1
|
Bardel B, Ayache SS, Lefaucheur JP. The contribution of EEG to assess and treat motor disorders in multiple sclerosis. Clin Neurophysiol 2024; 162:174-200. [PMID: 38643612 DOI: 10.1016/j.clinph.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Electroencephalography (EEG) can highlight significant changes in spontaneous electrical activity of the brain produced by altered brain network connectivity linked to inflammatory demyelinating lesions and neuronal loss occurring in multiple sclerosis (MS). In this review, we describe the main EEG findings reported in the literature to characterize motor network alteration in term of local activity or functional connectivity changes in patients with MS (pwMS). METHODS A comprehensive literature search was conducted to include articles with quantitative analyses of resting-state EEG recordings (spectrograms or advanced methods for assessing spatial and temporal dynamics, such as coherence, theory of graphs, recurrent quantification, microstates) or dynamic EEG recordings during a motor task, with or without connectivity analyses. RESULTS In this systematic review, we identified 26 original articles using EEG in the evaluation of MS-related motor disorders. Various resting or dynamic EEG parameters could serve as diagnostic biomarkers of motor control impairment to differentiate pwMS from healthy subjects or be related to a specific clinical condition (fatigue) or neuroradiological aspects (lesion load). CONCLUSIONS We highlight some key EEG patterns in pwMS at rest and during movement, both suggesting an alteration or disruption of brain connectivity, more specifically involving sensorimotor networks. SIGNIFICANCE Some of these EEG biomarkers of motor disturbance could be used to design future therapeutic strategies in MS based on neuromodulation approaches, or to predict the effects of motor training and rehabilitation in pwMS.
Collapse
Affiliation(s)
- Benjamin Bardel
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France
| | - Samar S Ayache
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France; Gilbert and Rose-Marie Chagoury School of Medicine, Department of Neurology, 4504 Byblos, Lebanon; Institut de la Colonne Vertébrale et des NeuroSciences (ICVNS), Centre Médico-Chirurgical Bizet, F-75116 Paris, France
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, Excitabilité Nerveuse et Thérapeutique (ENT), EA 4391, F-94010 Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Clinical Neurophysiology, DMU FIxIT, F-94010 Creteil, France.
| |
Collapse
|
2
|
Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
Collapse
Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
3
|
Hernandez CI, Kargarnovin S, Hejazi S, Karwowski W. Examining electroencephalogram signatures of people with multiple sclerosis using a nonlinear dynamics approach: a systematic review and bibliographic analysis. Front Comput Neurosci 2023; 17:1207067. [PMID: 37457899 PMCID: PMC10344458 DOI: 10.3389/fncom.2023.1207067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background Considering that brain activity involves communication between millions of neurons in a complex network, nonlinear analysis is a viable tool for studying electroencephalography (EEG). The main objective of this review was to collate studies that utilized chaotic measures and nonlinear dynamical analysis in EEG of multiple sclerosis (MS) patients and to discuss the contributions of chaos theory techniques to understanding, diagnosing, and treating MS. Methods Using the preferred reporting items for systematic reviews and meta-analysis (PRISMA), the databases EbscoHost, IEEE, ProQuest, PubMed, Science Direct, Web of Science, and Google Scholar were searched for publications that applied chaos theory in EEG analysis of MS patients. Results A bibliographic analysis was performed using VOSviewer software keyword co-occurrence analysis indicated that MS was the focus of the research and that research on MS diagnosis has shifted from conventional methods, such as magnetic resonance imaging, to EEG techniques in recent years. A total of 17 studies were included in this review. Among the included articles, nine studies examined resting-state, and eight examined task-based conditions. Conclusion Although nonlinear EEG analysis of MS is a relatively novel area of research, the findings have been demonstrated to be informative and effective. The most frequently used nonlinear dynamics analyses were fractal dimension, recurrence quantification analysis, mutual information, and coherence. Each analysis selected provided a unique assessment to fulfill the objective of this review. While considering the limitations discussed, there is a promising path forward using nonlinear analyses with MS data.
Collapse
|
4
|
Bertoli M, Tataranni A, Porziani S, Pasqualetti P, Gianni E, Grifoni J, L’Abbate T, Armonaite K, Conti L, Cancelli A, Cottone C, Marinozzi F, Bini F, Cecconi F, Tecchio F. Effects on Corticospinal Tract Homology of Faremus Personalized Neuromodulation Relieving Fatigue in Multiple Sclerosis: A Proof-of-Concept Study. Brain Sci 2023; 13:brainsci13040574. [PMID: 37190539 DOI: 10.3390/brainsci13040574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives: Fatigue in multiple sclerosis (MS) is a frequent and invalidating symptom, which can be relieved by non-invasive neuromodulation, which presents only negligible side effects. A 5-day transcranial direct-current stimulation, 15 min per day, anodically targeting the somatosensory representation of the whole body against a larger occipital cathode was efficacious against MS fatigue (fatigue relief in multiple sclerosis, Faremus treatment). The present proof-of-concept study tested the working hypothesis that Faremus S1 neuromodulation modifies the homology of the dominant and non-dominant corticospinal (CST) circuit recruitment. Methods: CST homology was assessed via the Fréchet distance between the morphologies of motor potentials (MEPs) evoked by transcranial magnetic stimulation in the homologous left- and right-hand muscles of 10 fatigued MS patients before and after Faremus. Results: In the absence of any change in MEP features either as differences between the two body sides or as an effect of the treatment, Faremus changed in physiological direction the CST’s homology. Faremus effects on homology were more evident than recruitment changes within the dominant and non-dominant sides. Conclusions: The Faremus-related CST changes extend the relevance of the balance between hemispheric homologs to the homology between body sides. With this work, we contribute to the development of new network-sensitive measures that can provide new insights into the mechanisms of neuronal functional patterning underlying relevant symptoms.
Collapse
|
5
|
Andrejeva J, Mockute E, Sniepiene G, Malyško E, Istomina N, Hendrixson V. The impact of WATSU as Physiotherapy Method on Fatigue for People Diagnosed with Multiple Sclerosis. ACTA BALNEOLOGICA 2023. [DOI: 10.36740/abal202301103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim: To identify the impact of WATSU method on fatigue which has an impact on sleep and quality of life, pain and depression or its
aggravation.
Materials and Methods: The study involved the four participants. The following instruments were used: Multiple Sclerosis Quality of Life questionnaire; Pittsburgh Sleep Quality Index; Burns Depression Checklist; Fatigue Impact Scale. The study was carried out in medical center in Lithuania from 09-11-2019 till 18-01-2020 during 10 weeks. Each participant of the study received ten WATSU sessions. The research data was processed using SPSS Statistics 20. Qualitative Outcome Measures were conducted by content analysis, observation, semi-structured individual interview methods.
Results: After 10 sessions, fatigue lessened in all people investigated. Initially, the average of fatigue was 70 points and decreased to 34 points after the investigation. The average sleep quality index was as high as 5 points, after ten weeks the average decreased to 3 points. Changes in assessment of major to mild depression: initially, the average was 36 points, which decreased to 14 points after ten weeks.
Conclusions: The WATSU method was effective in reducing fatigue as a physiotherapy method. Along with changes in fatigue, the Pittsburgh Sleep Quality Index decreased, energy and motivation increased, quality of life improved, level of depression reduced, and the change was statistically significant. While assessing the quality of life, pain was found to be decreased – it became less frequent after ten weeks of sessions and less intense or even absent, its influence on daily activities decreased.
