Abstract
Rehabilitation is recognized to be important in ameliorating motor and cognitive functions, reducing disease burden, and improving quality of life in patients with multiple sclerosis (MS). In this systematic review, we summarize the existing evidences that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with MS, as assessed by means of the most advanced neuroimaging techniques, including diffusion tensor imaging and task-related and resting-state functional magnetic resonance imaging (MRI). In most cases, the rehabilitation program was based on computer-assisted/video game exercises performed in either an outpatient or home setting. Despite their heterogeneity, all the included studies describe changes in white matter microarchitecture, in task-related activation, and/or in functional connectivity following both task-oriented and selective training. When explored, relevant correlation between improved function and MRI-detected brain changes was often found, supporting the hypothesis that training-induced brain plasticity is specifically linked to the trained domain. Small sample sizes, lack of randomization and/or an active control group, as well as missed relationship between MRI-detected changes and clinical performance, are the major drawbacks of the selected studies. Knowledge gaps in this field of research are also discussed to provide a framework for future investigations.
Highlights
Multiple sclerosis (MS) is a long-lasting disease typically affecting young adults characterized by the presence of multifocal inflammatory demyelinated plaques distributed over time and space within the central nervous system (CNS) [1]
We summarize the existing evidences that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with multiple sclerosis (MS), as assessed by means of the most advanced neuroimaging techniques, including diffusion tensor imaging and task-related and resting-state functional magnetic resonance imaging (MRI)
Six studies investigated whether motor rehabilitation strategies enhance brain plasticity, as evaluated by either taskrelated functional MRI (fMRI) (n = 2) [26, 27], diffusion tensor imaging (DTI) (n = 3) [28,29,30], or both techniques (n = 1) [31]
Summary
Multiple sclerosis (MS) is a long-lasting disease typically affecting young adults characterized by the presence of multifocal inflammatory demyelinated plaques distributed over time and space within the central nervous system (CNS) [1]. The management of motor and cognitive disturbances still relies on rehabilitative strategies [10, 11], which have been reported to be effective in ameliorating these functional domains, suggesting that remediation/compensation may occur into even damaged brain structures [12]. This may imply that rehabilitation is able to enhance neuroplasticity, that is, the intrinsic property of the CNS to structurally and functionally adapt itself in response to external stimuli, environmental changes, or injuries [13].
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