Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG
Motor fatigue is one of the most common symptoms in multiple sclerosis (MS) patients. Previous studies suggested that increased motor fatigue in MS may arise at the central nervous system level. However, the mechanisms underlying central motor fatigue in MS are still unclear.This paper investigated...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | Neurobiology of Disease |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0969996123000876 |
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| author | Giorgio Leodori Marco Mancuso Davide Maccarrone Matteo Tartaglia Antonio Ianniello Francesco Certo Viola Baione Gina Ferrazzano Leonardo Malimpensa Daniele Belvisi Carlo Pozzilli Alfredo Berardelli Antonella Conte |
| author_facet | Giorgio Leodori Marco Mancuso Davide Maccarrone Matteo Tartaglia Antonio Ianniello Francesco Certo Viola Baione Gina Ferrazzano Leonardo Malimpensa Daniele Belvisi Carlo Pozzilli Alfredo Berardelli Antonella Conte |
| author_sort | Giorgio Leodori |
| collection | DOAJ |
| description | Motor fatigue is one of the most common symptoms in multiple sclerosis (MS) patients. Previous studies suggested that increased motor fatigue in MS may arise at the central nervous system level. However, the mechanisms underlying central motor fatigue in MS are still unclear.This paper investigated whether central motor fatigue in MS reflects impaired corticospinal transmission or suboptimal primary motor cortex (M1) output (supraspinal fatigue). Furthermore, we sought to identify whether central motor fatigue is associated with abnormal M1 excitability and connectivity within the sensorimotor network.Twenty-two patients affected by relapsing-remitting MS and 15 healthy controls (HCs) performed repeated blocks of contraction at different percentages of maximal voluntary contraction with the right first dorsal interosseus muscle until exhaustion. Peripheral, central, and supraspinal components of motor fatigue were quantified by a neuromuscular assessment based on the superimposed twitch evoked by peripheral nerve and transcranial magnetic stimulation (TMS). Corticospinal transmission, excitability and inhibition during the task were tested by measurement of motor evoked potential (MEP) latency, amplitude, and cortical silent period (CSP). M1 excitability and connectivity was measured by TMS-evoked electroencephalography (EEG) potentials (TEPs) elicited by M1 stimulation before and after the task.Patients completed fewer blocks of contraction and showed higher values of central and supraspinal fatigue than HCs. We found no MEP or CSP differences between MS patients and HCs. Patients showed a post-fatigue increase in TEPs propagation from M1 to the rest of the cortex and in source-reconstructed activity within the sensorimotor network, in contrast to the reduction observed in HCs. Post-fatigue increase in source-reconstructed TEPs correlated with supraspinal fatigue values.To conclude, MS-related motor fatigue is caused by central mechanisms related explicitly to suboptimal M1 output rather than impaired corticospinal transmission. Furthermore, by adopting a TMS-EEG approach, we proved that suboptimal M1 output in MS patients is associated with abnormal task-related modulation of M1 connectivity within the sensorimotor network. Our findings shed new light on the central mechanisms of motor fatigue in MS by highlighting a possible role of abnormal sensorimotor network dynamics. These novel results may point to new therapeutical targets for fatigue in MS. |
| first_indexed | 2024-04-09T18:09:17Z |
| format | Article |
| id | doaj.art-b4449874a10843598f4fa57d598a1486 |
| institution | Directory Open Access Journal |
| issn | 1095-953X |
| language | English |
| last_indexed | 2024-04-09T18:09:17Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Neurobiology of Disease |