Collapse
Affiliation(s)
- Julija Andrejeva
- Klaipeda State University of Applied Sciences, Klaipeda, Lithuania
| | - Elinga Mockute
- Klaipeda State University of Applied Sciences, Klaipeda, Lithuania
| | | | | | | | | |
Collapse
|
6
|
Effect of music stimuli on corticomuscular coupling and the brain functional connectivity network. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
7
|
Pascarella A, Gianni E, Abbondanza M, Armonaite K, Pitolli F, Bertoli M, L’Abbate T, Grifoni J, Vitulano D, Bruni V, Conti L, Paulon L, Tecchio F. Normalized compression distance to measure cortico-muscular synchronization. Front Neurosci 2022; 16:933391. [PMID: 36440261 PMCID: PMC9687393 DOI: 10.3389/fnins.2022.933391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/19/2022] [Indexed: 06/29/2024] Open
Abstract
The neuronal functional connectivity is a complex and non-stationary phenomenon creating dynamic networks synchronization determining the brain states and needed to produce tasks. Here, as a measure that quantifies the synchronization between the neuronal electrical activity of two brain regions, we used the normalized compression distance (NCD), which is the length of the compressed file constituted by the concatenated two signals, normalized by the length of the two compressed files including each single signal. To test the NCD sensitivity to physiological properties, we used NCD to measure the cortico-muscular synchronization, a well-known mechanism to control movements, in 15 healthy volunteers during a weak handgrip. Independently of NCD compressor (Huffman or Lempel Ziv), we found out that the resulting measure is sensitive to the dominant-non dominant asymmetry when novelty management is required (p = 0.011; p = 0.007, respectively) and depends on the level of novelty when moving the non-dominant hand (p = 0.012; p = 0.024). Showing lower synchronization levels for less dexterous networks, NCD seems to be a measure able to enrich the estimate of functional two-node connectivity within the neuronal networks that control the body.
Collapse
Affiliation(s)
- Annalisa Pascarella
- Institute for the Applications of Calculus “M. Picone”, National Research Council, Rome, Italy
| | - Eugenia Gianni
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Matteo Abbondanza
- Department of Basic and Applied Sciences for Engineering (SBAI), University of Rome “La Sapienza”, Rome, Italy
| | - Karolina Armonaite
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Faculty of Psychology, Uninettuno University, Rome, Italy
| | - Francesca Pitolli
- Department of Basic and Applied Sciences for Engineering (SBAI), University of Rome “La Sapienza”, Rome, Italy
| | - Massimo Bertoli
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University “Gabriele D’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Teresa L’Abbate
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Faculty of Psychology, Uninettuno University, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University “Gabriele D’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Joy Grifoni
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Faculty of Psychology, Uninettuno University, Rome, Italy
| | - Domenico Vitulano
- Institute for the Applications of Calculus “M. Picone”, National Research Council, Rome, Italy
- Department of Basic and Applied Sciences for Engineering (SBAI), University of Rome “La Sapienza”, Rome, Italy
| | - Vittoria Bruni
- Institute for the Applications of Calculus “M. Picone”, National Research Council, Rome, Italy
- Department of Basic and Applied Sciences for Engineering (SBAI), University of Rome “La Sapienza”, Rome, Italy
| | - Livio Conti
- Faculty of Engineering, Uninettuno University, Rome, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione Roma Tor Vergata, Rome, Italy
| | - Luca Paulon
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
- Independent Researcher, Rome, Italy
| | - Franca Tecchio
- Laboratory of Electrophysiology for Translational NeuroScience, Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
| |
Collapse
|
8
|
Croce P, Tecchio F, Tamburro G, Fiedler P, Comani S, Zappasodi F. Brain electrical microstate features as biomarkers of a stable motor output. J Neural Eng 2022; 19. [PMID: 36195069 DOI: 10.1088/1741-2552/ac975b] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
Objective.The aim of the present study was to elucidate the brain dynamics underlying the maintenance of a constant force level exerted during a visually guided isometric contraction task by optimizing a predictive multivariate model based on global and spectral brain dynamics features.Approach.Electroencephalography (EEG) was acquired in 18 subjects who were asked to press a bulb and maintain a constant force level, indicated by a bar on a screen. For intervals of 500 ms, we calculated an index of force stability as well as indices of brain dynamics: microstate metrics (duration, occurrence, global explained variance, directional predominance) and EEG spectral amplitudes in the theta, low alpha, high alpha and beta bands. We optimized a multivariate regression model (partial least square (PLS)) where the microstate features and the spectral amplitudes were the input variables and the indexes of force stability were the output variables. The issues related to the collinearity among the input variables and to the generalizability of the model were addressed using PLS in a nested cross-validation approach.Main results.The optimized PLS regression model reached a good generalizability and succeeded to show the predictive value of microstates and spectral features in inferring the stability of the exerted force. Longer duration and higher occurrence of microstates, associated with visual and executive control networks, corresponded to better contraction performances, in agreement with the role played by the visual system and executive control network for visuo-motor integration.Significance.A combination of microstate metrics and brain rhythm amplitudes could be considered as biomarkers of a stable visually guided motor output not only at a group level, but also at an individual level. Our results may play an important role for a better understanding of the motor control in single trials or in real-time applications as well as in the study of motor control.
Collapse
Affiliation(s)
- Pierpaolo Croce
- Department of Neuroscience, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy.,Behavioral Imaging and Neural Dynamics Center, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Franca Tecchio
- Laboratory of Electrophysiology for Translational NeuroScience (LET'S), ISTC-CNR, Rome, Italy.,Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Gabriella Tamburro
- Department of Neuroscience, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy.,Behavioral Imaging and Neural Dynamics Center, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Silvia Comani
- Department of Neuroscience, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy.,Behavioral Imaging and Neural Dynamics Center, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy.,Behavioral Imaging and Neural Dynamics Center, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies, University 'Gabriele d'Annunzio' of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
9
|
Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review. Neurol Int 2022; 14:506-535. [PMID: 35736623 PMCID: PMC9228847 DOI: 10.3390/neurolint14020042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023] Open
Abstract
Fatigue is one of the most disabling symptoms of multiple sclerosis (MS); it influences patients’ quality of life. The etiology of fatigue is complex, and its pathogenesis is still unclear and debated. The objective of this review was to describe potential brain structural and functional dysfunctions underlying fatigue symptoms in patients with MS. To reach this purpose, a systematic review was conducted of published studies comparing functional brain activation and structural brain in MS patients with and without fatigue. Electronic databases were searched until 24 February 2021. The structural and functional outcomes were extracted from eligible studies and tabulated. Fifty studies were included: 32 reported structural brain differences between patients with and without fatigue; 14 studies described functional alterations in patients with fatigue compared to patients without it; and four studies showed structural and functional brain alterations in patients. The results revealed structural and functional abnormalities that could correlate to the symptom of fatigue in patients with MS. Several studies reported the differences between patients with fatigue and patients without fatigue in terms of conventional magnetic resonance imaging (MRI) outcomes and brain atrophy, specifically in the thalamus. Functional studies showed abnormal activation in the thalamus and in some regions of the sensorimotor network in patients with fatigue compared to patients without it. Patients with fatigue present more structural and functional alterations compared to patients without fatigue. Specifically, abnormal activation and atrophy of the thalamus and some regions of the sensorimotor network seem linked to fatigue.
