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Cortez-Lugo M, Huanca-Laura LX, Hernández-Bonilla D, Alamo-Hernández U, Montes S, García-Feregrino R, Velázquez S, Tristán-López LA. Impact of Cognitive Intervention on Neurocognitive Development of Schoolchildren Exposed to Lead in a Semi-Urban Community in Mexico. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00299. [PMID: 38985527 DOI: 10.1097/phh.0000000000001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Lead exposure is a severe public health issue that can adversely affect children's neurocognitive development. A semi-urban community in Mexico has been exposed to lead from food cooked in glazed clay pots. A cognitive intervention was conducted from 2015 to 2016 to minimize this negative impact. This intervention aimed to improve the neurocognitive development of the affected children. METHODS A quasi-experimental study with a control group was conducted in children aged 7 to 12 years from 2 communities in Morelos, Mexico. Blood lead levels were determined, and the neurocognitive function was assessed pre- and postintervention with the Wechsler Intelligence Scale for Children and Children's Auditory Verbal Learning Test-2. A cognitive intervention was conducted at the school. The difference-in-differences method adjusted for variables known as priori and evaluated the impact of cognitive intervention. RESULTS The differences-in-differences models indicated a significant average increase in scores on the Verbal Comprehension Index (9.58 points), Processing Speed Index (5.33 points), intelligence quotient (5.63 points) level of learning (7.66 points), interference trial (10.12 points), immediate memory span (7.98 points), and recognition accuracy (1.18 points) subtests after the cognitive intervention. CONCLUSION The results suggest that cognitive intervention improves neurocognitive development in schoolchildren exposed to Pb.
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Affiliation(s)
- Marlene Cortez-Lugo
- Author Affiliations: National Institute of Public Health, Environmental Health Department, Cuernavaca, Morelos, Mexico (Dr Cortez-Lugo); Universidad Mayor de San Andrés, Bolivian Institute of High-Altitude Biology, La Paz, Bolivia (Ms Huanca-Laura); Environmental Health Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico (Dr Hernández-Bonilla and Ms Alamo-Hernández); Universidad Autónoma de Tamaulipas, Unidad Académica Multidisciplinaria Reynosa-Aztlán, Reynosa, Tamaulipas, Mexico (Dr Montes); National Institute of Public Health, Center for Research in Evaluation and Surveys, Cuernavaca, Morelos, Mexico (Ms García-Feregrino); National Institute of Public Health, Environmental Health Department, Cuernavaca, Morelos, Mexico (Ms Velázquez); and National Institute of Neurology and Neurosurgery, Neurochemistry Department, Tlalpan, Ciudad de México, Mexico (Dr Tristán-López)
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2
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Renner A, Bätge SJ, Filser M, Lau S, Pöttgen J, Penner IK. Non-pharmacological randomized intervention trial for the management of neuropsychological symptoms in outpatients with progressive multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 37652158 DOI: 10.1080/23279095.2023.2233648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE Despite typically more pronounced cognitive and mental health issues in progressive disease courses of multiple sclerosis (PMS), rehabilitation research in this subgroup is rare. The efficacy of two non-pharmacological interventions with positive results from prior investigations was therefore examined in PMS specifically. METHODS Persons with PMS (pwPMS) received either computerized cognitive training (BrainStim), standardized cognitive-behavioral group sessions (Metacognitive Training [MaTiMS]), or a combination of both in an ambulatory setting. Neuropsychological assessment was conducted before and after the four-week intervention. RESULTS 37 participants (13 with primary/24 with secondary PMS, meanage = 52.87, SDage = 7.11, meanEDSS = 4.02, SDEDSS = 1.35) entered analyses. The BrainStim group improved in immediate and delayed verbal memory, recognition, verbal working memory, and perceived cognitive deficits while experiencing increased anxiety post-intervention. MaTiMS participants reported high program satisfaction and less cognitive difficulties at retest. The Combination group performed better in immediate and delayed verbal memory, and in information processing speed after training. Descriptive data further indicated positive effects on anxiety and depression in the MaTiMS and Combination group. CONCLUSIONS While objective cognitive performance improved when explicitly trained, psychoeducative sessions contributed to subjective mental health. The combination of both approaches is thus suggested, considering the specific needs of pwPMS treated in an ambulatory setting.
