the value of acute phase electrophysiological biomarkers for poststroke functional recovery in a wide group of patients. We enrolled 120 patients affected by a monohemispheric stroke within the middle cerebral artery territory (70 left and 50 right damages) and collected the NIH stroke scale (NIHSS) score in the acute phase (T0, median 4 days) and chronic follow-up (T1, median 6 months). At T0, we executed electrophysiological noninvasive assessment (19-channel electroencephalography (EEG) or 28 channels per side magnetoencephalography (MEG)) of brain activity at rest by means of band powers in the contra- and ipsilesional hemispheres (CLH, ILH) or the homologous area symmetry (HArS). Low-band (2-6 Hz) HArS entered the regression model for predicting the stabilized clinical state (p < 0.001), with bilateral impairment correlated with a poor outcome. Present data strengthen the fact that low-band impairment of homologous ipsi- and contralesional hemispheric regions in the acute stroke indicate a negative prognosis of clinical recovery.
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5
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Snow NJ, Wadden KP, Chaves AR, Ploughman M. Transcranial Magnetic Stimulation as a Potential Biomarker in Multiple Sclerosis: A Systematic Review with Recommendations for Future Research. Neural Plast 2019; 2019:6430596. [PMID: 31636661 PMCID: PMC6766108 DOI: 10.1155/2019/6430596] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/31/2019] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system. Disease progression is variable and unpredictable, warranting the development of biomarkers of disease status. Transcranial magnetic stimulation (TMS) is a noninvasive method used to study the human motor system, which has shown potential in MS research. However, few reviews have summarized the use of TMS combined with clinical measures of MS and no work has comprehensively assessed study quality. This review explored the viability of TMS as a biomarker in studies of MS examining disease severity, cognitive impairment, motor impairment, or fatigue. Methodological quality and risk of bias were evaluated in studies meeting selection criteria. After screening 1603 records, 30 were included for review. All studies showed high risk of bias, attributed largely to issues surrounding sample size justification, experimenter blinding, and failure to account for key potential confounding variables. Central motor conduction time and motor-evoked potentials were the most commonly used TMS techniques and showed relationships with disease severity, motor impairment, and fatigue. Short-latency afferent inhibition was the only outcome related to cognitive impairment. Although there is insufficient evidence for TMS in clinical assessments of MS, this review serves as a template to inform future research.
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Affiliation(s)
- Nicholas J. Snow
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P. Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Arthur R. Chaves
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Chieffo R. Changes in cortical motor outputs after a motor relapse of multiple sclerosis. Mult Scler J Exp Transl Clin 2019; 5:2055217319866480. [PMID: 31598329 PMCID: PMC6764060 DOI: 10.1177/2055217319866480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/08/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Motor recovery following a multiple sclerosis (MS) relapse depends on mechanisms of tissue repair but also on the capacity of the central nervous system for compensating of permanent damage. OBJECTIVES We aimed to investigate changes in corticospinal plasticity and interhemispheric connections after a relapse of MS using transcranial magnetic stimulation (TMS). METHODS Twenty healthy and 13 relapsing-remitting MS subjects with a first motor relapse were included. TMS mapping and ipsilateral silent period (iSP) were performed after relapse and at 6-month follow-up. RESULTS Strength and dexterity of the paretic hand were impaired at baseline and improved over time. After relapse, mapamplitude and mapdensity were decreased for the ipsilesional-corticospinal tract (IL-CST) while expanded for the contralesional-CST (CL-CST). At follow-up, map parameters normalized for the CL-CST independently from recovery while the increase of outputs from the IL-CST was associated with straight and dexterity improvement. iSP measurements were impaired in MS irrespective of the phase of the disease. Prolonged iSPduration at baseline was associated with less dexterity recovery. CONCLUSIONS After a motor relapse, TMS mapping shows acute changes in corticospinal excitability and rearrangements of motor outputs. iSP is less influenced by the phase of disease but may better predict recovery, possibly reflecting the integrity of interhemispheric motor networks.
