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Relationship between rehabilitation and functional reorganisation of the memory network in MS
Author(s): ,
A. Eshaghi
Affiliations:
NMR Research Unit, UCL Institute of Neurology, London, United Kingdom
,
M.A. Sahraian
Affiliations:
MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
R. Saeedi
Affiliations:
MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
S. Riyahi-Alam
Affiliations:
MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
A. Borghei
Affiliations:
MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
D.L. Thomas
Affiliations:
Leonard Wolfson Experimental Neurology Centre, UCL Institute of Neurology
,
B. Bahrami
Affiliations:
Institute of Cognitive Neuroscience, University College London, London, United Kingdom
,
A.R. Azimi
Affiliations:
MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
A.J. Thompson
Affiliations:
NMR Research Unit, UCL Institute of Neurology, London, United Kingdom
O. Ciccarelli
Affiliations:
NMR Research Unit, UCL Institute of Neurology, London, United Kingdom
ECTRIMS Online Library. Eshaghi A. Oct 8, 2015; 116626; 109
Dr. Arman Eshaghi
Dr. Arman Eshaghi
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Abstract: 99

Type: Oral

Abstract Category: MRI and cognition

Background: Patients with multiple sclerosis (MS) are a heterogenous group with varying response to rehabilitation. However, the underlying neural circuitry that may identify patients who could benefit from rehabilitation is not known. We hypothesised that the nervous system's ability to respond to extrinsic stimuli (plasticity) by reorganisation would differ among people with MS. To this end, we applied functional connectivity analysis with dynamic causal modelling (DCM) which can infer causal effects of experimental manipulations on neural dynamics, and longitudinal DCM to investigate plasticity.

Methods:
We recruited 27 patients with relapsing-remitting MS (mean age = 34.4 years, median EDSS = 2.5). Patients were randomised in two groups with assessments at baseline, after 3 and 6 months, in a cross-over design. Interventions included verbal and visual memory tasks repeated twice weekly with 2-hour computer-based (www.rehacom.com) sessions for 3 months, alternated with 3 months of no intervention. At each time-point patients performed working memory tasks (0-back, 1-back and 2-back digit tasks) while undergoing fMRI with 3T scanner. Neuropsychological tests of visual (brief visuospatial memory test, BVMT) and verbal memory (California Verbal learning test, CVLT), and information processing (Symbol-digit modalities test, SDMT) were obtained, and compared within group. We used DCM of longitudinal fMRI data and included rehabilitation as a modulatory input. Six models of memory networks of intraparietal sulcus (IPS), dorsolateral prefrontal cortex (DLPFC), and precuneus (chosen after standard fMRI group analysis) with 2-way connections were constructed that differed only on the location of modulatory effect of rehabilitation.

Results:
There was a significant improvement in SDMT and BVMT scores within groups (p < 0.05). Bayesian model selection showed that a model with modulatory effect of rehabilitation on the connection from IPS to DLPFC best explained the observed data (exceedance probability = 0.8). Connectivity strength from DLPFC to IPS predicted improvement in BVMT (p < 0.01, R2 = 0.29), and modulatory strength of rehabilitation predicted the post-rehabilitation CVLT scores (p= 0.02, R2 = 0.32),after adjusting for education.

Conclusion:
Functional reorganisation of memory networks may be associated with a favourable response to rehabilitation. The next step of this study will be to use baseline fMRI data to predict patients' response to rehabilitation.

Disclosure: AE, MAS, RS, SR, AB, DLT, and ARA have nothing to disclose.

AE was supported by the Du Pre´ Grant from Multiple Sclerosis International Federation (www.msif.org).

BB declares no conflict of interest. BB is supported by ERC stG grant code NEUROCODEC.

AT has received honoraria for consulting from Biogen, Eisai, and MedDay, and for speaking from Novartis, TEVA, and EXCEMED. He receives an honorarium from SAGE Publications as Editor-in-Chief of Multiple Sclerosis Journal.

OC receives research grant support from the Multiple Sclerosis Society of Great Britain and Northern Ireland, the Department of Health Comprehensive Biomedical Centre, the International Spinal Cord Research Trust (ISRT) and the Engineering and Physical Sciences Research Council (EPSRC); she serves as a consultant for Novartis, Biogen and GE and payments are made to UCL Institute of Neurology.
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