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Affiliation(s)
- Alina Renner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Sharon Jean Bätge
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Melanie Filser
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Stephanie Lau
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iris-Katharina Penner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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3
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Veréb D, Kovács MA, Kocsis K, Tóth E, Bozsik B, Király A, Kincses B, Faragó P, Fricska-Nagy Z, Bencsik K, Klivényi P, Kincses ZT, Szabó N. Functional Connectivity Lateralisation Shift of Resting State Networks is Linked to Visuospatial Memory and White Matter Microstructure in Relapsing-Remitting Multiple Sclerosis. Brain Topogr 2021; 35:268-275. [PMID: 34807323 PMCID: PMC8860794 DOI: 10.1007/s10548-021-00881-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Laterality patterns of resting state networks (RSN) change in various neuropsychiatric conditions. Multiple sclerosis (MS) causes neuro-cognitive symptoms involving dysfunctional large-scale brain networks. Yet, whether healthy laterality patterns of RSNs are maintained in MS and whether altered laterality patterns explain disease symptoms has not been explicitly investigated. We analysed functional MRI and diffusion tensor imaging data from 24 relapsing–remitting MS patients and 25 healthy participants. We performed group-level independent component analysis and used dual regression to estimate individual versions of well-established RSNs. Voxelwise laterality indices were calculated for each RSN. Group differences were assessed via a general linear model-based approach. The relationship between functional laterality and white matter microstructural asymmetry was assessed using Tract-Based Spatial Statistics. Spearman’s correlation was calculated between laterality indices and Brief International Cognitive Assessment for Multiple Sclerosis scores. Functional laterality of the dorsal attention network showed a significant leftward shift in the MS group in the posterior intraparietal sulcus (p < 0.033). Default-mode network laterality showed a significant leftward shift in the MS group in the angular gyrus (p < 0.005). Diminished dorsal attention network laterality was associated with increased fractional anisotropy asymmetry in the superior longitudinal fasciculus (p < 0.02). In the default-mode network, leftward laterality of the angular gyrus was associated with higher BVMT-R scores (R = − 0.52, p < 0.023). Our results confirm previous descriptions of RSN dysfunction in relapsing–remitting MS and show that altered functional connectivity lateralisation patterns of RSNs might contibute to cognitive performance and structural remodellation even in patients with mild clinical symptoms.
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Affiliation(s)
- Dániel Veréb
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Márton Attila Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bence Bozsik
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Psychiatry, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Neuroimaging Research Group, Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Semmelweis u. 6, 6725, Hungary.
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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4
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Zhang J, Cortese R, De Stefano N, Giorgio A. Structural and Functional Connectivity Substrates of Cognitive Impairment in Multiple Sclerosis. Front Neurol 2021; 12:671894. [PMID: 34305785 PMCID: PMC8297166 DOI: 10.3389/fneur.2021.671894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023] Open
Abstract
Cognitive impairment (CI) occurs in 43 to 70% of multiple sclerosis (MS) patients at both early and later disease stages. Cognitive domains typically involved in MS include attention, information processing speed, memory, and executive control. The growing use of advanced magnetic resonance imaging (MRI) techniques is furthering our understanding on the altered structural connectivity (SC) and functional connectivity (FC) substrates of CI in MS. Regarding SC, different diffusion tensor imaging (DTI) measures (e.g., fractional anisotropy, diffusivities) along tractography-derived white matter (WM) tracts showed relevance toward CI. Novel diffusion MRI techniques, including diffusion kurtosis imaging, diffusion spectrum imaging, high angular resolution diffusion imaging, and neurite orientation dispersion and density imaging, showed more pathological specificity compared to the traditional DTI but require longer scan time and mathematical complexities for their interpretation. As for FC, task-based functional MRI (fMRI) has been traditionally used in MS to brain mapping the neural activity during various cognitive tasks. Analysis methods of resting fMRI (seed-based, independent component analysis, graph analysis) have been applied to uncover the functional substrates of CI in MS by revealing adaptive or maladaptive mechanisms of functional reorganization. The relevance for CI in MS of SC–FC relationships, reflecting common pathogenic mechanisms in WM and gray matter, has been recently explored by novel MRI analysis methods. This review summarizes recent advances on MRI techniques of SC and FC and their potential to provide a deeper understanding of the pathological substrates of CI in MS.
