Bralić Antonia, Pavelin Sanda, Pleić Nikolina, Šoda Joško, Dolić Krešimir, Markotić Anita, Ćurković Katić Ana, Mastelić Angela, Režić Mužinić Nikolina, Duranović Jasna, Kljajić Zlatko, Stipica Safić Ivona, Đogaš Zoran, Rogić Vidaković Maja
Department of Interventional and Diagnostic Radiology, University Hospital of Split, Split, Croatia.
Department of Neurology, University Hospital of Split, Split, Croatia.
Ann Clin Transl Neurol. 2025 Jun;12(6):1240-1255. doi: 10.1002/acn3.70041. Epub 2025 Apr 17.
Considering the characteristics of multiple sclerosis (MS) disease and its impact on motor disability, this study aims to assess the functional integrity of the corticospinal tract by examining motor evoked potentials (MEPs), Expanded Disability Status Scale (EDSS) scores, magnetic resonance imaging (MRI) lesion counts, and psychological and physical status reported by patients with relapsing-remitting MS (RRMS).
In 23 RRMS subjects (17 in the follow-up), the corticospinal tract for upper and lower extremity muscles was longitudinally studied over 2 years using navigated transcranial magnetic stimulation (nTMS) and MEP scoring. MRI parameters included lesion detection by applying McDonald's criteria and additional lesion detection of the corticospinal tract. EDSS scoring included evaluation of the EDSS general score, EDSS functional pyramidal score, and EDSS functional pyramidal score for each extremity. Longitudinal analyses of nTMS (MEP), EDSS, and MRI parameters were conducted using linear mixed models with time, sex, age, and disease duration as fixed effects and individual-specific random intercepts. The correspondence of MRI and nTMS scoring with the EDSS pyramidal scoring was tested using McNemar's or Fisher's exact test.
RRMS patients with altered MEP latency had significantly higher general EDSS scores (β = -2.06, p = 0.006) and overall pyramid EDSS scores (β = -1.96, p = 0.002) compared to those with non-altered MEP latency. This difference was also observed in lower extremity pyramid EDSS scores, with higher scores in the right (β = -1.70, p = 0.001) and left leg (β = -1.50, p = 0.032) in the altered MEP latency group. RRMS patients with altered MEP latency had significantly more lesions in the corpus callosum (β = 2.38, p = 0.03) compared to subjects with non-altered MEP latency findings. The correspondence of MRI and nTMS (MEP latency) with EDSS scoring was confirmed.
RRMS subjects with altered MEP latency findings (prolonged MEP latency or absent MEP response) compared to subjects with non-altered MEP latency findings, had higher EDSS scores in lower extremity muscles as well as a higher number of lesions in the corpus callosum. This is the first longitudinal nTMS study to perform four-limb cortical mapping of corticospinal tract integrity in RRMS. The study opens perspectives for the nTMS as an objective method for longitudinally assessing MS motor disability.
ClinicalTrials.gov identifier: NCT04604041.
考虑到多发性硬化症（MS）的疾病特征及其对运动功能障碍的影响，本研究旨在通过检测运动诱发电位（MEP）、扩展残疾状态量表（EDSS）评分、磁共振成像（MRI）病灶计数以及复发缓解型MS（RRMS）患者报告的心理和身体状况，来评估皮质脊髓束的功能完整性。
对23例RRMS受试者（17例处于随访中），在2年时间里使用导航经颅磁刺激（nTMS）和MEP评分对上下肢肌肉的皮质脊髓束进行纵向研究。MRI参数包括应用麦克唐纳标准进行病灶检测以及对皮质脊髓束进行额外的病灶检测。EDSS评分包括对EDSS总体评分、EDSS功能锥体束评分以及每个肢体的EDSS功能锥体束评分进行评估。使用线性混合模型对nTMS（MEP）、EDSS和MRI参数进行纵向分析，将时间、性别、年龄和病程作为固定效应，个体特异性随机截距作为随机效应。使用麦克尼马尔检验或费舍尔精确检验来测试MRI和nTMS评分与EDSS锥体束评分的对应关系。
与MEP潜伏期未改变的RRMS患者相比，MEP潜伏期改变的RRMS患者的EDSS总体评分显著更高（β = -2.06，p = 0.006），总体锥体束EDSS评分也显著更高（β = -1.96，p = 0.002）。在下肢锥体束EDSS评分中也观察到了这种差异，MEP潜伏期改变组的右侧（β = -1.70，p = 0.001）和左侧下肢（β = -1.50，p = 0.032）评分更高。与MEP潜伏期未改变的受试者相比，MEP潜伏期改变的RRMS患者胼胝体中的病灶明显更多（β = 2.38，p = 0.
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