Evidence for widespread movement-associated functional MRI changes in patients with PPMS.
BACKGROUND
Previous work has suggested that functional reorganization of cortical motor areas might have a role in limiting the motor deficits in patients with MS.


OBJECTIVE
To test whether movement-associated cortical changes in MS might extend beyond the "classic" motor areas and involve sites for multimodal integration.


METHODS
fMRI was used to assess patterns of brain activations associated with 3 different motor tasks in 30 right-handed patients with primary progressive MS (PPMS) and variable degrees of motor impairment, which were compared with those from 15 right-handed, sex- and age-matched control subjects.


RESULTS
Compared with control subjects, patients with MS showed increased activation of brain regions within both traditional motor planning and execution regions (including the supplementary motor area and the cingulate motor area), the insula (a region implicated in sensory processing), and several multimodal cortical regions in the temporal, parietal, and occipital lobes. In patients, the extent of the fMRI activations was strongly correlated with MR lesion burden (r ranging from 0.70 to 0.86, p < 0.001).


CONCLUSIONS
This study shows that movement-associated cortical activation in patients with PPMS is widely distributed and also involves multimodal "nonmotor" cortical networks. It also suggests that adaptive cortical reorganization might be one of the mechanisms limiting the clinical impact of MS in the progressive phases of the disease.
Rocca
M A
MA
Neuroimaging Research, Department of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Italy.
Matthews
P M
PM
Caputo
D
D
Ghezzi
A
A
Falini
A
A
Scotti
G
G
Comi
G
G
Filippi
M
M
D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology; D004185:Disability Evaluation; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009068:Movement / Q000502:physiology*; D020528:Multiple Sclerosis, Chronic Progressive / Q000503:physiopathology*