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Affiliation(s)
- Jian Zhang
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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5
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Lin WS, Lin SJ, Hsu TR. Cognitive Assessment and Rehabilitation for Pediatric-Onset Multiple Sclerosis: A Scoping Review. CHILDREN-BASEL 2020; 7:children7100183. [PMID: 33076220 PMCID: PMC7602453 DOI: 10.3390/children7100183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is increasingly recognized as an important clinical issue in pediatric multiple sclerosis (MS). However, variations regarding its assessment and remediation are noted in clinical arena. This scoping review aims to collate available evidence concerning cognitive assessment tool and cognitive rehabilitation for pediatric MS. We performed a systematic search of electronic databases (MEDLINE, PubMed, CINAHL Plus, and Web of Science) from inception to February 2020. Reference lists of included articles and trial registers were also searched. We included original studies published in English that addressed cognitive assessment tools or cognitive rehabilitation for pediatric-onset MS. Fourteen studies fulfilled our inclusion criteria. Among them, 11 studies evaluated the psychometric aspects of various cognitive assessment tools in the context of pediatric MS, and different neuro-cognitive domains were emphasized across studies. There were only three pilot studies reporting cognitive rehabilitation for pediatric-onset MS, all of which used home-based computerized programs targeting working memory and attention, respectively. Overall, more systematic research on cognitive assessment tools and rehabilitation for pediatric MS is needed to inform evidence-based practice. Computer-assisted cognitive assessment and rehabilitation appear feasible and deserve further studies.
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Affiliation(s)
- Wei-Sheng Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Correspondence:
| | - Shan-Ju Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan;
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan
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Prosperini L, Di Filippo M. Beyond clinical changes: Rehabilitation-induced neuroplasticity in MS. Mult Scler 2020; 25:1348-1362. [PMID: 31469359 DOI: 10.1177/1352458519846096] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neural plasticity represents the substrate by which the damaged central nervous system (CNS) re-learns lost behaviors in response to rehabilitation. In persons with multiple sclerosis (MS), rehabilitation can therefore exploit the potential of neural plasticity to restore CNS functions beyond the spontaneous mechanisms of recovery from MS-related damage. METHODS Here, we reviewed the currently available evidence on the occurrence of mechanisms of structural and functional plasticity following rehabilitation, motor, and/or cognitive training. We presented both data gained from basic laboratory research on animal models and data on persons with MS obtained by advanced magnetic resonance imaging (MRI) techniques. RESULTS Studies on physical and environmental enrichment in experimental MS models showed beneficial effects mediated by both immune modulation and activity-dependent plasticity, lowering tissue destruction and restoring of CNS network function. Translational researches in MS people demonstrated structural and/or functional MRI changes after various interventions, but their heterogeneity and small sample sizes (5-42 patients) raise concerns about the interpretation and generalization of the obtained results. DISCUSSION We highlighted the limitations of published studies, focusing on the knowledge gaps to be filled in terms of neuropathological correlations between changes detected in animal models and changes detected in vivo by neuroimaging.
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Affiliation(s)
- Luca Prosperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
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7
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Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nat Rev Neurol 2020; 16:319-332. [PMID: 32372033 DOI: 10.1038/s41582-020-0355-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade.