Collapse
|
10
|
Franca T, Andrea C, Arianna P, Teresa L, Eugenia G, Massimo B, Luca P, Silvana Z, Alessandro G, Domenico L, Patrizio P, Massimiliano M, Maddalena FM. Home treatment against fatigue in multiple sclerosis by a personalized, bilateral whole-body somatosensory cortex stimulation. Mult Scler Relat Disord 2022; 63:103813. [DOI: 10.1016/j.msard.2022.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
|
11
|
Corticomuscular coherence dependence on body side and visual feedback. Neuroscience 2022; 490:144-154. [DOI: 10.1016/j.neuroscience.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/02/2022] [Accepted: 02/17/2022] [Indexed: 12/26/2022]
|
12
|
Bao SC, Chen C, Yuan K, Yang Y, Tong RKY. Disrupted cortico-peripheral interactions in motor disorders. Clin Neurophysiol 2021; 132:3136-3151. [PMID: 34749233 DOI: 10.1016/j.clinph.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/08/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
Abstract
Motor disorders may arise from neurological damage or diseases at different levels of the hierarchical motor control system and side-loops. Altered cortico-peripheral interactions might be essential characteristics indicating motor dysfunctions. By integrating cortical and peripheral responses, top-down and bottom-up cortico-peripheral coupling measures could provide new insights into the motor control and recovery process. This review first discusses the neural bases of cortico-peripheral interactions, and corticomuscular coupling and corticokinematic coupling measures are addressed. Subsequently, methodological efforts are summarized to enhance the modeling reliability of neural coupling measures, both linear and nonlinear approaches are introduced. The latest progress, limitations, and future directions are discussed. Finally, we emphasize clinical applications of cortico-peripheral interactions in different motor disorders, including stroke, neurodegenerative diseases, tremor, and other motor-related disorders. The modified interaction patterns and potential changes following rehabilitation interventions are illustrated. Altered coupling strength, modified coupling directionality, and reorganized cortico-peripheral activation patterns are pivotal attributes after motor dysfunction. More robust coupling estimation methodologies and combination with other neurophysiological modalities might more efficiently shed light on motor control and recovery mechanisms. Future studies with large sample sizes might be necessary to determine the reliabilities of cortico-peripheral interaction measures in clinical practice.
Collapse
Affiliation(s)
- Shi-Chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Cheng Chen
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Yuan Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, OK, USA; Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
13
|
Neurostructural and Neurophysiological Correlates of Multiple Sclerosis Physical Fatigue: Systematic Review and Meta-Analysis of Cross-Sectional Studies. Neuropsychol Rev 2021; 32:506-519. [PMID: 33961198 PMCID: PMC9381450 DOI: 10.1007/s11065-021-09508-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 04/14/2021] [Indexed: 01/01/2023]
Abstract
Fatigue is one of the most debilitating symptoms for people with multiple sclerosis (PwMS). By consolidating a diverse and conflicting evidence-base, this systematic review and meta-analysis aimed to gain new insights into the neurobiology of MS fatigue. MEDLINE, ProQuest, CINAHL, Web of Science databases and grey literature were searched using Medical Subject Headings. Eligible studies compared neuroimaging and neurophysiological data between people experiencing high (MS-HF) versus low (MS-LF) levels of perceived MS fatigue, as defined by validated fatigue questionnaire cut-points. Data were available from 66 studies, with 46 used for meta-analyses. Neuroimaging studies revealed lower volumetric measures in MS-HF versus MS-LF for whole brain (-22.74 ml; 95% CI: -37.72 to -7.76 ml; p = 0.003), grey matter (-18.81 ml; 95% CI: -29.60 to -8.03 ml; p < 0.001), putamen (-0.40 ml; 95% CI: -0.69 to -0.10 ml; p = 0.008) and acumbens (-0.09 ml; 95% CI: -0.15 to -0.03 ml; p = 0.003) and a higher volume of T1-weighted hypointense lesions (1.10 ml; 95% CI: 0.47 to 1.73 ml; p < 0.001). Neurophysiological data showed reduced lower-limb maximum voluntary force production (-19.23 N; 95% CI: -35.93 to -2.53 N; p = 0.02) and an attenuation of upper-limb (-5.77%; 95% CI:-8.61 to -2.93%; p < 0.0001) and lower-limb (-2.16%; 95% CI:-4.24 to -0.07%; p = 0.04) skeletal muscle voluntary activation, accompanied by more pronounced upper-limb fatigability (-5.61%; 95% CI: -9.57 to -1.65%; p = 0.006) in MS-HF versus MS-LF. Results suggest that MS fatigue is characterised by greater cortico-subcortical grey matter atrophy and neural lesions, accompanied by neurophysiological decrements, which include reduced strength and voluntary activation. Prospero registration Prospero registration number: CRD42016017934.
Collapse
|
14
|
Padalino M, Scardino C, Zito G, Cancelli A, Cottone C, Bertoli M, Gianni E, L'Abbate T, Trombetta E, Porcaro C, Bini F, Marinozzi F, Filippi MM, Tecchio F. Effects on Motor Control of Personalized Neuromodulation Against Multiple Sclerosis Fatigue. Brain Topogr 2021; 34:363-372. [PMID: 33656622 DOI: 10.1007/s10548-021-00820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
Fatigue is a hidden symptom of Multiple Sclerosis (MS) disease that nevertheless impacts severely on patients' everyday life. Evidence indicates the involvement of the sensorimotor network and its inter-nodes communication at the basis of this symptom. Two randomized controlled trials (RCTs) showed that the personalized neuromodulation called Fatigue Relief in Multiple Sclerosis (FaReMuS) efficaciously fights multiple sclerosis (MS) fatigue. By this Proof of Concept study, we tested whether FaReMuS reverts the alteration of the brain-muscular synchronization previously observed occurring with fatigue. The cortico muscular coherence (CMC) was studied in 11 patients before and after FaReMuS, a 5-day tDCS (1.5 mA, 15 min per day) anodal over the whole body's somatosensory representation (S1) via a personalized MRI-based electrode (35 cm2) against the occipital cathode (70 cm2). Before FaReMuS, the CMC was observed at a mean frequency of 31.5 ± 1.6 Hz (gamma-band) and positively correlated with the level of fatigue (p = .027). After FaReMuS, fatigue reduced in average of 28% ± 33% the baseline level, and the CMC frequency reduced to 26.6 ± 1.5 Hz (p = .022), thus forthcoming the physiological beta-band as observed in healthy people. The personalized S1 neuromodulation treatment, ameliorating the central-peripheral communication that subtends simple everyday movements, supports the appropriateness of neuromodulations aiming at increasing the parietal excitability in fighting MS fatigue. The relationship between central-peripheral features and fatigue profile strengthens a central more than peripheral origin of the symptom.
Collapse
Affiliation(s)
| | - Carla Scardino
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Giancarlo Zito
- Complex Operative Unit of Neurology, Emergency Department, San Camillo de Lellis Hospital, Viale Kennedy, Rieti, 02100, RI, Italy.,Diagnostic and Clinical Assessment Unit, Istituto di Ortofonologia, Via Salaria, 30, Rome, 00198, RM, Italy
| | | | | | - Massimo Bertoli
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Department of Imaging and Neuroscience and Clinical Sciences, University 'G. D'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Eugenia Gianni
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Camillo Porcaro
- LET'S-ISTC-CNR, via Palestro 32, 00185, Rome, Italy.,Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK.,Department of Information Engineering, Università Politecnica Delle Marche, Ancona, Italy.,S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Maria Maddalena Filippi
- Complex Operative Unit of Neurology, Emergency Department, San Camillo de Lellis Hospital, Viale Kennedy, Rieti, 02100, RI, Italy
| | | |
Collapse
|
15
|
Abstract
The last decade has seen the emergence of new theoretical frameworks to explain pathological fatigue, a much neglected, yet highly significant symptom across a wide range of diseases. While the new models of fatigue provide new hypotheses to test, they also raise a number of questions. The primary purpose of this essay is to examine the predictions of three recently proposed models of fatigue, the overlap and differences between them, and the evidence from diseases that may lend support to the models of fatigue. I also present expansions for the sensory attenuation model of fatigue. Further questions examined here are the following: What are the neural substrates of fatigue? How can sensory attenuation, which underpins agency also explain fatigue? Are fatigue and agency related?