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Affiliation(s)
- Raffaella Chieffo
- Department of Neurorehabilitation and Department of Clinical
Neurophysiology, Hospital San Raffaele, Milan, Italy
- Experimental Neurophysiology Unit, Institute of Experimental Neurology
(INSPE), San Raffaele Scientific Institute, Milan, Italy
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Stampanoni Bassi M, Gilio L, Buttari F, Maffei P, Marfia GA, Restivo DA, Centonze D, Iezzi E. Remodeling Functional Connectivity in Multiple Sclerosis: A Challenging Therapeutic Approach. Front Neurosci 2017; 11:710. [PMID: 29321723 PMCID: PMC5733539 DOI: 10.3389/fnins.2017.00710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Neurons in the central nervous system are organized in functional units interconnected to form complex networks. Acute and chronic brain damage disrupts brain connectivity producing neurological signs and/or symptoms. In several neurological diseases, particularly in Multiple Sclerosis (MS), structural imaging studies cannot always demonstrate a clear association between lesion site and clinical disability, originating the "clinico-radiological paradox." The discrepancy between structural damage and disability can be explained by a complex network perspective. Both brain networks architecture and synaptic plasticity may play important roles in modulating brain networks efficiency after brain damage. In particular, long-term potentiation (LTP) may occur in surviving neurons to compensate network disconnection. In MS, inflammatory cytokines dramatically interfere with synaptic transmission and plasticity. Importantly, in addition to acute and chronic structural damage, inflammation could contribute to reduce brain networks efficiency in MS leading to worse clinical recovery after a relapse and worse disease progression. These evidence suggest that removing inflammation should represent the main therapeutic target in MS; moreover, as synaptic plasticity is particularly altered by inflammation, specific strategies aimed at promoting LTP mechanisms could be effective for enhancing clinical recovery. Modulation of plasticity with different non-invasive brain stimulation (NIBS) techniques has been used to promote recovery of MS symptoms. Better knowledge of features inducing brain disconnection in MS is crucial to design specific strategies to promote recovery and use NIBS with an increasingly tailored approach.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Luana Gilio
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Pierpaolo Maffei
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Diego Centonze
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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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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Stampanoni Bassi M, Mori F, Buttari F, Marfia GA, Sancesario A, Centonze D, Iezzi E. Neurophysiology of synaptic functioning in multiple sclerosis. Clin Neurophysiol 2017; 128:1148-1157. [DOI: 10.1016/j.clinph.2017.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 01/16/2023]
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Zahiri N, Abollahi I, Nabavi SM, Ehsani F, Arab AM, Shaw I, Shariat A, Shaw BS, Dastoorpoor M, Danaee M, Sangelaji B. Interference Effect of Prior Explicit Information on Motor Sequence Learning in Relapsing-Remitting Multiple Sclerosis Patients. Malays J Med Sci 2017; 24:69-80. [PMID: 28381930 DOI: 10.21315/mjms2017.24.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most widespread disabling neurological condition in young adults around the world. The purpose of this study was to investigate the impact of explicit information (EI) on motor-sequence learning in MS patients. METHODS Thirty patients with relapsing-remitting MS (RRMS), age: 29.5 (SD = 5.6) years and 30 healthy gender-, age-, and education-matched control group participants, age: 28.8 (SD = 6.0) years, were recruited for this study. The participants in the healthy group were then randomly assigned into an EI (n = 15) group and a no-EI (n = 15) group. Similarly, the participants in the control group were then randomly assigned into EI (n = 15) and no-EI (n = 15) groups. The participants performed a serial reaction time (SRT) task and reaction times. A retention test was performed after 48 hours. RESULTS All participants reduced their reaction times across acquisition (MS group: 46.4 (SD = 3.3) minutes, P < 0.001, and healthy group: 39.4 (SD = 3.3) minutes, P < 0.001). The findings for the within-participants effect of repeated measures of time were significant (F(5.06, 283.7) = 71.33. P < 0.001). These results indicate that the interaction between group and time was significant (F(5.06, 283.7) = 6.44. P < 0.001), which indicated that the reaction time in both groups was significantly changed between the MS and healthy groups across times (B1 to B10). The main effect of the group (MS and healthy) (F(1, 56) = 22.78. P < 0.001) and also the main effect of no-EI vs EI (F(1, 56) = 4.71. P < 0.001) were significant. CONCLUSION This study demonstrated that that RRMS patients are capable of learning new skills, but the provision of EI prior to physical practice is deleterious to implicit learning. It is sufficient to educate MS patients on the aim and general content of the training and only to provide feedback at the end of the rehabilitative session.