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8
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Oldrati V, Corti C, Poggi G, Borgatti R, Urgesi C, Bardoni A. Effectiveness of Computerized Cognitive Training Programs (CCTP) with Game-like Features in Children with or without Neuropsychological Disorders: a Meta-Analytic Investigation. Neuropsychol Rev 2020; 30:126-141. [PMID: 32112369 DOI: 10.1007/s11065-020-09429-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
Computerized cognitive training programs (CCTP) are based on the assumption that cognitive abilities may be boosted by repetitively performing challenging tasks. The integration of game-like features in these programs, associated with the goal of amusing or rewarding participants, may contribute to generate cognitive benefits. Indeed, reinforcement contingencies have been reported to produce positive effects on performance and motivation, especially in children. This meta-analysis was aimed at providing a quantitative summary of the effectiveness of CCTP with game-like features in school-aged children with typical and atypical development. A total of 24 studies, with the cognitive and behavioral outcome data of 1547 participants, were selected for inclusion in the meta-analysis. Subgroup analyses were performed to identify the sources of the observed methodological heterogeneity. A robust variance estimation model, after removal of study outliers, yielded a small-to-moderate significant effect size. Final results pointed out smaller but more precise estimate effect sizes according to methodological aspects related to cognitive domain of outcomes, standardization of measures and type of control applied. Alongside supporting the use of CCTP for rehabilitating cognitive functions, the present results shed light on how different methodological choices are able to shape research findings in the field of children's cognitive rehabilitation.
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Affiliation(s)
- Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy
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9
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Shahpouri MM, Barekatain M, Tavakoli M, Sanaei S, Shaygannejad V. Evaluation of cognitive rehabilitation on the cognitive performance in multiple sclerosis: A randomized controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 24:110. [PMID: 31949461 PMCID: PMC6950338 DOI: 10.4103/jrms.jrms_124_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/15/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
Background Multiple sclerosis (MS) can involve cognitive entities, including memory, attention, performance, and information processing. Furthermore, MS causes depression and negatively affects the quality of life (QOL). This study was aimed to assess the efficacy of cognitive rehabilitation on cognitive entities of MS patients. Materials and Methods This is a clinical trial study conducted on 56 MS patients in 2016-2017. Patients were randomly divided into two Groups of A (cognitive rehabilitation) and B (control group). Patients were evaluated in terms of memory, attention, QOL, and depression. Questionnaires included Abbreviated Mental Test, Prospective and Retrospective Memory Questionnaire, Everyday Memory Questionnaire, Digit Spam test for attention assessment, QOL-54 questionnaire, and Second version of Beck questionnaire assessing depression. They were filled through an interview before the study initiation, and then, the intervention group underwent ten sessions of cognitive rehabilitation and questionnaires refilled within 3 months after study initiation. Outcomes of the two groups were compared. Results Memory, attention, QOL, and depression improved significantly following the intervention in cases (P < 0.05), while no significant change was observed among controls (P > 0.05). Comparison of cases and controls in the second evaluation showed a significant difference between cases and controls (P < 0.05). Conclusion Ten sessions of cognitive rehabilitation could significantly improve MS patients' cognitive performance. Moreover, this approach affected their QOL and sense of depression in a decisive trend. It can be concluded that cognitive rehabilitation can successfully affect numerous aspects of MS patients, while numerous medical therapies may be required for treatment of each mere aspect. Further evaluations are strongly recommended.
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Affiliation(s)
- Mohammad Mahdi Shahpouri
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahgol Tavakoli
- Department of Psychology, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
| | - Shahin Sanaei
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus. CHILDREN-BASEL 2019; 6:children6020021. [PMID: 30720736 PMCID: PMC6406784 DOI: 10.3390/children6020021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is relatively rare, but as technology and neuroimaging advance, an increasing number of cases are identified, and our understanding of how multiple sclerosis (MS) impacts the developing brain improves. There are consistent findings in the literature highlighting the impact of MS and other demyelinating diseases on cognitive functioning and cognitive development. We also have a better understanding of how POMS impacts psychosocial functioning and functional outcomes in daily living. This paper hopes to review findings associated with cognitive and psychosocial functioning in patients with POMS, as well as explore more recent advances in the field and how they relate to cognitive and psychosocial outcomes. We also discuss the ongoing need for future studies with a focus on better understanding deficits and disease correlates, but also preventative measures and potential rehabilitation.