Collapse
Affiliation(s)
- Annapoorna Kuppuswamy
- Department of Clinical and Movement Neuroscience, Institute of Neurology, University College London, London, UK
| |
Collapse
|
16
|
Bertoli M, Tecchio F. Fatigue in multiple sclerosis: Does the functional or structural damage prevail? Mult Scler 2020; 26:1809-1815. [DOI: 10.1177/1352458520912175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Fatigue in multiple sclerosis (MS) is a highly invalidating symptom, lacking efficacious drugs. This topical review aims at assessing the signs in the literature of functional versus structural damage prevalence at the origin of MS fatigue by focusing on papers that assessed the two counterparts in the same patients, paying attention that the fatigue levels do not correlate with clinical severity. We summarize and discuss evidence of increased levels of fatigue occurring together with the alterations of functional connectivity at multiple levels, in the absence of any relationship with lesion load and local atrophy of the involved structures. Specifically, neuronal communication mainly altered in the corticomuscular synchronizations, between hemispheric homologs and in the resting-state networks involved in emotion (cingulate cortex) and effort-reward balance (striatum and inferior parietal lobule). Finally, given the functional prevalence in neuronal network alterations at the origin of fatigue in MS, we highlight the relevance of developing treatments aiming at compensating the neuronal electric communication dysfunctions.
Collapse
Affiliation(s)
- Massimo Bertoli
- LET’S – ISTC – CNR, Catholic University of the Sacred Heart, Rome, Italy
| | - Franca Tecchio
- LET’S – ISTC – CNR, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
17
|
Gao Y, Su H, Li R, Zhang Y. Synchronous analysis of brain regions based on multi-scale permutation transfer entropy. Comput Biol Med 2019; 109:272-279. [DOI: 10.1016/j.compbiomed.2019.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/27/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
|
18
|
Liu J, Sheng Y, Liu H. Corticomuscular Coherence and Its Applications: A Review. Front Hum Neurosci 2019; 13:100. [PMID: 30949041 PMCID: PMC6435838 DOI: 10.3389/fnhum.2019.00100] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
Corticomuscular coherence (CMC) is an index utilized to indicate coherence between brain motor cortex and associated body muscles, conventionally. As an index of functional connections between the cortex and muscles, CMC research is the focus of neurophysiology in recent years. Although CMC has been extensively studied in healthy subjects and sports disorders, the purpose of its applications is still ambiguous, and the magnitude of CMC varies among individuals. Here, we aim to investigate factors that modulate the variation of CMC amplitude and compare significant CMC between these factors to find a well-developed research prospect. In the present review, we discuss the mechanism of CMC and propose a general definition of CMC. Factors affecting CMC are also summarized as follows: experimental design, band frequencies and force levels, age correlation, and difference between healthy controls and patients. In addition, we provide a detailed overview of the current CMC applications for various motor disorders. Further recognition of the factors affecting CMC amplitude can clarify the physiological mechanism and is beneficial to the implementation of CMC clinical methods.
Collapse
Affiliation(s)
- Jinbiao Liu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yixuan Sheng
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Honghai Liu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
19
|
Proudfoot M, van Ede F, Quinn A, Colclough GL, Wuu J, Talbot K, Benatar M, Woolrich MW, Nobre AC, Turner MR. Impaired corticomuscular and interhemispheric cortical beta oscillation coupling in amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:1479-1489. [DOI: 10.1016/j.clinph.2018.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 01/01/2023]
|
20
|
Iodice R, Manganelli F, Dubbioso R. The therapeutic use of non-invasive brain stimulation in multiple sclerosis - a review. Restor Neurol Neurosci 2018; 35:497-509. [PMID: 28984619 DOI: 10.3233/rnn-170735] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and a leading cause of disability in young adults. Many disabling symptoms in MS, such as spasticity, pain, depression and cognitive deficits are not fully controlled by drug treatment. Non-invasive brain stimulation (NIBS) techniques can be used as tools for modulating altered cortical excitability and plasticity MS patients, providing an improvement in disabling symptoms affecting such patients. OBJECTIVE This review reported and summarized some of the most interesting and promising recent achievements regarding the therapeutic use of NIBS in MS patients. METHODS We reviewed the clinical application of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), emphasizing their effect on clinical symptoms and signs that are commonly involved in MS patients. In addition, we shortly described new NIBS protocols, such as transcranial alternating current stimulation and transcranial focused ultrasound stimulation as potential and innovative therapeutic options to be applied in future studies in MS patients. RESULTS We reviewed twenty-one studies covering six main clinical domains. Most of such studies focused on fatigues (33.3%), motor performance (19%) and spasticity (19%), sparse results were about pain (9.5%), cognitive abilities (9.5%), sensory deficit (4.8%) and bladder function (4.8%). The most promising results have been published for the improvement of motor (i.e. hand dexterity) and cognitive performances (i.e. attention and working memory) by applying rTMS or tDCS alone or in association with motor/cognitive training, for pain's treatment by using tDCS. CONCLUSION There are still no official recommendations for the therapeutic use of tDCS or rTMS in MS. The huge inter-individual variability of NIBS efficacy is still a big challenge which needs to be solved. However, well-designed studies, deeper knowledge about pathomechanisms underlying MS, and the combination of such techniques with motor and cognitive rehabilitation might results in higher effectiveness of NIBS.
Collapse
Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy
| |
Collapse
|
21
|
Porcaro C, Cottone C, Cancelli A, Salustri C, Tecchio F. Functional Semi-Blind Source Separation Identifies Primary Motor Area Without Active Motor Execution. Int J Neural Syst 2018; 28:1750047. [DOI: 10.1142/s0129065717500472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High time resolution techniques are crucial for investigating the brain in action. Here, we propose a method to identify a section of the upper-limb motor area representation (FS_M1) by means of electroencephalographic (EEG) signals recorded during a completely passive condition (FS_M1bySS). We delivered a galvanic stimulation to the median nerve and we applied to EEG the semi-Blind Source Separation (s-BSS) algorithm named Functional Source Separation (FSS). In order to prove that FS_M1bySS is part of FS_M1, we also collected EEG in a motor condition, i.e. during a voluntary movement task (isometric handgrip) and in a rest condition, i.e. at rest with eyes open and closed. In motor condition, we show that the cortico-muscular coherence (CMC) of FS_M1bySS does not differ from FS_ M1 CMC (0.04 for both sources). Moreover, we show that the FS_M1bySS’s ongoing whole band activity during Motor and both rest conditions displays high mutual information and time correlation with FS_M1 (above 0.900 and 0.800, respectively) whereas much smaller ones with the primary somatosensory cortex [Formula: see text] (about 0.300 and 0.500, [Formula: see text]). FS_M1bySS as a marker of the upper-limb FS_M1 representation obtainable without the execution of an active motor task is a great achievement of the FSS algorithm, relevant in most experimental, neurological and psychiatric protocols.
Collapse
Affiliation(s)
- Camillo Porcaro
- LET’S - ISTC - CNR, Rome 00185, Italy
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven 3001, Belgium
- Birmingham University Imaging Centre (BUIC), School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | | |
Collapse
|
22
|
Gao Y, Ren L, Li R, Zhang Y. Electroencephalogram-Electromyography Coupling Analysis in Stroke Based on Symbolic Transfer Entropy. Front Neurol 2018; 8:716. [PMID: 29354091 PMCID: PMC5758532 DOI: 10.3389/fneur.2017.00716] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
The coupling strength between electroencephalogram (EEG) and electromyography (EMG) signals during motion control reflects the interaction between the cerebral motor cortex and muscles. Therefore, neuromuscular coupling characterization is instructive in assessing motor function. In this study, to overcome the limitation of losing the characteristics of signals in conventional time series symbolization methods, a variable scale symbolic transfer entropy (VS-STE) analysis approach was proposed for corticomuscular coupling evaluation. Post-stroke patients (n = 5) and healthy volunteers (n = 7) were recruited and participated in various tasks (left and right hand gripping, elbow bending). The proposed VS-STE was employed to evaluate the corticomuscular coupling strength between the EEG signal measured from the motor cortex and EMG signal measured from the upper limb in both the time-domain and frequency-domain. Results showed a greater strength of the bi-directional (EEG-to-EMG and EMG-to-EEG) VS-STE in post-stroke patients compared to healthy controls. In addition, the strongest EEG–EMG coupling strength was observed in the beta frequency band (15–35 Hz) during the upper limb movement. The predefined coupling strength of EMG-to-EEG in the affected side of the patient was larger than that of EEG-to-EMG. In conclusion, the results suggested that the corticomuscular coupling is bi-directional, and the proposed VS-STE can be used to quantitatively characterize the non-linear synchronization characteristics and information interaction between the primary motor cortex and muscles.