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Affiliation(s)
- Nahid Zahiri
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Iraj Abollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Amir Masoud Arab
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ina Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Ardalan Shariat
- Department of Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Brandon S Shaw
- Department of Sport and Movement Studies, University of Johannesburg, Doornfontein, Johannesburg, Republic of South Africa
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmoud Danaee
- University of Malaya Centre of Addiction Sciences (UMCAS), Malaysia
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Ayache SS, Créange A, Farhat WH, Zouari HG, Lesage C, Palm U, Abdellaoui M, Lefaucheur JP. Cortical excitability changes over time in progressive multiple sclerosis. FUNCTIONAL NEUROLOGY 2016; 30:257-63. [PMID: 26727704 DOI: 10.11138/fneur/2015.30.4.257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In 25 patients with progressive forms of multiple sclerosis (MS), motor cortex excitability was longitudinally studied over one year by means of transcranial magnetic stimulation (TMS). The following TMS parameters were considered: resting and active motor thresholds (MTs), input-output curve, short-interval intracortical inhibition (SICI), and intracortical facilitation. Clinical evaluation was based on the Expanded Disability Status Scale (EDSS). In the 16 patients not receiving disease-modifying drugs, the EDSS score worsened, resting MT increased, and SICI decreased. By contrast, no clinical for neurophysiological changes were found over time in the nine patients receiving immunomodulatory therapy. The natural course of progressive MS appears to be associated with a decline in cortical excitability of both pyramidal neurons and inhibitory circuits. This pilot study based on a small sample suggests that disease-modifying drugs may allow cortical excitability to remain stable, even in patients with progressive MS.
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12
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Mandolesi G, Gentile A, Musella A, Fresegna D, De Vito F, Bullitta S, Sepman H, Marfia GA, Centonze D. Synaptopathy connects inflammation and neurodegeneration in multiple sclerosis. Nat Rev Neurol 2015; 11:711-24. [PMID: 26585978 DOI: 10.1038/nrneurol.2015.222] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis (MS) has long been regarded as a chronic inflammatory disease of the white matter that leads to demyelination and eventually to neurodegeneration. In the past decade, several aspects of MS pathogenesis have been challenged, and degenerative changes of the grey matter, which are independent of demyelination, have become a topic of interest. CNS inflammation in MS and experimental autoimmune encephalomyelitis (EAE; a disease model used to study MS in rodents) causes a marked imbalance between GABAergic and glutamatergic transmission, and a loss of synapses, all of which leads to a diffuse 'synaptopathy'. Altered synaptic transmission can occur early in MS and EAE, independently of demyelination and axonal loss, and subsequently causes excitotoxic damage. Inflammation-driven synaptic abnormalities are emerging as a prominent pathogenic mechanism in MS-importantly, they are potentially reversible and, therefore, represent attractive therapeutic targets. In this Review, we focus on the connection between inflammation and synaptopathy in MS and EAE, which sheds light not only on the pathophysiology of MS but also on that of primary neurodegenerative disorders in which inflammatory processes contribute to disease progression.