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11
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Rocca MA, Preziosa P, Filippi M. Application of advanced MRI techniques to monitor pharmacologic and rehabilitative treatment in multiple sclerosis: current status and future perspectives. Expert Rev Neurother 2018; 19:835-866. [PMID: 30500303 DOI: 10.1080/14737175.2019.1555038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Advances in magnetic resonance imaging (MRI) technology and analyses are improving our understanding of the pathophysiology of multiple sclerosis (MS). Due to their ability to grade the presence of irreversible tissue loss, microstructural tissue abnormalities, metabolic changes and functional plasticity, the application of these techniques is also expanding our knowledge on the efficacy and mechanisms of action of different pharmacological and rehabilitative treatments. Areas covered: This review discusses recent findings derived from the application of advanced MRI techniques to evaluate the structural and functional substrates underlying the effects of pharmacologic and rehabilitative treatments in patients with MS. Current applications as outcome in clinical trials and observational studies, their interpretation and possible pitfalls in their use are discussed. Finally, how these techniques could evolve in the future to improve monitoring of disease progression and treatment response is examined. Expert commentary: The number of treatments currently available for MS is increasing. The application of advanced MRI techniques is providing reliable and specific measures to better understand the targets of different treatments, including neuroprotection, tissue repair, and brain plasticity. This is a fundamental progress to move toward personalized medicine and individual treatment selection.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan , Italy
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12
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Tahedl M, Levine SM, Greenlee MW, Weissert R, Schwarzbach JV. Functional Connectivity in Multiple Sclerosis: Recent Findings and Future Directions. Front Neurol 2018; 9:828. [PMID: 30364281 PMCID: PMC6193088 DOI: 10.3389/fneur.2018.00828] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023] Open
Abstract
Multiple sclerosis is a debilitating disorder resulting from scattered lesions in the central nervous system. Because of the high variability of the lesion patterns between patients, it is difficult to relate existing biomarkers to symptoms and their progression. The scattered nature of lesions in multiple sclerosis offers itself to be studied through the lens of network analyses. Recent research into multiple sclerosis has taken such a network approach by making use of functional connectivity. In this review, we briefly introduce measures of functional connectivity and how to compute them. We then identify several common observations resulting from this approach: (a) high likelihood of altered connectivity in deep-gray matter regions, (b) decrease of brain modularity, (c) hemispheric asymmetries in connectivity alterations, and (d) correspondence of behavioral symptoms with task-related and task-unrelated networks. We propose incorporating such connectivity analyses into longitudinal studies in order to improve our understanding of the underlying mechanisms affected by multiple sclerosis, which can consequently offer a promising route to individualizing imaging-related biomarkers for multiple sclerosis.
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Affiliation(s)
- Marlene Tahedl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Seth M. Levine
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Mark W. Greenlee
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jens V. Schwarzbach
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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13
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Simone M, Viterbo RG, Margari L, Iaffaldano P. Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial. BMC Neurol 2018; 18:82. [PMID: 29884144 PMCID: PMC5992821 DOI: 10.1186/s12883-018-1087-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/31/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The treatment of cognitive deficits is challenging in pediatric onset multiple sclerosis (POMS) and in patients with attention deficit hyperactivity disorder (ADHD). We performed a pilot double-blind RCT to evaluate the efficacy of a home-based computerized-program for retraining attention in two cohorts of POMS and ADHD patients. METHODS POMS and ADHD patients failing in at least 2/4 attention tests on a neuropsychological battery were randomized to specific or nonspecific computerized training (ST, nST), performed in one-hour sessions, twice/week for 3 months. The primary outcome was the effect of the training on global neuropsychological performances measured by the cognitive impairment index (CII). The efficacy of the intervention was evaluated in each disease group by using repeated measures ANOVA. RESULTS Sixteen POMS (9 females, age 15.75 ± 1.74 years) and 20 ADHD (2 females, age 11.19 ± 2.49 years) patients were enrolled. In POMS patients the ST exposure was associated to a significantly more pronounced improvement of the CII (p < 0.0001) and on cognitive test exploring attention, concentration, planning strategies and visuo-spatial memory performances in comparison to nST exposure. In ADHD patients the difference between the ST and nST on the CII was not statistical significant (p = 0.06), but a greater effect of the ST was found only on cognitive test exploring attention and delayed recall of visuo-spatial memory performances. CONCLUSIONS Our data suggest that a cognitive rehabilitation program that targets attention is a suitable tool for improving global cognitive functioning in POMS patients, whereas it has a less pronounced transfer effect in ADHD patients. TRIAL REGISTRATION ClinicalTrials.gov; NCT03190902 ; registration date: June 15, 2017; retrospectively registered.