Collapse
Affiliation(s)
- Yunyuan Gao
- College of Automation, Intelligent Control & Robotics Institute, Hangzhou Dianzi University, Hangzhou, China
| | - Leilei Ren
- College of Automation, Intelligent Control & Robotics Institute, Hangzhou Dianzi University, Hangzhou, China
| | - Rihui Li
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States.,Guangdong Provincial Work-Injury Rehabilitation Hospital, Guangzhou, China
| | - Yingchun Zhang
- College of Automation, Intelligent Control & Robotics Institute, Hangzhou Dianzi University, Hangzhou, China.,Department of Biomedical Engineering, University of Houston, Houston, TX, United States.,Guangdong Provincial Work-Injury Rehabilitation Hospital, Guangzhou, China
| |
Collapse
|
23
|
Cancelli A, Cottone C, Giordani A, Migliore S, Lupoi D, Porcaro C, Mirabella M, Rossini PM, Filippi MM, Tecchio F. Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis. Mult Scler 2017; 24:1366-1374. [PMID: 28756744 DOI: 10.1177/1352458517720528] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The patients suffering from multiple sclerosis (MS) often consider fatigue the most debilitating symptom they experience, but conventional medicine currently offers poorly efficacious therapies. OBJECTIVE We executed a replication study of an innovative approach for relieving MS fatigue. METHODS According to the sample size estimate, we recruited 10 fatigued MS patients who received 5-day transcranial direct current stimulation (tDCS) in a randomized, double-blind, Sham-controlled, crossover study, with modified Fatigue Impact Scale (mFIS) score reduction at the end of the treatment as primary outcome. A personalized anodal electrode, shaped on the magnetic resonance imaging (MRI)-derived individual cortical folding, targeted the bilateral whole-body primary somatosensory cortex (S1) with an occipital cathode. RESULTS The amelioration of fatigue symptoms after Real stimulation (40% of baseline) was significantly larger than after Sham stimulation (14%, p = 0.012). Anodal whole body S1 induced a significant fatigue reduction in mildly disabled MS patients when the fatigue-related symptoms severely hampered their quality of life. CONCLUSION This second result in an independent group of patients supports the idea that neuromodulation interventions that properly select a personalized target might be a suitable non-pharmacological treatment for MS fatigue.
Collapse
Affiliation(s)
- Andrea Cancelli
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Carlo Cottone
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Alessandro Giordani
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy/Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy
| | - Simone Migliore
- Clinical Psychology Service, University Campus Bio-Medico, Rome, Italy/LIRH Foundation, Rome, Italy
| | - Domenico Lupoi
- Neuroscience and Imaging, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Camillo Porcaro
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| | - Massimiliano Mirabella
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Paolo Maria Rossini
- Department of Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | | | - Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Rome, Italy
| |
Collapse
|
24
|
Buyukturkoglu K, Porcaro C, Cottone C, Cancelli A, Inglese M, Tecchio F. Simple index of functional connectivity at rest in Multiple Sclerosis fatigue. Clin Neurophysiol 2017; 128:807-813. [DOI: 10.1016/j.clinph.2017.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/02/2017] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
|
25
|
Vecchio F, Miraglia F, Porcaro C, Cottone C, Cancelli A, Rossini PM, Tecchio F. Electroencephalography-Derived Sensory and Motor Network Topology in Multiple Sclerosis Fatigue. Neurorehabil Neural Repair 2016; 31:56-64. [DOI: 10.1177/1545968316656055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
People with multiple sclerosis (MS) frequently complain of excessive fatigue, which is the most disabling symptom for half of them. While the few drugs used to treat MS fatigue are of limited utility, we recently observed the efficacy of a personalized neuromodulation treatment. Here, we aim at strengthening knowledge of the brain network changes that occur when MS fatigue increases, using graph theory. We collected electroencephalographic (EEG; 23 or 64 channels) data in resting state with eyes open in 27 relapsing-remitting (RR) patients with mild MS (EDSS ≤2), suffering a wide range of fatigue as scored by the modified Fatigue Impact Scale (mFIS) (2-69, within a total range 0-84). To estimate graph theory small-world index (SW), we calculated the lagged linear coherence between EEG cortical eLORETA sources, in the standard frequency bands delta (2-4 Hz), theta (4-8 Hz), alpha1 (8-10.5 Hz), alpha2 (10.5-13 Hz), beta1 (13-20 Hz), beta2 (20-30 Hz), and gamma (30-45 Hz). We calculated the SW of these undirected and weighted networks separately in the four left and right frontal (motor) and parieto-occipito-temporal (sensory) brain networks. A correlative analysis demonstrated increased fatigue symptoms along with the SW specifically in the Sensory network of the left dominant hemisphere in the beta1 band (Pearson’s r = 0.404, P = .020). Our study indicates a specific involvement of the dominant-hemisphere sensory network in MS fatigue. It suggests that compensatory neuromodulation interventions could enhance efficacy in relieving this debilitating symptom by targeting this area.
Collapse
Affiliation(s)
| | | | - Camillo Porcaro
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
- Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Cottone
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
| | - Andrea Cancelli
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
- Catholic University, Rome, Italy
| | | | - Franca Tecchio
- LET’S-ISTC-CNR, Fatebenefratelli Hospital–Isola Tiberina, Rome, Italy
| |
Collapse
|
26
|
Abstract
CONCEPT Fatigue is a major concern for patients with multiple sclerosis (MS). A clear definition of MS-related fatigue is a prerequisite for appropriate instruments for fatigue assessment. In turn, accurate assessment of fatigue in MS will enhance exploration of plausible mechanisms underlying this common and distressing symptom. Content/Objectives: To provide an integrative review of the current literature on theoretical models used to study fatigue in MS, instruments used to assess fatigue and other factors that impact fatigue during the various phases of MS. DATA SOURCES PUBMED, OVID, Ovid Health Star, Ovid MEDINE, CINAHL, Health and Psychosocial Instruments (HaPI), and PsycINFO. Seventeen articles fit the inclusion criteria and were included in the review. RESULTS Definitions of MS-related fatigue are reviewed. Several studies found a link with neurotransmitter dysfunction, circadian rhythm, and the timing of fatigue. Central fatigue in MS is associated with neurotransmitters disruptions as well as circadian rhythm disorders, but the evidence is not strong. Perceptions of fatigue or fatigability may arise as either a primary or secondary manifestation of disease. Based on findings from the literature review, a theoretical model of fatigue in MS is proposed. CONCLUSION Future research on MS-related fatigue may consider a longitudinal design with a carefully selected self-report instrument to advance understanding of the underlying pathological mechanisms.
