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Natsheh JY, DeLuca J, Costa SL, Chiaravalloti ND, Dobryakova E. Methylphenidate may improve mental fatigue in individuals with multiple sclerosis: A pilot clinical trial. Mult Scler Relat Disord 2021; 56:103273. [PMID: 34564057 DOI: 10.1016/j.msard.2021.103273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fatigue is the most common symptom in multiple sclerosis (MS), previously attributed to dopamine imbalance. Evidence suggests that methylphenidate, a psychostimulant that increases striatal and prefrontal dopamine levels, is effective in reducing fatigue in various disorders. However, its effect on state vs. trait mental fatigue in MS is yet to be examined. METHODS This pilot study investigates the efficacy of methylphenidate on decreasing self-reported mental fatigue in 12 individuals with MS in a double-blind, placebo-controlled, cross-over randomized clinical trial. RESULTS Our results show that "state", but not "trait" MS-related fatigue, was reduced after 4 weeks of methylphenidate administration as compared to placebo.
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Affiliation(s)
- J Y Natsheh
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Children's Specialized Hospital Research Center, New Brunswick, NJ, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA; Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine.
| | - J DeLuca
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - S L Costa
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - N D Chiaravalloti
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - E Dobryakova
- Kessler Foundation, 120 Eagle Rock Ave, Suite 100, East Hanover, NJ 07936, USA; Departments of Physical Medicine and Rehabilitation; and Neurology, Rutgers, New Jersey Medical School, Newark, NJ, USA.
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Wylie GR, Genova H, Dobryakova E, DeLuca J, Chiaravalloti N, Falvo M, Cook D. Fatigue in Gulf War Illness is associated with tonically high activation in the executive control network. Neuroimage Clin 2018; 21:101641. [PMID: 30558870 PMCID: PMC6411905 DOI: 10.1016/j.nicl.2018.101641] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/06/2018] [Accepted: 12/09/2018] [Indexed: 11/21/2022]
Abstract
Gulf War Illness (GWI) is a chronic, multi-symptom illness that affects approximately 25% of Gulf veterans, with cognitive fatigue as one of its primary symptoms. Here, we investigated the neural networks associated with cognitive fatigue in GWI by asking 35 veterans with GWI and 25 healthy control subjects to perform a series of fatiguing tasks while in the MRI scanner. Two types of cognitive fatigue were assessed: state fatigue, which is the fatigue that developed as the tasks were completed, and trait fatigue, or one's propensity to experience fatigue when assessed over several weeks. Our results showed that the neural networks associated with state and trait fatigue differed. Irrespective of group, the network underlying trait fatigue included areas associated with memory whereas the neural network associated with state fatigue included key areas of a fronto-striatal-thalamic circuit that has been implicated in fatigue in other populations. As in other investigations of fatigue, the caudate of the basal ganglia was implicated in fatigue. Furthermore, individuals with GWI showed greater activation than the HC group in frontal and parietal areas for the less difficult task. This suggests that an inability to modulate brain activation as task demands change may underlie fatigue in GWI. Fatigue-related brain activation can be induced and measured in veterans with GWI. A network of brain areas was associated with cognitive fatigue during a working memory task. The fatigue network included the basal ganglia, prefrontal and parietal areas. Persistent activation in frontal and parietal areas in the GWI group suggests dysregulation of the cognitive control network.
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Affiliation(s)
- G R Wylie
- The Department of Veterans' Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange Campus, East Orange, NJ 07018, United States; Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States.
