Neurophysiological alterations in multiple sclerosis patients during acute disease acivity

复发性缓解性多发性硬化症(RRMS)以急性疾病活动发作为特征，基础研究表明在这些发作期间GABA能减少，谷氨酸能过程增加。一些关于RRMS的研究已经能够利用疾病活动时的经颅磁刺激(TMS)和磁共振波谱(MRS)找到这些GABA能和谷氨酸能变化的证据。到目前为止，在RRMS急性疾病活动期间缺乏系统的、纵向的调查，特别是当比较这两种方法时。在这个项目中，急性疾病活动时的复发缓解型多发性硬化症患者，无论是急性复发还是MRI上新的对比剂增强病变，将使用TMS和MRS进行纵向检查，记录疾病活动时、治疗后3天和42天后的GABA能和谷氨酸能参数(TMS：GABA能短期皮质内抑制SICI，谷氨酸能皮层内促进ICF；MRS：GABA和谷氨酸浓度)，并与一组病程稳定但没有疾病活动迹象的RRMS患者进行比较。本方案首次使用这些方法系统地记录了疾病活动时RRMS中GABA能和谷氨酸能的变化，以便更好地了解体内的病理生理过程，并将其与TMS和MRS进行比较，并前瞻性地为神经生理调节疗法的介入应用奠定基础。

Relapsing remitting multiple sclerosis (RRMS) is characterized by episodes of acute disease activity, with basic studies indicating a reduction of GABA-ergic and an increase of glutamatergic processes during these episodes. A few studies on RRMS have been able to find evidence of these GABA-ergic and glutamatergic alterations using Transcranial Magnetic Stimulation (TMS) and Magnetic Resonance Spectroscopy (MRS) at the time of disease activity. Until now, a systematic, longitudinal investigation during acute disease activity in RRMS is lacking, especially when comparing the two methods.In this project, patients with relapsing-remitting multiple sclerosis at the time of acute disease activity, defined by either an acute relapse or a new, contrast-enhancing lesion on MRI, will be examined longitudinally using TMS and MRS. GABA-ergic and glutamatergic parameters are recorded at the time of disease activity, after three days of therapy and after 42 days (TMS: GABA-ergic short intracortical inhibition SICI, glutamatergic intracortical facilitation ICF; MRS: GABA and glutamate concentration) and compared with a group of RRMS patients with a stable course without signs of disease activity.This protocol is the first to systematically record GABA-ergic and glutamatergic changes in RRMS at the time of disease activity using these methods, in order to better understand the pathophysiological processes in vivo, to compare them also between the TMS and MRS, and perspectively create the basis for an interventional use of neurophysiologically modulating therapies.