Neurophysiological alterations in multiple sclerosis patients during acute disease acivity

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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.