title: Multiple Sclerosis: Changes in Thalamic Resting-State Functional Connectivity Induced by a Home-based Cognitive Rehabilitation Program.
abstract: Purpose To investigate thalamic connectivity changes after use of a video game-based cognitive rehabilitation program, as thalamic damage and alterations in thalamocortical functional connectivity (FC) are important factors in cognitive dysfunction in patients with multiple sclerosis (MS). Materials and Methods This prospective study was approved by the local ethical committee. Twenty-four patients with MS and cognitive impairment were randomly assigned to either an intervention or a wait-list group. Patients were evaluated with cognitive tests and 3-T resting-state functional magnetic resonance (MR) imaging at baseline and after an 8-week period. In addition, 11 healthy subjects underwent baseline resting-state functional MR imaging. Patients in the intervention group performed the video game-based cognitive rehabilitation program, while those in the wait-list group served as control subjects. Repeated measures analysis of variance was used to test efficacy of the intervention. The thalamic resting-state network was identified with a seed-based method; both first-level and high-level analyses were performed by using software tools. Results Patients showed lower baseline FC compared with healthy subjects. A significant improvement was seen in results of the Paced Auditory Serial Addition Test and the Stroop Test after 8 weeks of cognitive rehabilitation (F = 6.616, [P = .018] and F = 5.325 [P = .030], respectively). At follow-up, the intervention group had an increased FC in the cingulum, precuneus, and bilateral parietal cortex and a lower FC in the cerebellum and in left prefrontal cortex compared with the wait-list group (P < .05, family-wise error corrected); correlations were found between FC changes in these regions and cognitive improvement (P < .05, family-wise error corrected). Conclusion The results of this study show the relevance of thalamic regulation of the brain networks involved in cognition and suggest that changes in thalamic resting-state network connectivity may represent a functional substrate for cognitive improvement associated with a video game-based cognitive rehabilitation program. (©) RSNA, 2016.
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Laura
authors.initials: L
authors.lastname: De Giglio
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Tona
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Francesca
authors.initials: F
authors.lastname: De Luca
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Petsas
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Luca
authors.initials: L
authors.lastname: Prosperini
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Valentina
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Carlo
authors.initials: C
authors.lastname: Pozzilli
authors.affiliation: From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00186 Rome, Italy (L.D.G., F.T., F.D.L., N.P., L.P., C.P., P.P.); MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy (L.D.G., L.P., V.B., C.P.); and IRCCS Neuromed, Pozzilli, Italy (P.P.).
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pantano
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000534:rehabilitation; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012146:Rest; D013788:Thalamus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016896:Treatment Outcome; D018910:Video Games