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Affiliation(s)
- Marta Simone
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Rosa Gemma Viterbo
- MS Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Bari, Piazza G. Cesare, 11, 70121 Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Pietro Iaffaldano
- MS Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, Bari, Piazza G. Cesare, 11, 70121 Bari, Italy
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14
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Rossignoli-Palomeque T, Perez-Hernandez E, González-Marqués J. Brain Training in Children and Adolescents: Is It Scientifically Valid? Front Psychol 2018; 9:565. [PMID: 29780336 PMCID: PMC5946581 DOI: 10.3389/fpsyg.2018.00565] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/04/2018] [Indexed: 01/14/2023] Open
Abstract
Background: Brain training products are becoming increasingly popular for children and adolescents. Despite the marketing aimed at their use in the general population, these products may provide more benefits for specific neurologically impaired populations. A review of Brain Training (BT) products analyzing their efficacy while considering the methodological limitations of supporting research is required for practical applications. Method: searches were made of the PubMed database (until March 2017) for studies including: (1) empirical data on the use of brain training for children or adolescents and any effects on near transfer (NT) and/or far transfer (FT) and/or neuroplasticity, (2) use of brain training for cognitive training purposes, (3) commercially available training applications, (4) computer-based programs for children developed since the 1990s, and (5) relevant printed and peer-reviewed material. Results: Database searches yielded a total of 16,402 references, of which 70 met the inclusion criteria for the review. We classified programs in terms of neuroplasticity, near and far transfer, and long-term effects and their applied methodology. Regarding efficacy, only 10 studies (14.2%) have been found that support neuroplasticity, and the majority of brain training platforms claimed to be based on such concepts without providing any supporting scientific data. Thirty-six studies (51.4%) have shown far transfer (7 of them are non-independent) and only 11 (15.7%) maintained far transfer at follow-up. Considering the methodology, 40 studies (68.2%) were not randomized and controlled; for those randomized, only 9 studies (12.9%) were double-blind, and only 13 studies (18.6%) included active controls in their trials. Conclusion: Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. There is a lack of double-blind randomized trials which include an active control group as well as a passive control to properly control for contaminant variables. Based on our results, Brain Training Programs as commercially available products are not as effective as first expected or as they promise in their advertisements.
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Affiliation(s)
- Teresa Rossignoli-Palomeque
- Department of Basic Psychology II, Complutense University of Madrid, Madrid, Spain.,Department of Psychology and Education, Centro Universitario Cardenal Cisneros, Alcalá de Henares, Madrid, Spain
| | - Elena Perez-Hernandez
- Department of Development and Educational Psychology, Autonomous University of Madrid, Madrid, Spain
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15
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Covey TJ, Shucard JL, Benedict RH, Weinstock-Guttman B, Shucard DW. Improved cognitive performance and event-related potential changes following working memory training in patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217317747626. [PMID: 29348927 PMCID: PMC5768274 DOI: 10.1177/2055217317747626] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/09/2017] [Indexed: 12/04/2022] Open
Abstract
Background Few studies of cognitive rehabilitation in multiple sclerosis (MS) have targeted working memory specifically. Objective We examined the effects of n-back working memory training on cognitive performance and brain function in patients with MS. Methods Patients with MS (n = 12) and healthy controls (HC; n = 12) underwent 20 sessions of n-back working memory training. Before and after training (pre- and posttest) cognitive event-related potential (ERP) measures were obtained during a 3-back task. In addition, a battery of cognitive tests was administered. Results Following n-back training, both MS patients and HCs showed significant improvement on tests of working memory, processing speed, complex attention, and reasoning ability. MS and HCs also exhibited an enhancement of N2 ERP component amplitude, and earlier N2 and P3 latencies, following n-back training. Conclusions Targeted training of working memory with the n-back task may improve cognitive function in MS. Enhancement of N2 ERP component amplitude and shorter N2 and P3 latency following training in patients with MS is consistent with plasticity of neural processes that are involved in working memory.