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Affiliation(s)
- Georgia Mandolesi
- IRCCS Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Antonietta Gentile
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Alessandra Musella
- IRCCS Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Diego Fresegna
- IRCCS Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Francesca De Vito
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Silvia Bullitta
- IRCCS Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Via del Fosso di Fiorano 64, 00143 Rome, Italy
| | - Helena Sepman
- IRCCS Fondazione Santa Lucia/Centro Europeo per la Ricerca sul Cervello (CERC), Via del Fosso di Fiorano 64, 00143 Rome, Italy.,Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Girolama A Marfia
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Diego Centonze
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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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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14
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Simpson M, Macdonell R. The use of transcranial magnetic stimulation in diagnosis, prognostication and treatment evaluation in multiple sclerosis. Mult Scler Relat Disord 2015; 4:430-436. [PMID: 26346791 DOI: 10.1016/j.msard.2015.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
Despite advances in brain imaging which have revolutionised the diagnosis and monitoring of patients with Multiple Sclerosis (MS), current imaging techniques have limitations, including poor correlation with clinical disability and prognosis. There is growing evidence that electrophysiological techniques may provide complementary functional information which can aid in diagnosis, prognostication and perhaps even monitoring of treatment response in patients with MS. Transcranial magnetic stimulation (TMS) is an underutilised technique with potential to assist diagnosis, predict prognosis and provide an objective surrogate marker of clinical progress and treatment response. This review explores the existing body of evidence relating to the use of TMS in patients with MS, outlines the practical aspects and scope of TMS testing and reviews the current evidence relating to the use of TMS in diagnosis, disease classification, prognostication and response to symptomatic and disease-modifying therapies.
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Affiliation(s)
- Marion Simpson
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia.
| | - Richard Macdonell
- Department of Neurology, Austin Health and Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
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15
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Dogonowski AM, Siebner HR, Soelberg Sørensen P, Paulson OB, Dyrby TB, Blinkenberg M, Madsen KH. Resting-state connectivity of pre-motor cortex reflects disability in multiple sclerosis. Acta Neurol Scand 2013; 128:328-35. [PMID: 23461607 DOI: 10.1111/ane.12121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the relationship between motor resting-state connectivity of the dorsal pre-motor cortex (PMd) and clinical disability in patients with multiple sclerosis (MS). MATERIALS AND METHODS A total of 27 patients with relapsing-remitting MS (RR-MS) and 15 patients with secondary progressive MS (SP-MS) underwent functional resting-state magnetic resonance imaging. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Independent component analysis was used to characterize motor resting-state connectivity. Multiple regression analysis was performed in SPM8 between the individual expression of motor resting-state connectivity in PMd and EDSS scores including age as covariate. Separate post hoc analyses were performed for patients with RR-MS and SP-MS. RESULTS The EDSS scores ranged from 0 to 7 with a median score of 4.3. Motor resting-state connectivity of left PMd showed a positive linear relation with clinical disability in patients with MS. This effect was stronger when considering the group of patients with RR-MS alone, whereas patients with SP-MS showed no increase in coupling strength between left PMd and the motor resting-state network with increasing clinical disability. No significant relation between motor resting-state connectivity of the right PMd and clinical disability was detected in MS. CONCLUSIONS The increase in functional coupling between left PMd and the motor resting-state network with increasing clinical disability can be interpreted as adaptive reorganization of the motor system to maintain motor function, which appears to be limited to the relapsing-remitting stage of the disease.
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Affiliation(s)
- A.-M. Dogonowski
- Danish Research Centre for Magnetic Resonance; Copenhagen University Hospital Hvidovre; Hvidovre; Denmark
| | - H. R. Siebner
- Danish Research Centre for Magnetic Resonance; Copenhagen University Hospital Hvidovre; Hvidovre; Denmark
| | - P. Soelberg Sørensen
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen; Denmark
| | | | - T. B. Dyrby
- Danish Research Centre for Magnetic Resonance; Copenhagen University Hospital Hvidovre; Hvidovre; Denmark
| | - M. Blinkenberg
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen; Denmark
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Short interval intracortical facilitation correlates with the degree of disability in multiple sclerosis. Brain Stimul 2013; 6:67-71. [DOI: 10.1016/j.brs.2012.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/23/2012] [Accepted: 02/06/2012] [Indexed: 11/19/2022] Open
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17
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Bonzano L, Tacchino A, Roccatagliata L, Sormani M, Mancardi G, Bove M. Impairment in explicit visuomotor sequence learning is related to loss of microstructural integrity of the corpus callosum in multiple sclerosis patients with minimal disability. Neuroimage 2011; 57:495-501. [DOI: 10.1016/j.neuroimage.2011.04.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022] Open
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