Kauv Paul, Chalah Moussa A, Créange Alain, Lefaucheur Jean-Pascal, Hodel Jérôme, Ayache Samar S
Service de Neuroradiologie, Hôpital Henri-Mondor, Assistance Publique- Hôpitaux de Paris (AP-HP), 51 avenue du Maréchal de Lattre de Tassigny, Créteil Cedex, 94010, France.
EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.
J Neural Transm (Vienna). 2025 Feb;132(2):265-273. doi: 10.1007/s00702-024-02849-0. Epub 2024 Oct 17.
Multiple sclerosis (MS) is a central nervous system disease involving gray and white matters. Transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI) could help identify potential markers of disease evolution, disability, and treatment response. This work evaluates the relationship between intracortical inhibition and facilitation, motor cortex lesions, and corticospinal tract (CST) integrity. Consecutive adult patients with progressive MS were included. Sociodemographic and clinical data were collected. MRI was acquired to assess primary motor cortex lesions (double inversion and phase-sensitive inversion recovery) and CST integrity (diffusion tensor imaging). TMS outcomes were obtained: motor evoked potentials (MEP) latency, resting motor threshold, short-interval intracortical facilitation (ICF) and inhibition. Correlation analysis was performed. Twenty-five patients completed the study (13 females, age: 55.60 ± 11.49 years, Expanded Disability Status Score: 6.00 ± 1.25). Inverse correlations were found between ICF mean and each of CST radial diffusivity (RD) (ρ =-0.56; p < 0.01), CST apparent diffusion coefficient (ADC) (ρ=-0.44; p = 0.03), and disease duration (ρ=-0.46; p = 0.02). MEP latencies were directly correlated with disability scores (ρ = 0.55; p < 0.01). High ADC/RD and low ICF have been previously reported in patients with MS. While the former could reflect structural damage of the CST, the latter could hint towards an aberrant synaptic transmission as well as a depletion of facilitatory compensatory mechanisms that helps overcoming functional decline. The findings suggest concomitant structural and functional abnormalities at later disease stages that would be accompanied with a heightened disability. The results should be interpreted with caution mainly because of the small sample size that precludes further comparisons (e.g., treated vs. untreated patients, primary vs. secondary progressive MS). The role of these outcomes as potential MS biomarkers merit to be further explored.
多发性硬化症（MS）是一种累及灰质和白质的中枢神经系统疾病。经颅磁刺激（TMS）和磁共振成像（MRI）有助于识别疾病进展、残疾和治疗反应的潜在标志物。本研究评估了皮质内抑制与易化、运动皮层病变和皮质脊髓束（CST）完整性之间的关系。纳入了连续性成年进展型MS患者。收集了社会人口统计学和临床数据。进行MRI检查以评估初级运动皮层病变（双反转和相位敏感反转恢复序列）和CST完整性（扩散张量成像）。获得了TMS结果：运动诱发电位（MEP）潜伏期、静息运动阈值、短间隔皮质内易化（ICF）和抑制。进行了相关性分析。25名患者完成了研究（13名女性，年龄：55.60±11.49岁，扩展残疾状态评分：6.00±1.25）。发现ICF平均值与CST径向扩散率（RD）（ρ=-0.56；p<0.01）、CST表观扩散系数（ADC）（ρ=-0.44；p=0.03）以及病程（ρ=-0.46；p=0.02）之间呈负相关。MEP潜伏期与残疾评分直接相关（ρ=0.55；p<0.01）。此前在MS患者中已报道有高ADC/RD和低ICF。前者可能反映CST的结构损伤，而后者可能提示异常的突触传递以及有助于克服功能衰退的易化性代偿机制的耗竭。研究结果表明在疾病后期存在结构和功能异常，且会伴有残疾程度加重。主要由于样本量小，无法进行进一步比较（如治疗组与未治疗组患者、原发进展型与继发进展型MS），因此对这些结果的解释应谨慎。这些结果作为潜在MS生物标志物的作用值得进一步探索。
