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Motor function in multiple sclerosis assessed by navigated transcranial magnetic stimulation mapping

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Abstract

Introduction

Impaired motor function is a major cause of disability in multiple sclerosis (MS), involving various neuroplasticity processes typically assessed by neuroimaging. This study aimed to determine whether navigated transcranial magnetic stimulation (nTMS) could also provide biomarkers of motor cortex plasticity in patients with MS (pwMS).

Methods

nTMS motor mapping was performed for hand and leg muscles bilaterally. nTMS variables included the amplitude and latency of motor evoked potentials (MEPs), corticospinal excitability measures, and the size of cortical motor maps (CMMs). Clinical assessment included disability (Expanded Disability Status Scale, EDSS), strength (MRC scale, pinch and grip), and dexterity (9-hole Pegboard Test).

Results

nTMS motor mapping was performed in 68 pwMS. PwMS with high disability (EDSS ≥ 3) had enlarged CMMs with less dense distribution of MEPs and various MEP parameter changes compared to pwMS with low disability (EDSS < 3). Patients with progressive MS had also various MEP parameter changes compared to pwMS with relapsing remitting form. MRC score correlated positively with MEP amplitude and negatively with MEP latency, pinch strength correlated negatively with CMM volume and dexterity with MEP latency.

Conclusions

This is the first study to perform 4-limb cortical motor mapping in pwMS using a dedicated nTMS procedure. By quantifying the cortical surface representation of a given muscle and the variability of MEP within this representation, nTMS can provide new biomarkers of motor function impairment in pwMS. Our study opens perspectives for the use of nTMS as an objective method for assessing pwMS disability in clinical practice.

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Data availability

Data supporting the findings are available upon reasonable request.

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Acknowledgements

The authors would like to thank the Observatoire Français de la Sclérose en Plaques (OFSEP, http://www.ofsep.org/fr/), which is supported by a grant provided by the French government and administered by the Agence Nationale de la Recherche, within the framework of the ‘Investments for the Future’ programme (reference ANR‐10‐COHO‐002), the Eugène Devic EDMUS Foundation against Multiple Sclerosis and the ARSEP Foundation.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France

    Benjamin Bardel, Alain Créange, Nathalie Bonardet, Blanche Bapst, Samar S. Ayache & Jean-Pascal Lefaucheur

  2. Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France

    Benjamin Bardel, Samar S. Ayache & Jean-Pascal Lefaucheur

  3. Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France

    Benjamin Bardel, Alain Créange, Blanche Bapst, Mickael Zedet, Abir Wahab & Samar S. Ayache

  4. Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France

    Alain Créange, Mickael Zedet, Abir Wahab & Samar S. Ayache

  5. Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, DMU FIxIT, 1 Rue Gustave Eiffel, 94000, Creteil, France

    Blanche Bapst

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  1. Benjamin Bardel
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  8. Jean-Pascal Lefaucheur
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Contributions

Benjamin Bardel: conceptualization of the study, main contribution to data collection and analyses, acquisition of neurophysiological data, programming, statistical analysis, drafted the manuscript; Alain Créange: main contribution to patient recruitment, data collection, interpretation of data, revision of the manuscript; Nathalie Bonardet, Mickael Zedet, Abir Wahab: contribution to patient recruitment and data collection; Blanche Bapst: contribution to data collection and analyses; Samar Ayache: main contribution to concept and design of study; Jean-Pascal Lefaucheur: supervision of the study, validation of results, supervision of writing the article, revising the manuscript critically for important intellectual content.

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Correspondence to Benjamin Bardel.

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Bardel, B., Créange, A., Bonardet, N. et al. Motor function in multiple sclerosis assessed by navigated transcranial magnetic stimulation mapping. J Neurol (2024). https://doi.org/10.1007/s00415-024-12398-x

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