Collapse
Affiliation(s)
- Pamela Newland
- Office of Nursing Research, Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA,Correspondence to: Pamela Newland, Goldfarb School of Nursing at Barnes Jewish College, Office of Nursing Research, 4483 Duncan Avenue, St. Louis, USA, MO 63110.
| | - Angela Starkweather
- Center for Advancement of Managing Pain, University of Connecticut School of Nursing, Storrs, CT, USA
| | - Matthew Sorenson
- DePaul University School of Nursing, Chicago, IL, USA,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
27
|
Cancelli A, Cottone C, Tecchio F, Truong DQ, Dmochowski J, Bikson M. A simple method for EEG guided transcranial electrical stimulation without models. J Neural Eng 2016; 13:036022. [PMID: 27172063 DOI: 10.1088/1741-2560/13/3/036022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE There is longstanding interest in using EEG measurements to inform transcranial Electrical Stimulation (tES) but adoption is lacking because users need a simple and adaptable recipe. The conventional approach is to use anatomical head-models for both source localization (the EEG inverse problem) and current flow modeling (the tES forward model), but this approach is computationally demanding, requires an anatomical MRI, and strict assumptions about the target brain regions. We evaluate techniques whereby tES dose is derived from EEG without the need for an anatomical head model, target assumptions, difficult case-by-case conjecture, or many stimulation electrodes. APPROACH We developed a simple two-step approach to EEG-guided tES that based on the topography of the EEG: (1) selects locations to be used for stimulation; (2) determines current applied to each electrode. Each step is performed based solely on the EEG with no need for head models or source localization. Cortical dipoles represent idealized brain targets. EEG-guided tES strategies are verified using a finite element method simulation of the EEG generated by a dipole, oriented either tangential or radial to the scalp surface, and then simulating the tES-generated electric field produced by each model-free technique. These model-free approaches are compared to a 'gold standard' numerically optimized dose of tES that assumes perfect understanding of the dipole location and head anatomy. We vary the number of electrodes from a few to over three hundred, with focality or intensity as optimization criterion. MAIN RESULTS Model-free approaches evaluated include (1) voltage-to-voltage, (2) voltage-to-current; (3) Laplacian; and two Ad-Hoc techniques (4) dipole sink-to-sink; and (5) sink to concentric. Our results demonstrate that simple ad hoc approaches can achieve reasonable targeting for the case of a cortical dipole, remarkably with only 2-8 electrodes and no need for a model of the head. SIGNIFICANCE Our approach is verified directly only for a theoretically localized source, but may be potentially applied to an arbitrary EEG topography. For its simplicity and linearity, our recipe for model-free EEG guided tES lends itself to broad adoption and can be applied to static (tDCS), time-variant (e.g., tACS, tRNS, tPCS), or closed-loop tES.
Collapse
Affiliation(s)
- Andrea Cancelli
- Laboratory of Electrophysiology for Translational neuroScience (LET'S)-ISTC-CNR, Italy. Institute of Neurology, Catholic University, Rome, Italy
| | | | | | | | | | | |
Collapse
|
28
|
Cunningham DA, Janini D, Wyant A, Bonnett C, Varnerin N, Sankarasubramanian V, Potter-Baker KA, Roelle S, Wang X, Siemionow V, Yue GH, Plow EB. Post-exercise depression following submaximal and maximal isometric voluntary contraction. Neuroscience 2016; 326:95-104. [PMID: 27058145 DOI: 10.1016/j.neuroscience.2016.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
It is well known that corticomotor excitability is altered during the post-exercise depression following fatigue within the primary motor cortex (M1). However, it is currently unknown whether corticomotor reorganization following muscle fatigue differs between magnitudes of force and whether corticomotor reorganization occurs measured with transcranial magnetic stimulation (TMS). Fifteen young healthy adults (age 23.8±1.4, 8 females) participated in a within-subjects, repeated measures design study, where they underwent three testing sessions separated by one-week each. Subjects performed separate sessions of each: low-force isometric contraction (30% maximal voluntary contraction [MVC]), high-force isometric contraction (95% MVC) of the first dorsal interosseous (FDI) muscle until self-perceived exhaustion, as well as one session of a 30-min rest as a control. We examined changes in corticomotor map area, excitability and location of the FDI representation in and around M1 using TMS. The main finding was that following low-force, but not high-force fatigue (HFF) corticomotor map area and excitability reduced [by 3cm(2) (t(14)=-2.94, p=0.01) and 56% respectively t(14)=-4.01, p<0.001)]. Additionally, the region of corticomotor excitability shifted posteriorly (6.4±2.5mm) (t(14)=-6.33, p=.019). Corticomotor output became less excitable particularly in regions adjoining M1. Overall, post-exercise depression is present in low-force, but not for HFF. Further, low-force fatigue (LFF) results in a posterior shift in corticomotor output. These changes may be indicative of increased sensory feedback from the somatosensory cortex during the recovery phase of fatigue.
Collapse
Affiliation(s)
- David A Cunningham
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; School of Biomedical Sciences, Kent State University, Kent, OH, United States
| | - Daniel Janini
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Alexandria Wyant
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Corin Bonnett
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nicole Varnerin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Kelsey A Potter-Baker
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sarah Roelle
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Vlodek Siemionow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Guang H Yue
- Human Performance & Engineering Research, Kessler Foundation, West Orange, NJ, United States; Department of Physical Medicine & Rehab, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, United States.
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Physical Medicine & Rehab, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
29
|
Collett J, Meaney A, Howells K, Dawes H. Acute recovery from exercise in people with multiple sclerosis: an exploratory study on the effect of exercise intensities. Disabil Rehabil 2016; 39:551-558. [DOI: 10.3109/09638288.2016.1152604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Johnny Collett
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Andy Meaney
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Ken Howells
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Movement Science Group, Oxford Brookes University, Oxford, UK
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| |
Collapse
|
30
|
McCarthy CS, Ramprashad A, Thompson C, Botti JA, Coman IL, Kates WR. A comparison of FreeSurfer-generated data with and without manual intervention. Front Neurosci 2015; 9:379. [PMID: 26539075 PMCID: PMC4612506 DOI: 10.3389/fnins.2015.00379] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/29/2015] [Indexed: 01/18/2023] Open
Abstract
This paper examined whether FreeSurfer-generated data differed between a fully-automated, unedited pipeline and an edited pipeline that included the application of control points to correct errors in white matter segmentation. In a sample of 30 individuals, we compared the summary statistics of surface area, white matter volumes, and cortical thickness derived from edited and unedited datasets for the 34 regions of interest (ROIs) that FreeSurfer (FS) generates. To determine whether applying control points would alter the detection of significant differences between patient and typical groups, effect sizes between edited and unedited conditions in individuals with the genetic disorder, 22q11.2 deletion syndrome (22q11DS) were compared to neurotypical controls. Analyses were conducted with data that were generated from both a 1.5 tesla and a 3 tesla scanner. For 1.5 tesla data, mean area, volume, and thickness measures did not differ significantly between edited and unedited regions, with the exception of rostral anterior cingulate thickness, lateral orbitofrontal white matter, superior parietal white matter, and precentral gyral thickness. Results were similar for surface area and white matter volumes generated from the 3 tesla scanner. For cortical thickness measures however, seven edited ROI measures, primarily in frontal and temporal regions, differed significantly from their unedited counterparts, and three additional ROI measures approached significance. Mean effect sizes for edited ROIs did not differ from most unedited ROIs for either 1.5 or 3 tesla data. Taken together, these results suggest that although the application of control points may increase the validity of intensity normalization and, ultimately, segmentation, it may not affect the final, extracted metrics that FS generates. Potential exceptions to and limitations of these conclusions are discussed.