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Affiliation(s)
- Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.,Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Janet L Shucard
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.,Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Ralph Hb Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.,Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
| | - David W Shucard
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.,Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA
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16
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Till C, Kuni B, De Somma E, Yeh EA, Banwell B. A feasibility study of working memory training for individuals with paediatric-onset multiple sclerosis. Neuropsychol Rehabil 2017; 29:1177-1192. [PMID: 28920511 DOI: 10.1080/09602011.2017.1372786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To investigate the feasibility and experiences of paediatric-onset multiple sclerosis (MS) patients completing a working memory training programme. Methods: Nine paediatric-onset MS patients (mean age 19.3 ± 4.1 years) identified as having attention and/or working memory difficulties underwent a five-week (five days/week) internet-based working memory training programme (Cogmed™); weekly coaching was provided. Measures of adherence and tolerance were used to establish the feasibility of implementing computerised cognitive training. Qualitative experiences reported by the patients were analysed and factors that may modulate the effects of training were explored. Results: Six of the nine enrolled patients completed the programme within the recommended time, and all individuals, with the exception of one, were considered to tolerate the training well. Eight of the nine participants acknowledged that training was helpful in one or more ways. All but one participant reported improvements in working memory, although evidence for improvement on objective neuropsychological testing was limited. Lower normalised brain volume emerged as a potentially important variable in predicting extent of improvement on the training programme. Conclusion: Selected paediatric-onset MS patients can tolerate and complete an intensive cognitive rehabilitation programme. Future investigation of moderators of training effects and the stability of the findings over time is needed.
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Affiliation(s)
- Christine Till
- a Department of Psychology , York University , Toronto , Canada.,b Neurosciences and Mental Health Program, Research Institute , The Hospital for Sick Children , Toronto , Canada
| | - Bravina Kuni
- a Department of Psychology , York University , Toronto , Canada
| | - Elisea De Somma
- a Department of Psychology , York University , Toronto , Canada
| | - E Ann Yeh
- b Neurosciences and Mental Health Program, Research Institute , The Hospital for Sick Children , Toronto , Canada.,c Department of Neurology , The Hospital for Sick Children , Toronto , Canada
| | - Brenda Banwell
- b Neurosciences and Mental Health Program, Research Institute , The Hospital for Sick Children , Toronto , Canada.,d Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , USA
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17
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Ghezzi A, Baroncini D, Zaffaroni M, Comi G. Pediatric versus adult MS: similar or different? ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40893-017-0022-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Vacchi L, Rocca MA, Meani A, Rodegher M, Martinelli V, Comi G, Falini A, Filippi M. Working memory network dysfunction in relapse-onset multiple sclerosis phenotypes: A clinical-imaging evaluation. Mult Scler 2016; 23:577-587. [PMID: 27354020 DOI: 10.1177/1352458516656809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated clinical, behavioural and functional magnetic resonance imaging (fMRI) correlates of working memory load in relapse-onset multiple sclerosis (MS) patients. METHODS In total, 12 clinically isolated syndromes (CIS) patients at risk of MS, 38 relapsing-remitting multiple sclerosis (RRMS), 22 secondary progressive multiple sclerosis (SPMS) and 24 healthy controls (HC) performed an N-back fMRI task. Correlations between fMRI abnormalities and clinico-behavioural and structural magnetic resonance imaging (MRI) measures were assessed. RESULTS Participants activated brain regions of the working memory network, especially in fronto-parietal lobes and cerebellum, and deactivated areas of the default mode network (DMN). During the N-back load contrast, compared to HC, the three groups of MS patients had a common pattern of decreased activation of the right superior parietal lobule, left inferior parietal lobule and left middle frontal gyrus. Areas specifically more active in CIS patients compared to the other study groups were found in the left medial superior frontal gyrus and right anterior cingulate cortex, whereas SPMS patients selectively activated the left parahippocampal gyrus and left superior temporal pole (STP). Worse accuracy and global cognitive scores correlated with increased STP activation. CONCLUSION Load-dependent alterations of working memory network recruitment occur in MS. Frontal hyperactivation is maintained in CIS and lost in SPMS. Abnormal recruitment of DMN areas is related to worse cognitive and behavioural outcomes.