| spelling | doaj.art-b4449874a10843598f4fa57d598a14862023-04-14T04:18:43ZengElsevierNeurobiology of Disease1095-953X2023-05-01180106073Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEGGiorgio Leodori0Marco Mancuso1Davide Maccarrone2Matteo Tartaglia3Antonio Ianniello4Francesco Certo5Viola Baione6Gina Ferrazzano7Leonardo Malimpensa8Daniele Belvisi9Carlo Pozzilli10Alfredo Berardelli11Antonella Conte12IRCCS Neuromed, Pozzilli (IS), Pozzilli 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy; Multiple Sclerosis Center, S. Andrea Hospital, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyIRCCS Neuromed, Pozzilli (IS), Pozzilli 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy; Multiple Sclerosis Center, S. Andrea Hospital, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome 00185, ItalyIRCCS Neuromed, Pozzilli (IS), Pozzilli 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, ItalyIRCCS Neuromed, Pozzilli (IS), Pozzilli 86077, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy; Corresponding author at: Department of Human Neurosciences, Sapienza, University of Rome, Viale dell'Università, 30, Rome 00185, Italy.Motor fatigue is one of the most common symptoms in multiple sclerosis (MS) patients. Previous studies suggested that increased motor fatigue in MS may arise at the central nervous system level. However, the mechanisms underlying central motor fatigue in MS are still unclear.This paper investigated whether central motor fatigue in MS reflects impaired corticospinal transmission or suboptimal primary motor cortex (M1) output (supraspinal fatigue). Furthermore, we sought to identify whether central motor fatigue is associated with abnormal M1 excitability and connectivity within the sensorimotor network.Twenty-two patients affected by relapsing-remitting MS and 15 healthy controls (HCs) performed repeated blocks of contraction at different percentages of maximal voluntary contraction with the right first dorsal interosseus muscle until exhaustion. Peripheral, central, and supraspinal components of motor fatigue were quantified by a neuromuscular assessment based on the superimposed twitch evoked by peripheral nerve and transcranial magnetic stimulation (TMS). Corticospinal transmission, excitability and inhibition during the task were tested by measurement of motor evoked potential (MEP) latency, amplitude, and cortical silent period (CSP). M1 excitability and connectivity was measured by TMS-evoked electroencephalography (EEG) potentials (TEPs) elicited by M1 stimulation before and after the task.Patients completed fewer blocks of contraction and showed higher values of central and supraspinal fatigue than HCs. We found no MEP or CSP differences between MS patients and HCs. Patients showed a post-fatigue increase in TEPs propagation from M1 to the rest of the cortex and in source-reconstructed activity within the sensorimotor network, in contrast to the reduction observed in HCs. Post-fatigue increase in source-reconstructed TEPs correlated with supraspinal fatigue values.To conclude, MS-related motor fatigue is caused by central mechanisms related explicitly to suboptimal M1 output rather than impaired corticospinal transmission. Furthermore, by adopting a TMS-EEG approach, we proved that suboptimal M1 output in MS patients is associated with abnormal task-related modulation of M1 connectivity within the sensorimotor network. Our findings shed new light on the central mechanisms of motor fatigue in MS by highlighting a possible role of abnormal sensorimotor network dynamics. These novel results may point to new therapeutical targets for fatigue in MS.http://www.sciencedirect.com/science/article/pii/S0969996123000876Neuromuscular assessmentMotor cortexCorticospinal tractTranscranial magnetic stimulation-electroencephalographyMotor fatigue |
| spellingShingle | Giorgio Leodori Marco Mancuso Davide Maccarrone Matteo Tartaglia Antonio Ianniello Francesco Certo Viola Baione Gina Ferrazzano Leonardo Malimpensa Daniele Belvisi Carlo Pozzilli Alfredo Berardelli Antonella Conte Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG Neurobiology of Disease Neuromuscular assessment Motor cortex Corticospinal tract Transcranial magnetic stimulation-electroencephalography Motor fatigue |
| title | Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG |
| title_full | Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG |
| title_fullStr | Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG |
| title_full_unstemmed | Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG |
| title_short | Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG |
| title_sort | neural bases of motor fatigue in multiple sclerosis a multimodal approach using neuromuscular assessment and tms eeg |
| topic | Neuromuscular assessment Motor cortex Corticospinal tract Transcranial magnetic stimulation-electroencephalography Motor fatigue |
| url | http://www.sciencedirect.com/science/article/pii/S0969996123000876 |
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