| | - H Genova
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States
| | - E Dobryakova
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States
| | - J DeLuca
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Neurology, Newark, NJ 07101, United States
| | - N Chiaravalloti
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States
| | - M Falvo
- The Department of Veterans' Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange Campus, East Orange, NJ 07018, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Physical Medicine & Rehabilitation, Newark, NJ 07101, United States; Rutgers New Jersey Medical School, Rutgers University, Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Newark, NJ 07101, United States
| | - D Cook
- The Department of Veterans' Affairs, Research Service, William S Middleton Memorial Veterans Hospital, Madison, WI 53705, United States; University of Wisconsin, Department of Kinesiology, Madison, WI 53706, United States
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Wylie GR, Dobryakova E, DeLuca J, Chiaravalloti N, Essad K, Genova H. Cognitive fatigue in individuals with traumatic brain injury is associated with caudate activation. Sci Rep 2017; 7:8973. [PMID: 28827779 PMCID: PMC5567054 DOI: 10.1038/s41598-017-08846-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/18/2017] [Indexed: 01/09/2023] Open
Abstract
We investigated differences in brain activation associated with cognitive fatigue between persons with traumatic brain injury (TBI) and healthy controls (HCs). Twenty-two participants with moderate-severe TBI and 20 HCs performed four blocks of a difficult working memory task and four blocks of a control task during fMRI imaging. Cognitive fatigue, assessed before and after each block, was used as a covariate to assess fatigue-related brain activation. The TBI group reported more fatigue than the HCs, though their performance was comparable. Regarding brain activation, the TBI group showed a Task X Fatigue interaction in the caudate tail resulting from a positive correlation between fatigue and brain activation for the difficult task and a negative relationship for the control task. The HC group showed the same Task X Fatigue interaction in the caudate head. Because we had prior hypotheses about the caudate, we performed a confirmatory analysis of a separate dataset in which the same subjects performed a processing speed task. A relationship between Fatigue and brain activation was evident in the caudate for this task as well. These results underscore the importance of the caudate nucleus in relation to cognitive fatigue.
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Affiliation(s)
- G R Wylie
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA. .,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA. .,The War Related Illness and Injury Study Center, The Department of Veterans' Affairs, New Jersey Healthcare System, East Orange Campus, East Orange, NJ, 07018, USA.
| | - E Dobryakova
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - J DeLuca
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA.,Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - N Chiaravalloti
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - K Essad
- Dartmouth College, Dartmouth College Medical School, Hanover, NH, 03755, USA
| | - H Genova
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
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Huiskamp M, Dobryakova E, Wylie GD, DeLuca J, Chiaravalloti ND. A pilot study of changes in functional brain activity during a working memory task after mSMT treatment: The MEMREHAB trial. Mult Scler Relat Disord 2016; 7:76-82. [PMID: 27237764 PMCID: PMC4886276 DOI: 10.1016/j.msard.2016.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/08/2016] [Accepted: 03/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Working memory deficits are common in multiple sclerosis (MS). The modified Story Memory Technique (mSMT) has been shown to improve new learning and memory in MS, but its effects on working memory (WM) are currently unknown. OBJECTIVE The present study presents a secondary analysis of data from a larger double-blind, placebo-controlled, randomized clinical trial and examines changes in cerebral activation on a WM task following mSMT treatment. METHODS Sixteen participants with clinically definite MS were randomly assigned to treatment (n=7) or placebo-control groups (n=9) matched for gender, age and education. Baseline and immediate follow-up functional Magnetic Resonance Imaging (fMRI) was obtained for all subjects. During fMRI participants completed an N-back task, consisting of 0-, 1-and 2-back conditions. RESULTS Significant increases in cerebral activation were noted in the dorsolateral prefrontal cortex, supplementary motor area and inferior parietal lobule at follow-up in the treatment group. No significant changes were noted in the placebo control group. CONCLUSION Due to the small sample size, results of the current study should be interpreted as preliminary. However, the observed pattern of activation of the frontoparietal network involved in WM found in the treatment group, suggests that mSMT training increases recruitment of attention- and WM-related neural networks. We conclude that mSMT treatment leads to changes in WM-related cerebral activation.
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Affiliation(s)
- M Huiskamp
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States
| | - E Dobryakova
- Traumatic Brain Injury Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, United States
| | - G D Wylie
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, United States
| | - J DeLuca
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Traumatic Brain Injury Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, United States; Department of Neurosciences, Rutgers - New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101, United States
| | - N D Chiaravalloti
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Traumatic Brain Injury Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, United States; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, United States.
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