Matthias Grothe

Impaired recognition of emotional facial expressions in patients with multiple sclerosis

BACKGROUND Disturbances that occur in patients with multiple sclerosis (MS) are not restricted to motor, sensory, or urinary functions; they also include cognitive dysfunction, fatigue, and depression. Moreover, people with MS are known to have fewer social activities and a reduced quality of life. One aspect of social interaction is accurate recognition of facial expressions. Several studies have suggested impairment in the processing of facial expressions in patients with multiple sclerosis, but it is not clear if these deficits are based on cognitive, depressive, or other attendant symptoms. OBJECTIVE To investigate emotion recognition and facial identity recognition abilities and their relation with cognitive functions, depression, and fatigue in a cohort of MS patients. METHODS Emotion recognition and facial identity recognition abilities were investigated in a cohort of 61 MS patients with unimpaired visual acuity and 53 healthy controls using the Florida Affect Battery. Additionally, we investigated possible relationships between impaired facial expression recognition and other clinical features. RESULTS MS patients were not impaired in facial identity discrimination, but showed a poor performance in all subtests that required emotion recognition. CONCLUSION Impaired recognition of facial emotions by patients with MS seems to be associated with both cognitive and affective (depression) aspects of the disease.

Prevalence and outcome of late‐onset seizures due to autoimmune etiology: A prospective observational population‐based cohort study

The increasing incidence of new‐onset seizures with age is well known. Often, the etiology cannot be clarified. In the present study, patients with unprovoked late‐onset seizures and without known neoplasm, who might have had paraneoplastic encephalitis, were investigated for a potentially underlying autoimmunity.

The role of global and regional gray matter volume decrease in multiple sclerosis.

Disability in multiple sclerosis (MS) patients is associated with white matter (WM) and gray matter (GM) pathology, and both processes contribute differently over the disease course. Total and regional GM volume loss can be imaged via voxel-based morphometry (VBM). Here, we retrospectively analyzed a group of 213 MS patients [163 relapsing remitting (RR) and 50 secondary progressive (SP)] using semi-automated white matter (WM) lesion mapping and voxel-based morphometry (VBM). Our aim was to assess the association of increasing disability with decreasing total and regional GM volume. As expected, total GM volume and WM lesion load were associated with patients disability, measured with the Expanded Disability Status Scale (EDSS). The more impaired the patients, the greater the statistical association to the total GM volume. Regional volume loss in the cerebellar gray matter was associated with increasing EDSS and WM lesion volume. Furthermore, SPMS patients had significantly more gray matter volume loss in the cerebellum and the hippocampus compared to RRMS patients. Our results confirm histopathological studies emphasizing the important role of the cerebellum and the hippocampus in MS patients’ disability.

Connectivity-Based Predictions of Hand Motor Outcome for Patients at the Subacute Stage After Stroke

Background: Connectivity-based predictions of hand motor outcome have been proposed to be useful in stroke patients. We intended to assess the prognostic value of different imaging methods on short-term (3 months) and long-term (6 months) motor outcome after stroke. Methods: We measured resting state functional connectivity (rsFC), diffusion weighted imaging (DWI) and grip strength in 19 stroke patients within the first days (5–9 days) after stroke. Outcome measurements for short-term (3 months) and long-term (6 months) motor function was assessed by the Motricity Index (MI) of the upper limb and the box and block test (BB). Patients were predominantly mildly affected since signed consent was necessary at inclusion. We performed a multiple stepwise regression analysis to compare the predictive value of rsFC, DWI and clinical measurements. Results: Patients showed relevant improvement in both motor outcome tests. As expected grip strength at inclusion was a predictor for short- and long-term motor outcome as assessed by MI. Diffusion-based tract volume (DTV) of the tracts between ipsilesional primary motor cortex and contralesional anterior cerebellar hemisphere showed a strong trend (p = 0.05) for a predictive power for long-term motor outcome as measured by MI. DTV of the interhemispheric tracts between both primary motor cortices was predictive for both short- and long-term motor outcome in BB. rsFC was not associated with motor outcome. Conclusions: Grip strength is a good predictor of hand motor outcome concerning strength-related measurements (MI) for mildly affected subacute patients. Therefore additional connectivity measurements seem to be redundant in this group. Using more complex movement recruiting bilateral motor areas as an outcome parameter, DTV and in particular interhemispheric pathways might enhance predictive value of hand motor outcome.

Inhibition of the primary sensorimotor cortex by topical anesthesia of the forearm in patients with complex regional pain syndrome

Abstract Complex regional pain syndrome (CRPS) type I is characterized by somatosensory and motor deficits, and abnormalities have been reported for primary somatosensory (S1) and motor cortex (M1) excitability. For the latter, reduced short-latency intracortical inhibition (SICI) has been demonstrated in the somatotopic representation of the affected side. Recently, an intervention of applying anesthetic cream to the forearm has been shown to modulate both somatosensory deficits (eg, spatial tactile resolution [STR]) and SICI measured in hand muscles. We examined the efficacy of this intervention in patients with CRPS I. Cutaneous anesthesia of the forearm of the affected side was used to increase SICI of hand muscles and decrease impaired STR of the affected limb. In a double-blinded placebo-controlled study, we enrolled 12 patients with unilateral CRPS I of the hand in the chronic state. Before and after intervention, we measured motor evoked potentials of the first dorsal interosseus to obtain SICI and STR of both hand sides. Patients showed decreased STR on the tip of the thumb of their affected side, which improved after anesthetic cream but not after placebo application. Hand motor function of the affected side improved after anesthetic cream but not after placebo. Pain intensity was not modulated after intervention. At both hemispheres, SICI was decreased compared with reference values but selectively increased at the intervention side only after analgesic cream and not after placebo. Temporary deafferentation of an area neighbouring the CRPS-affected region can modulate neuropathological characteristics of CRPS and might be a promising strategy for therapeutic interventions.

