Functional cortical changes of the sensorimotor network are associated with clinical recovery in multiple sclerosis

Mezzapesa, Domenico Maria; Rocca, Maria A.; Rodegher, Mariaemma; Comi, Giancarlo; Filippi, Massimo

doi:10.1002/hbm.20418

Cited by 84 publications

(73 citation statements)

References 44 publications

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“…The concept that over-recruitment of a given network might represent a negative prognostic factor for subsequent clinical evolution is also supported by studies on stroke patients [Calautti and Baron, 2003] and MS patients with previous motor relapses [Mezzapesa et al, 2008], in whom a persistent over-activation of the undamaged cerebral hemisphere has been associated with an absent or only poor clinical recovery.…”

Section: Discussionmentioning

confidence: 94%

Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?

Rocca¹,

Absinta²,

Ghezzi³

et al. 2008

Human Brain Mapping

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We evaluated the functional magnetic resonance imaging (fMRI) correlates of simple movement performance in patients with pediatric multiple sclerosis (MS) and their relation with the extent of T2 lesion volume (LV), to improve our understanding of the mechanisms leading to their short/medium term favorable clinical course. We obtained fMRI during repetitive flexion-extension of the last four fingers of the right hand and brain dual-echo scans from 17 right-handed patients with pediatric relapsing-remitting MS and 9 sex- and age-matched right-handed healthy controls. T2 LV was measured using a local thresholding segmentation technique. fMRI activations and functional connectivity analysis were performed using SPM2. Compared to controls, pediatric MS patients had an increased recruitment of the left (L) primary sensorimotor cortex (SMC). They also showed reduced functional connectivity between the L primary SMC and the L thalamus (P = 0.03), the L insula and the L secondary sensorimotor cortex (SII) (P = 0.02), the supplementary motor area and the L SII (P = 0.02), the L thalamus and the L insula (P = 0.01) and the L thalamus and the L SII (P = 0.003). In patients with pediatric MS, the activity of the L primary SMC was significantly correlated with brain T2 LV (r = 0.78). No correlation was found between coefficients of abnormal connectivity and structural MRI measures. The maintenance of a selective and strictly lateralized pattern of movement-associated brain activations and a modulation of its functional connections suggest a preserved functional reserve in patients with pediatric MS, which, in turn, might contribute to explain their favorable clinical evolution at short/medium term.

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Section: Discussionmentioning

confidence: 94%

Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?

Rocca¹,

Absinta²,

Ghezzi³

et al. 2008

Human Brain Mapping

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“…In patients with MS, lesions in one area of the brain lead to recruitment of other areas of the brain to carry out tasks. 24 Whether there is remodeling of bladder sensory and motor function after neurological injury is not known. Activation of centers outside of those seen in neurologically intact controls could lead to differences in response to standard drug therapies and may provide opportunities for novel therapies in these patients.…”

Section: Imaging Of Upper Tracts In Patients With Bladder Dysfunctionmentioning

confidence: 99%

Neurological patients need evidence‐based urological care

Wyndaele

Bruschini

Madersbacher

et al. 2010

Neurourology and Urodynamics

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“…4 Although the role of cortical reorganization on the clinical manifestations of MS remains to be established, such correlations suggest that an increased recruitment of "critical" cortical networks might contribute to limiting the functional impact of MS-related damage. This hypothesis is supported by the results of a longitudinal study that assessed cortical changes following acute motor relapses secondary to pseudotumoral lesions in 12 patients with MS. 71 Short-term cortical changes were characterized by the recruitment of pathways in the unaffected hemisphere. A recovery of function of the primary SMC of the affected hemisphere was found in patients with good clinical improvement, while patients without or only a poor clinical recovery showed a persistent recruitment of the primary SMC of the unaffected hemisphere.…”

Section: Cortical Reorganizationmentioning

confidence: 99%

MR Imaging of Gray Matter Involvement in Multiple Sclerosis: Implications for Understanding Disease Pathophysiology and Monitoring Treatment Efficacy

Filippi

Rocca²

2009

AJNR Am J Neuroradiol

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SUMMARY: Recent pathologic and MR imaging studies have challenged the classic view of MS as a chronic inflammatory-demyelinating condition affecting solely the WM of the central nervous system. Indeed, an involvement of the GM has been shown to occur from the early stages of the disease, to progress with time, and to be only moderately correlated with the extent of WM injury. In this review, we summarize how advances in MR imaging technology and methods of analysis are contributing to ameliorating the detection of focal lesions and to quantifying the extent of "occult" pathology and atrophy, as well as to defining the topographic distribution of such changes in the GM of patients with MS. These advances, combined with the imaging of brain reorganization occurring after tissue injury, should ultimately result in an improved understanding and monitoring of MS clinical manifestations and evolution, either natural or modified by treatment.ABBREVIATIONS: Cereb ϭ cerebellum; Cho ϭ choline; CIS ϭ clinically isolated syndromes; DIR ϭ double inversion recovery; DTI ϭ diffusion tensor imaging; EDSS ϭ Expanded Disability Status Scale; FA ϭ fractional anisotropy; FLAIRϭ fluid-attenuated inversion recovery; fMRI ϭ functional MR imaging; GM ϭ gray matter; L ϭ left; MD ϭ mean diffusivity; MS ϭ multiple sclerosis; MT ϭ magnetization transfer; MTR ϭ magnetization transfer ratio; NAA ϭ N-acetylaspartate; NAWM ϭ normal-appearing white matter; PM ϭ premotor cortex; PPMS ϭ primary-progressive MS; R ϭ right; RRMS ϭ relapsing-remitting MS; RT ϭ relaxation time; SII ϭ secondary sensorimotor cortex; SMA ϭ supplementary motor area; SMC ϭ sensorimotor cortex; SPM ϭ statistical parametric mapping; SPMS ϭ secondary-progressive MS; Thal ϭ thalamus; WM ϭ white matter P athologic and MR imaging studies are challenging the view of MS as a chronic inflammatory-demyelinating condition affecting solely the WM of the central nervous system. Indeed, there is a growing body of evidence showing that a significant portion of MS-related damage affects virtually all the GM structures. Pathologically, cortical lesions have been distinguished in mixed WM-GM lesions (type I) and purely intracortical lesions (types II, III, and IV).1 The latter may represent more than two-thirds of macroscopic cortical pathology in the disease, 1 and the extent of cortical demyelination can exceed that occurring in the WM.1 Demyelination is seen not only in the neocortex (especially in the cingulate cortex) 1,2 but also in the GM of the thalamus, basal ganglia, hypothalamus, hippocampus, cerebellum, and spinal cord. Compared with WM lesions, GM lesions are characterized by a much milder lymphocytic infiltration, less microglial activation, and fewer perivascular cuffs.3 GM lesions also lack complement deposition and have only a modest increase in bloodbrain barrier permeability.2 In MS, GM pathology also includes neuronal injury, with neuritic swelling as well as dendritic and axonal transections.2 In addition to focal lesions, wallerian and trans-synaptic degeneration of fi...

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Functional cortical changes of the sensorimotor network are associated with clinical recovery in multiple sclerosis

Abstract: Pseudotumoral MS lesions affecting the motor system can determine short-term cortical changes characterized by the recruitment of pathways in the unaffected hemisphere. The regain of function of motor areas of the affected hemisphere seems to be a critical factor for a favorable recovery.

Cited by 84 publications

References 44 publications

Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?

Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?

Neurological patients need evidence‐based urological care

MR Imaging of Gray Matter Involvement in Multiple Sclerosis: Implications for Understanding Disease Pathophysiology and Monitoring Treatment Efficacy

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