Department of Neurological and Behavioural Sciences, University of Siena, Italy.
Mult Scler. 2010 Nov;16(11):1326-34. doi: 10.1177/1352458510377333. Epub 2010 Jul 29.
Patients with multiple sclerosis (MS) who have a favourable clinical status several years after disease onset are classified as 'benign'. In many cases brain tissue damage does not differ between benign MS and the 'classical' MS forms.
To assess whether the favourable clinical course in benign MS could be explained by the presence of an efficient functional cortical reorganization.
Twenty-five right-handed patients with benign MS (defined as having Expanded Disability Status Scale ≤ 3 and disease duration >15 years) underwent functional MRI during a simple motor task (right-hand tapping) to assess movement-associated brain activation. This was compared with that of 10 patients with relapsing-remitting MS and 10 normal controls. Benign MS patients also underwent conventional brain MRI and magnetization transfer imaging, which was compared with an identical examination obtained 1 year before. Quantitative structural magnetic resonance measures were baseline and changes over time in T2-lesion volume, magnetization transfer ratio in T2 lesions and normal-appearing brain and total brain volume.
Movement-related activation was greater in patients with benign MS than in those with relapsing-remitting MS or normal controls, extensively involving bilateral regions of the sensorimotor network as well as basal ganglia, insula and cerebellum. Greater activation correlated with lower T2-lesion magnetization transfer ratio, and with decreasing brain volume and increasing T2 lesion volume.
The results suggest that bilateral brain networks, beyond those normally engaged in motor tasks, are recruited during a simple hand movement in patients with benign MS. This increased activation is probably the expression of an extensive, compensatory and tissue-damage related functional cortical reorganization. This can explain, at least in part, the favourable clinical expression of patients with benign MS.
在疾病发病后数年具有良好临床状态的多发性硬化症（MS）患者被归类为“良性”。在许多情况下，良性 MS 与“经典”MS 形式之间的脑组织损伤没有差异。
评估良性 MS 中有利的临床病程是否可以通过存在有效的皮质功能重组来解释。
对 25 名右侧手良性 MS 患者（定义为扩展残疾状态量表≤3 和病程> 15 年）进行功能磁共振成像，在简单运动任务（右手敲击）中评估运动相关脑激活。这与 10 名复发缓解型 MS 患者和 10 名正常对照组进行了比较。良性 MS 患者还接受了常规脑 MRI 和磁化转移成像检查，并与 1 年前获得的相同检查进行了比较。定量结构磁共振测量是 T2 病变体积、T2 病变磁化转移率和正常表现脑及总脑体积的基线和随时间变化。
良性 MS 患者的运动相关激活大于复发缓解型 MS 患者或正常对照组，广泛涉及感觉运动网络以及基底节、岛叶和小脑的双侧区域。更大的激活与较低的 T2 病变磁化转移率相关，并且与脑体积减少和 T2 病变体积增加相关。
结果表明，在良性 MS 患者进行简单的手部运动时，除了通常参与运动任务的大脑网络外，双侧大脑网络也被招募。这种增加的激活可能是广泛的、代偿性和与组织损伤相关的皮质功能重组的表达。这至少可以部分解释良性 MS 患者良好的临床表现。