Collapse
Affiliation(s)
- Christopher S McCarthy
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| | - Avinash Ramprashad
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| | - Carlie Thompson
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| | - Jo-Anna Botti
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| | - Ioana L Coman
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Neuroimaging, State University of New York at Upstate Medical University Syracuse, NY, USA
| |
Collapse
|
31
|
Tailoring Brain Stimulation to the Nature of Rehabilitative Therapies in Stroke: A Conceptual Framework Based on their Unique Mechanisms of Recovery. Phys Med Rehabil Clin N Am 2015; 26:759-74. [PMID: 26522911 DOI: 10.1016/j.pmr.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite showing early promise, several recent clinical trials of noninvasive brain stimulation (NIBS) failed to augment rehabilitative outcomes of the paretic upper limb. This article addresses why pairing NIBS with unilateral approaches is weakly generalizable to patients in all ranges of impairments. The article also addresses whether alternate therapies are better suited for the more impaired patients, where they may be more feasible and offer neurophysiologic advantages not offered with unilateral therapies. The article concludes by providing insight on how to create NIBS paradigms that are tailored to distinctly augment the effects of therapies across patients with varying degrees of impairment.
Collapse
|
32
|
Houdayer E, Comi G, Leocani L. The Neurophysiologist Perspective into MS Plasticity. Front Neurol 2015; 6:193. [PMID: 26388835 PMCID: PMC4558527 DOI: 10.3389/fneur.2015.00193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/18/2015] [Indexed: 01/17/2023] Open
Abstract
Multiple sclerosis (MS) is a frequent, highly debilitating inflammatory demyelinating disease, starting to manifest in early adulthood and presenting a wide variety of symptoms, which are often resistant to pharmacological treatments. Cortical dysfunctions have been demonstrated to be key components of MS condition, and plasticity of the corticospinal motor system is highly involved in major MS symptoms, such as fatigue, spasticity, or pain. Cortical dysfunction in MS can be studied with neurophysiological tools, such as electroencephalography (EEG) and related techniques (evoked potentials) or transcranial magnetic stimulation (TMS). These techniques are now widely used to provide essential elements of MS diagnosis and can also be used to modulate plasticity. Indeed, the recent development of non-invasive brain stimulation techniques able to induce cortical plasticity, such as repetitive TMS or transcranial direct current stimulation, has brought promising results as add-on treatments. In this review, we will focus on the use of these tools (EEG and TMS) to study plasticity in MS and on the major techniques used to modulate plasticity in MS.
Collapse
Affiliation(s)
- Elise Houdayer
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy
| | - Giancarlo Comi
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy ; University Vita-Salute San Raffaele, San Raffaele Scientific Institute , Milan , Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute , Milan , Italy ; University Vita-Salute San Raffaele, San Raffaele Scientific Institute , Milan , Italy
| |
Collapse
|
33
|
Tecchio F, Cancelli A, Cottone C, Ferrucci R, Vergari M, Zito G, Pasqualetti P, Filippi MM, Ghazaryan A, Lupoi D, Smits FM, Giordani A, Migliore S, Porcaro C, Salustri C, Rossini PM, Priori A. Brain Plasticity Effects of Neuromodulation Against Multiple Sclerosis Fatigue. Front Neurol 2015; 6:141. [PMID: 26191036 PMCID: PMC4490242 DOI: 10.3389/fneur.2015.00141] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022] Open
Abstract
Rationale We recently reported on the efficacy of a personalized transcranial direct current stimulation (tDCS) treatment in reducing multiple sclerosis (MS) fatigue. The result supports the notion that interventions targeted at modifying abnormal excitability within the sensorimotor network could represent valid non-pharmacological treatments. Objective The present work aimed at assessing whether the mentioned intervention also induces changes in the excitability of sensorimotor cortical areas. Method Two separate groups of fatigued MS patients were given a 5-day tDCS treatments targeting, respectively, the whole body somatosensory areas (S1wb) and the hand sensorimotor areas (SM1hand). The study had a double blind, sham-controlled, randomized, cross-over (Real vs. Sham) design. Before and after each treatment, we measured fatigue levels (by the modified fatigue impact scale, mFIS), motor evoked potentials (MEPs) in response to transcranial magnetic stimulation and somatosensory evoked potentials (SEPs) in response to median nerve stimulation. We took MEPs and SEPs as measures of the excitability of the primary motor area (M1) and the primary somatosensory area (S1), respectively. Results The Real S1wb treatment produced a 27% reduction of the mFIS baseline level, while the SM1hand treatment showed no difference between Real and Sham stimulations. M1 excitability increased on average 6% of the baseline in the S1wb group and 40% in the SM1hand group. Observed SEP changes were not significant and we found no association between M1 excitability changes and mFIS decrease. Conclusion The tDCS treatment was more effective against MS fatigue when the electrode was focused on the bilateral whole body somatosensory area. Changes in S1 and M1 excitability did not correlate with symptoms amelioration. Significance The neuromodulation treatment that proved effective against MS fatigue induced only minor variations of the motor cortex excitability, not enough to explain the beneficial effects of the intervention.
Collapse
Affiliation(s)
- Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy
| | - Andrea Cancelli
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy
| | - Carlo Cottone
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
| | - Maurizio Vergari
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
| | - Giancarlo Zito
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Patrizio Pasqualetti
- Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | | | - Anna Ghazaryan
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Domenico Lupoi
- AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | | | - Alessandro Giordani
- Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy ; AFaR Division, Fatebenefratelli Foundation for Health Research and Education , Rome , Italy
| | - Simone Migliore
- University of Campus Biomedico, Psychology Service , Rome , Italy
| | - Camillo Porcaro
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy ; Institute of Neuroscience, Medical School, Newcastle University , Newcastle upon Tyne , UK
| | - Carlo Salustri
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), Department of Neuroscience, ISTC, CNR, Fatebenefratelli Hospital - Isola Tiberina , Rome , Italy
| | - Paolo M Rossini
- Unit of Neuroimaging, IRCCS San Raffaele Pisana , Rome , Italy ; Clinical Neurology, Catholic University, Policlinico A. Gemelli , Rome , Italy
| | - Alberto Priori
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano , Milan , Italy
| |
Collapse
|
34
|
Cogliati Dezza I, Zito G, Tomasevic L, Filippi MM, Ghazaryan A, Porcaro C, Squitti R, Ventriglia M, Lupoi D, Tecchio F. Functional and structural balances of homologous sensorimotor regions in multiple sclerosis fatigue. J Neurol 2014; 262:614-22. [DOI: 10.1007/s00415-014-7590-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 12/22/2022]
|
35
|
Tecchio F, Cancelli A, Cottone C, Zito G, Pasqualetti P, Ghazaryan A, Rossini PM, Filippi MM. Multiple sclerosis fatigue relief by bilateral somatosensory cortex neuromodulation. J Neurol 2014; 261:1552-8. [PMID: 24854634 DOI: 10.1007/s00415-014-7377-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis-related fatigue is highly common and often refractory to medical therapy. Ten fatigued multiple sclerosis patients received two blocks of 5-day anodal bilateral primary somatosensory areas transcranial direct current stimulation in a randomized, double-blind sham-controlled, cross-over study. The real neuromodulation by a personalized electrode, shaped on the MR-derived primary somatosensory cortical strip, reduced fatigue in all patients, by 26 % in average (p = 0.002), which did not change after sham (p = 0.901). Anodal tDCS over bilateral somatosensory areas was able to relief fatigue in mildly disabled MS patients, when the fatigue-related symptoms severely hamper their quality of life. These small-scale study results support the concept that interventions modifying the sensorimotor network activity balances could be a suitable non-pharmacological treatment for multiple sclerosis fatigue.