Changes in motor cortex excitability for the trained and non-trained hand after long-term unilateral motor training

Repetitive unilateral upper limb motor training does not only affect behavior but also increases excitability of the contralateral primary motor cortex (M1). The behavioral gain is partially transferred to the non-trained side. Changes in M1 intracortical facilitation (ICF) might as well be observed for both hand sides. We measured ICF of both left and right abductor pollicis brevis muscles (APB) before and after a two-week period of arm ability training (AAT) of the left hand in 13 strongly right handed healthy volunteers. Performance with AAT-tasks improved for both the left trained and right untrained hand. ICF for the untrained hand decreased over training while it remained unchanged for the left trained hand. Decrease of ICF for the right hand was moderately associated with an increase of AAT-performance for the untrained right hand. We conclude that ICF-imbalance between dominant and non-dominant hand is sensitive to long-term motor training: training of the non-dominant hand results in a decrease of ICF of the dominant hand. The ICF-decrease is associated with a transfer of training-induced improvement of performance from the non-dominant to the dominant hand.

Juvenile Myoclonic Epilepsy Shows Potential Structural White Matter Abnormalities: A TBSS Study

Background: Several studies on patients with juvenile myoclonic epilepsy (JME) showed widespread white matter (WM) abnormalities in the brain. The aim of this study was to investigate potential structural abnormalities in JME patients (1) compared to healthy controls, (2) among JME subgroups with or without photoparoxysmal responses (PPR), and (3) in correlation with clinical variables. Methods: A selection of 31 patients with JME (12 PPR positive) and 27 age and gender matched healthy controls (HC) were studied at a tertiary epilepsy center. Fractional anisotropy (FA) was calculated and intergroup differences analyzed using Tract Based Spatial Statistics (TBSS). Results: Compared to HC the JME group showed reduced FA widespread and bilateral in the longitudinal fasciculus, inferior fronto-occipital fasciculus, corticospinal tract, anterior and posterior thalamic radiation, corona radiata, corpus callosum, cingulate gyrus and external capsule (p < 0.01). Subgroup analysis revealed no significant differences of WM alterations between PPR positive and negative patients and with clinical and epilepsy-related factors. Conclusions: Widespread microstructural abnormalities among patients with JME have been identified.Prior findings of frontal and thalamofrontal microstructural abnormalities have been confirmed. Additionally, microstructural abnormalities were found in widespread extra-frontal regions that may help to validate pathophysiological concepts of JME.

P97. Functional MRI of the symbol digit modalities task in relapsing remitting multiple sclerosis

Background The symbol digit modalities task (SDMT) is recommended for assessing cognitive disabilities in multiple sclerosis (MS). There is a broad literature of adaptations of cognitive tasks (like the paced auditory serial addition task) for functional MRI, but only a few studies investigated the SDMT in both patients and healthy controls (HC). Here, we adapted an oral version of the SDMT for fMRI to study the cognitive networks involved in the task in both patients and healthy controls. Methods In total, 20 patients with relapsing remitting MS (EDSS 1–8; median 2.0) and 20 healthy controls, matched due to age (mean 41y) and gender (10 female) were investigated. Study design was an oral version of the SDMT with 4 blocks 30 s each of assigning numbers to symbols. Results Both patients and healthy controls had strong functional activation in areas involved in language processing (Brodmann area (BA) 22), working memory (BA9), motor (BA4, BA6), visuomotor (BA7) and visual function (BA17-19) at p (FWE)   HC). Interestingly, HC had increased activation in wernicke‘s area (BA 22) and in the insula (BA13) compared to the patients group (HC > MS). Discussion Here we could demonstrate a fMRI adaptation of the SDMT task. In our data, patiens had a decreased activation in language processing areas, indicating a disrupted network in MS-patients involved in this task.

P 3 Cerebellar gray matter volume decrease is associated with epileptic seizures in multiple sclerosis

Background Prevalence rates of epileptic seizures are three times higher in patients with multiple sclerosis (MS) compared to healthy controls ( van Munster et al., 2015 ). There is some evidence of gray matter (GM) as well as white matter (WM) lesions associated with epilepsy in MS ( van Munster et al., 2015 ). Here, we compared regional GM volume decrease using voxel based morphometry (VBM) to compare MS patients with and without epilepsy. Methods MRI images of 30 MS patients (15 with, 15 without epilepsy, matched due to disease duration, disease course, EDSS and age) were analyzed using voxel based morphometry. Second level analysis was done comparing regional GM volume in MS patients without compared to with epileptic seizures. Results MS-patients with epilepsy had regional GM volume decrease in the cerebellum compared to MS patients without epilepsy, mainly in the posterior lobe. Neither cerebral or deep GM structures revealed significant regional GM volume decrease. Discussion There is some evidence of hippocampal GM pathology associated with epilepsy ( Nicholas et al., 2016 ). In contrast, our VBM analyses did not reveal any association to cortical or subcortical GM volume decrease. Against our expectations, we found significant cerebellar GM volume decrease in the patients with, compared to without epileptic seizures. Interestingly, there is some evidence of cerebellar lesions generating seizures ( Foit et al., 2016 ), cerebellar abnormalities in idiopathic generalized epilepsy ( Li et al., 2010 ) as well as a cerebellar mediated, inhibitory effect on hippocampal seizures ( Krook-Magnuson et al., 2014 ). Our data has to be confirmed in larger samples, but at least are indicating a possible role of the cerebellum in MS patients with epilepsy.