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Affiliation(s)
- Laura Vacchi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mariaemma Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vittorio Martinelli
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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19
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Adamski N, Adler M, Opwis K, Penner IK. A pilot study on the benefit of cognitive rehabilitation in Parkinson's disease. Ther Adv Neurol Disord 2016; 9:153-64. [PMID: 27134671 DOI: 10.1177/1756285616628765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Patients with Parkinson's disease (PD) show inefficiencies in cognitive performance including working memory functions. Since these problems impact on quality of life and overall well-being, the current study was aimed at improving patients' situations by evaluating the computerized cognitive training tool, BrainStim. METHOD A total of 19 healthy controls (HCs) and six patients with PD were included in the study. While all PD patients received cognitive training, the HC sample was subdivided into 12 subjects with training (HC-T) and 10 subjects without (HC-NT). Participants underwent a double baseline assessment, a post-training assessment, and a 3-month follow up on neuropsychological tests and self-report measures on fatigue and depression. Training was administered between the second baseline and postassessment. It comprised 16 supervised sessions according to a standardized training protocol over 4 weeks. RESULTS Significant improvements in verbal and visuospatial short-term and long-term memory were found in both training groups. In addition, the HC-T improved on mental speed, and verbal and visuospatial working memory. Both training groups showed stable results for all short-term visuospatial measures after 3 months. Further, the HC-T showed stable results for working memory, verbal, and visuospatial short-term and long-term memory. CONCLUSIONS The efficacy of the applied computerized cognitive training tool BrainStim could be verified in patients with PD and healthy age-matched controls. The preliminary findings highlighted the suitability of a specific cognitive intervention to improve cognitive inefficiencies in patients with PD as well as in healthy older people. Further research on cognitive training in combination with PD drug therapy is needed to better understand the mutual interaction and to offer optimal therapeutic approaches to patients.
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Affiliation(s)
- Natalia Adamski
- Department of Cognitive Psychology and Methodology, University of Basel, Switzerland
| | - Matthias Adler
- Department of Cognitive Psychology and Methodology, University of Basel, Switzerland
| | - Klaus Opwis
- Department of Cognitive Psychology and Methodology, University of Basel, Switzerland
| | - Iris-Katharina Penner
- COGITO Center for Applied Neurocognition and Neuropsychological Research and Neurology Department, University Hospital, Merowingerplatz 1, 40225 Düsseldorf, Germany
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Enzinger C, Pinter D, Rocca MA, De Luca J, Sastre-Garriga J, Audoin B, Filippi M. Longitudinal fMRI studies: Exploring brain plasticity and repair in MS. Mult Scler 2015; 22:269-78. [DOI: 10.1177/1352458515619781] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/04/2015] [Indexed: 11/17/2022]
Abstract
Functional magnetic resonance imaging (fMRI) has greatly advanced our understanding of cerebral functional changes occurring in patients with multiple sclerosis (MS). However, most of our knowledge regarding brain plasticity and repair in MS as evidenced by fMRI has been extrapolated from cross-sectional studies across different phenotypes of the disease. This topical review provides an overview of this research, but also highlights limitations of existing fMRI studies with cross-sectional design. We then review the few existing longitudinal fMRI studies and discuss the feasibility and constraints of serial fMRI in individuals with MS. We further emphasize the potential to track fMRI changes in evolving disease and the insights this may give in terms of mechanisms of adaptation and repair, focusing on serial fMRI to monitor response to disease-modifying therapies or rehabilitation interventions. Finally, we offer recommendations for designing future research studies to overcome previous methodological shortcomings.
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Affiliation(s)
- Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Maria A Rocca
- Neuroimaging Research Unit and Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - John De Luca
- Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bertrand Audoin
- Aix-Marseille University, National Center for Scientific Research, Center for Magnetic Resonance in Biology and Medicine UMR 7339; Department of Neurology and Clinical Neurosciences, Timone University Hospital, Marseille, France
| | - Massimo Filippi
- Neuroimaging Research Unit and Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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