Collapse
Affiliation(s)
- Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S)-ISTC-CNR, Department of Clinical Neuroscience, Fatebenefratelli Hospital, Isola Tiberina, 00186, Rome, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Zito G, Luders E, Tomasevic L, Lupoi D, Toga AW, Thompson PM, Rossini PM, Filippi MM, Tecchio F. Inter-hemispheric functional connectivity changes with corpus callosum morphology in multiple sclerosis. Neuroscience 2014; 266:47-55. [PMID: 24486438 DOI: 10.1016/j.neuroscience.2014.01.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 12/27/2022]
Abstract
Multiple sclerosis (MS) affects myelin sheaths within the central nervous system, concurring to cause brain atrophy and neurodegeneration as well as gradual functional disconnections. To explore early signs of altered connectivity in MS from a structural and functional perspective, the morphology of corpus callosum (CC) was correlated with a dynamic inter-hemispheric connectivity index. Twenty mildly disabled patients affected by a relapsing-remitting (RR) form of MS (EDSS⩽3.5) and 15 healthy subjects underwent structural MRI to measure CC thickness over 100 sections and electroencephalography to assess a spectral coherence index between primary regions devoted to hand control, at rest and during an isometric handgrip. In patients, an overall CC atrophy was associated with increased lesion load. A less efficacious inter-hemispheric coherence (IHCoh) during movement was associated with CC atrophy in sections interconnecting homologous primary motor areas (anterior mid-body). In healthy controls, less efficacious IHCoh at rest was associated with a thinner CC splenium. Our data suggest that in mildly disabled RR-MS patients a covert impairment may be detected in the correlation between the structural (CC thickness) and functional (IHCoh) measures of homologous networks, whereas these two counterparts do not yet differ individually from controls.
Collapse
Affiliation(s)
- G Zito
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), ISTC, Consiglio Nazionale delle Ricerche, 'S. Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy; Department of Clinical Neuroscience, AFaR, 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy.
| | - E Luders
- Laboratory of Neuro Imaging, Department of Neurology, University of California, Los Angeles, School of Medicine, Los Angeles, CA 90095-7334, USA
| | - L Tomasevic
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), ISTC, Consiglio Nazionale delle Ricerche, 'S. Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy; Department of Clinical Neuroscience, AFaR, 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy
| | - D Lupoi
- Department of Clinical Neuroscience, AFaR, 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy
| | - A W Toga
- Laboratory of Neuro Imaging, Department of Neurology, University of California, Los Angeles, School of Medicine, Los Angeles, CA 90095-7334, USA
| | - P M Thompson
- Laboratory of Neuro Imaging, Department of Neurology, University of California, Los Angeles, School of Medicine, Los Angeles, CA 90095-7334, USA
| | - P M Rossini
- Department of Imaging, IRCCS San Raffale Pisana, Rome I-00163, Italy; Institute of Neurology, Università Cattolica del Sacro Cuore, Rome I-00168, Italy
| | - M M Filippi
- Department of Clinical Neuroscience, AFaR, 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy
| | - F Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S), ISTC, Consiglio Nazionale delle Ricerche, 'S. Giovanni Calibita' Fatebenefratelli Hospital, Rome I-00186, Italy; Department of Imaging, IRCCS San Raffale Pisana, Rome I-00163, Italy
| |
Collapse
|
37
|
Dawes H, Collett J, Meaney A, Duda J, Sackley C, Wade D, Barker K, Izadi H. Delayed Recovery of Leg Fatigue Symptoms Following a Maximal Exercise Session in People With Multiple Sclerosis. Neurorehabil Neural Repair 2013; 28:139-48. [DOI: 10.1177/1545968313503218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Fatigue is a chronic symptom for people with multiple sclerosis (PwMS). Objective. Symptoms of fatigue were investigated during and following a single exercise session. Methods. In all, 58 PwMS and 15 healthy, low-active controls performed a cycle ergometer incremental exercise test to voluntary exhaustion. Physiological intensity (expired air and heart rate), perceived breathlessness, and leg fatigue (Rating of Perceived Exertion [RPE] CR-10 Scale) were measured during and for 10 minutes following exercise. Measures of baseline disability (Barthel Index), activity (Physical Activity Scale for the Elderly), vitality (Subjective Vitality Scale), and general fatigue (Fatigue Severity Scale [FSS]) were recorded. Results. PwMS had reduced exercise capacity ( P = .00 to .01), but sensations of breathlessness and leg fatigue were the same at voluntary exercise termination in both groups ( P = .09). PwMS with fatigue (FSS ≥ 4) exhibited reduced exercise capacity ( P = .03 to .05) but reached the same physiological intensity, breathlessness, and leg fatigue symptoms at test termination as nonfatigued peers ( P = .16 to .59). During recovery, there was no difference in observed means between groups, except for leg RPE, which was higher in the MS group ( P = .047) and higher at 3 and 5 minutes after exercise in the fatigued MS group ( P = .02). Physiological markers and breathlessness recovered at the same rate in both groups ( P = .33 to .67). Conclusion. Monitoring leg fatigue symptoms during and through recovery from physical activities may help guide participation in physical activities for PwMS, particularly in people managing high levels of fatigue.
Collapse
Affiliation(s)
| | | | | | - Joan Duda
- University of Birmingham, Birmingham, UK
| | | | | | | | | |
Collapse
|
38
|
Tecchio F, Cancelli A, Cottone C, Tomasevic L, Devigus B, Zito G, Ercolani M, Carducci F. Regional personalized electrodes to select transcranial current stimulation target. Front Hum Neurosci 2013; 7:131. [PMID: 23626529 PMCID: PMC3631708 DOI: 10.3389/fnhum.2013.00131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/25/2013] [Indexed: 11/18/2022] Open
Abstract
Rationale: Personalizing transcranial stimulations promises to enhance beneficial effects for individual patients. Objective: To stimulate specific cortical regions by developing a procedure to bend and position custom shaped electrodes; to probe the effects on cortical excitability produced when the properly customized electrode is targeting different cortical areas. Method: An ad hoc neuronavigation procedure was developed to accurately shape and place the personalized electrodes on the basis of individual brain magnetic resonance images (MRI) on bilateral primary motor (M1) and somatosensory (S1) cortices. The transcranial alternating current stimulation (tACS) protocol published by Feurra et al. (2011b) was used to test the effects on cortical excitability of the personalized electrode when targeting S1 or M1. Results: Neuronal excitability as evaluated by tACS was different when targeting M1 or S1, with the General Estimating Equation model indicating a clear tCS Effect (p < 0.001), and post hoc comparisons showing solely M1 20 Hz tACS to reduce M1 excitability with respect to baseline and other tACS conditions. Conclusions: The present work indicates that specific cortical regions can be targeted by tCS properly shaping and positioning the stimulating electrode. Significance: Through multimodal brain investigations continuous efforts in understanding the neuronal changes related to specific neurological or psychiatric diseases become more relevant as our ability to build the compensating interventions improves. An important step forward on this path is the ability to target the specific cortical area of interest, as shown in the present pilot work.
Collapse
Affiliation(s)
- Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience (LET'S) - ISTC - CNR, Department of Neuroscience, Fatebenefratelli Hospital Rome, Italy ; Department of Neuroimaging, IRCCS San Raffaele Pisana Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Paoloni M, Giovannelli M, Mangone M, Leonardi L, Tavernese E, Di Pangrazio E, Bernetti A, Santilli V, Pozzilli C. Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial. Clin Rehabil 2013; 27:803-12. [DOI: 10.1177/0269215513480956] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis. Design: Single-blind, randomized controlled trial. Setting: Physical medicine and rehabilitation outpatients service. Subjects: Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin). Main measures: Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation. Results: Modified Ashworth Scale at knee and ankle significantly decreased over time ( p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 ( p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)]. Conclusion: Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.
Collapse
Affiliation(s)
- Marco Paoloni
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Massimiliano Mangone
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Laura Leonardi
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
| | - Emanuela Tavernese
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Andrea Bernetti
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Valter Santilli
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Carlo Pozzilli
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
| |
Collapse
|