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Related Experiment Video

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Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation
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Motor function in multiple sclerosis assessed by navigated transcranial magnetic stimulation mapping.

Benjamin Bardel1,2,3, Alain Créange4,5,6, Nathalie Bonardet4

  • 1Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France. benjamin.bardel@aphp.fr.

Journal of Neurology
|May 6, 2024
PubMed
Summary

Navigated transcranial magnetic stimulation (nTMS) can identify biomarkers of motor cortex plasticity in multiple sclerosis (MS). This technique quantifies cortical changes, offering objective measures for assessing motor function impairment in patients with MS (pwMS).

Keywords:
Cortical motor mappingCortical plasticityMotor evoked potentialsMultiple sclerosisNeuronavigationTranscranial magnetic stimulation

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Area of Science:

  • Neuroscience
  • Neurology
  • Biomarkers

Background:

  • Motor dysfunction is a primary disability in multiple sclerosis (MS), linked to neuroplasticity changes often evaluated via neuroimaging.
  • The potential of navigated transcranial magnetic stimulation (nTMS) to serve as a biomarker for motor cortex plasticity in MS remains to be fully explored.

Purpose of the Study:

  • To investigate whether nTMS can provide reliable biomarkers of motor cortex plasticity in patients with MS (pwMS).
  • To correlate nTMS-derived measures with clinical assessments of disability, strength, and dexterity in pwMS.

Main Methods:

  • Performed bilateral nTMS motor mapping of hand and leg muscles in 68 pwMS.
  • Assessed nTMS variables including motor evoked potential (MEP) amplitude and latency, corticospinal excitability, and cortical motor map (CMM) size.
  • Utilized clinical assessments: Expanded Disability Status Scale (EDSS), Medical Research Council (MRC) scale, pinch/grip strength, and the 9-hole Pegboard Test.

Main Results:

  • PwMS with higher EDSS scores (≥3) exhibited enlarged CMMs with sparser MEP distribution and altered MEP parameters compared to those with lower EDSS scores (<3).
  • Progressive MS patients showed distinct MEP parameter changes compared to relapsing-remitting MS patients.
  • Correlations were found between MRC score and MEP amplitude/latency, pinch strength and CMM volume, and dexterity and MEP latency.

Conclusions:

  • This study demonstrates the feasibility of 4-limb cortical motor mapping using nTMS in pwMS, yielding novel insights into motor cortex organization.
  • nTMS-quantified cortical representation and MEP variability serve as potential biomarkers for motor impairment in MS.
  • nTMS offers a promising objective tool for assessing disability in pwMS within clinical settings.