A transcranial magnetic stimulation study evaluating methylprednisolone treatment in multiple sclerosis

Fierro, Brigida; Salemi, Giuseppe; Brighina, Filippo; Buffa, D; Conte, Stella; Bua, Vincenzo; Piazza, Aurelio; Savettieri, Giovanni

doi:10.1034/j.1600-0404.2002.1o369.x

Cited by 38 publications

(26 citation statements)

References 25 publications

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“…Considering the simplicity and the clinical applicability of our MEP study, further investigations of a larger group of patients seems justified. In our opinion, in clinical trial testing, it would be worth including MEP as a functional marker of therapeutic efficacy in MS using not only the CMCT [18] but also amplitude/ area parameters. In addition, prospective studies can be designed to test the hypothesis that MEP amplitudes and areas may contribute to predict, in a multiparametric approach, the occurrence of disability in the ongoing years of disease (prediction of disability and/or MRI evolution), particularly in those subjects who currently are without disability or with mild/moderate disability, and therefore in a potentially reversible period of the pathogenetic process.…”

Section: Discussionmentioning

confidence: 99%

Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities

et al. 2007

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We used Motor Evoked Potentials (MEPs), elicited by transcranial magnetic stimulation, for assessing a motor pathways dysfunction in a selected group of Multiple Sclerosis (MS) patients, without limitation in walking. We selected 32 Relapsing Remitting MS patients, in remission phase, with EDSS < or = 3.5 and 20 healthy individuals with similar height and age distribution. We measured the following MEP parameters: motor thresholds; central motor conduction time (CMCT); amplitude and area, both expressed as MEP/CMAP ratio. Patients were divided into two groups according to the EDSS score: non-disabled group (ND; EDSS 0-1.5) and disabled group (D; EDSS 2-3.5). Mean average MEP values were significantly different in the patients compared with the controls. Even in MS patients with no or minor neurological signs (ND group), MEP parameters showed differences from controls and furthermore all MEP parameters were significantly different in the D group compared with the ND group. The 75% of the patients had an amplitude or area alteration; this percentage was significantly higher than the percentage of patients with a CMCT alteration (56.2%). In addition, CMCT increase was always associated with reduced amplitude and area, but amplitude and area alterations were present also in patients with normal CMCT. In early stages of MS, the higher percentage shown in alteration of MEP amplitudes and areas as opposed to CMCTs has not previously been highlighted in the literature. Independently of its pathogenesis (demyelination or axonal loss), the amplitude or area decrease should be considered in clinical trials and in follow-up studies, as a marker of the motor pathways dysfunction, at least as much as CMCT increase.

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Section: Discussionmentioning

confidence: 99%

Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities

et al. 2007

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“…A recent neuropathological study identified four different types of demyelinating lesions (immunopatterns I-IV) with intraindividual homogeneity but interindividual heterogeneity, suggesting different pathologic mechanisms that lead to a final common pathway of demyelinating lesions disseminated in time and space. [1][2][3][4][5][6] Clinical evaluation and neurological examination, MRI, cerebrospinal fluid (CSF) testing and evoked potentials (EP) are among the methods used for disease diagnosis and monitoring in MS. [7][8][9] To date there are no established markers of disease progression or prognosis.…”

Section: Introductionmentioning

confidence: 99%

Correlation between disability and transcranial magnetic stimulation abnormalities in patients with multiple sclerosis

Kale

Agaoglu

Onder

et al. 2009

Journal of Clinical Neuroscience

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“…Studies using transcranial magnetic stimulation (TMS) have repeatedly reported white-matter involvement in patients with MS as documented by the prolonged central motor conduction time (CMCT). Even though a prolonged CMCT can differentiate patients with secondary progressive MS (SPMS) from those with relapsing-remitting MS (RRMS) [16], changes in CMCT rarely correlate with the severity of motor symptoms or with improved motor function after corticosteroid therapy [10,16,20]. Paired-pulse TMS provides information on mechanisms of motor cortical inhibition and facilitation [1,2,6,7,21,32].…”

Section: Introductionmentioning

confidence: 99%

Intracortical excitability in patients with relapsing–remitting and secondary progressive multiple sclerosis

et al. 2009

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We designed this study to investigate possible correlations between variables measuring primary motor cortex excitability detected by single and paired-pulse transcranial magnetic stimulation (TMS) and the severity of clinical manifestations in patients with multiple sclerosis (MS). Thirty patients with MS in remission, 16 with relapsing-remitting (RR), 14 with secondary progressive disease (SP) and 17 healthy subjects participated in the study. In each subject, the central motor conduction time (CMCT) was calculated, and single-pulse and paired-pulse TMS at 3 and 10 ms interstimulus intervals was delivered over the primary motor cortex of the dominant hemisphere to measure the amplitude of motor-evoked potentials (MEPs), motor threshold (MTh), intracortical inhibition (ICI) and facilitation (ICF). Correlations were determined between the patients' TMS findings and magnetic resonance imaging (MRI) (lesion load) and clinical features (expanded disability status scale, EDSS score). EDSS scores were significantly higher in SPMS than in RRMS patients. The MTh was significantly higher, and the MEP was significantly smaller in SPMS patients than in RRMS patients and control subjects. All patients had longer CMCTs than healthy subjects. In all patients, paired-pulse TMS elicited an inhibited test MEP at the 3-ms ISI and a facilitated test MEP at the 10 ms ISI. Post hoc analysis showed that ICI was significantly lower in SPMS patients than in those with RRMS and healthy subjects. EDSS scores correlated significantly with TMS measures (MEP, ICI, CMCT and MTh), but not with MRI lesion load. It was found that intracortical excitability as measured with TMS differs according to the clinical course of MS; it remains normal in patients with low EDSS scores and is altered in patients with high EDSS scores.

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A transcranial magnetic stimulation study evaluating methylprednisolone treatment in multiple sclerosis

Abstract: The dose of 2 g/day of IVMP is more effective in MS relapse.

Cited by 38 publications

References 25 publications

Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities

Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities

Correlation between disability and transcranial magnetic stimulation abnormalities in patients with multiple sclerosis

Intracortical excitability in patients with relapsing–remitting and secondary progressive multiple sclerosis

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