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Functional role of ipsilateral motor areas in multiple sclerosis
  1. Daniel Zeller1,
  2. Su-Yin Dang1,
  3. Katja Stefan1,
  4. Armin Biller3,4,
  5. Andreas Bartsch3,4,
  6. Dorothee Saur2,
  7. Martin Bendszus3,4,
  8. Peter Rieckmann1,5,
  9. Klaus V Toyka1,
  10. Joseph Classen1,2
  1. 1Department of Neurology, University of Würzburg, Würzburg, Germany
  2. 2Department of Neurology, University of Leipzig, Leipzig, Germany
  3. 3Department of Neuroradiology, University of Würzburg, Würzburg, Germany
  4. 4Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
  5. 5Neurologische Klinik Bamberg, Bamberg, Germany
  1. Correspondence to Professor J Classen, Department of Neurology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; joseph.classen{at}


Background In patients with multiple sclerosis (MS), motor tasks are associated with increased activation of ipsilateral motor cortical areas. The authors examined the role of two ipsilateral motor areas during performance of a simple motor task in MS patients in relation to their motor impairment and CNS injury.

Methods Single pulses of transcranial magnetic stimulation (TMS) were used to interfere transiently with neuronal processing in the contralateral (M1CONTRA) or ipsilateral (M1IPSI) primary motor cortex or ipsilateral dorsal premotor cortex (PMdIPSI) during a simple reaction time (RT) task in 26 right-handed patients with moderately severe stable MS and matched healthy controls. Subjects responded to an auditorily presented Go signal as quickly as possible by performing isometric right-thumb abductions. TMS was applied 100 ms after the Go signal. Motor impairment was evaluated by hand function tests. CNS injury was assessed by magnetic resonance spectroscopy (normalised N-acetyl-aspartate spectra, NAA/Cr), by the total cerebral T2-weighted MRI hyperintense lesion load, and by corticomuscular latency (CML) to the abductor pollicis brevis muscle.

Results TMS applied to M1CONTRA slowed RT in patients and controls. In contrast, stimulation of M1IPSI or PMdIPSI increased RT only in MS patients. In patients, the relative RT changes following TMS over M1IPSI or PMdIPSI did not correlate with any of the motor function tests or with NAA/Cr or total cerebral lesion load. However, RT changes following TMS over M1IPSI correlated inversely with CML.

Conclusions Recruitment of ipsilateral motor areas may be a functionally relevant, yet limited adaptive response to chronic brain injury in MS patients.

  • Multiple sclerosis
  • motor plasticity
  • TMS
  • motor cortex
  • rehabilitation
  • magnetic stimulation
  • motor physiology
  • multiple sclerosis
  • rehabilitation

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  • Funding Supported by the Gemeinnützige Hertie-Stiftung, Frankfurt, Germany (GHS#1.319.110) and the University Research Fund.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethics committee of the Medical Faculty at the University of Würzburg.

  • Provenance and peer review Not commissioned; externally peer reviewed.