Neurophysiological alterations in multiple sclerosis patients during acute disease acivity

复发缓解型多发性硬化症 (RRMS) 的特点是急性疾病活动发作，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 的研究已经能够在疾病活动时使用经颅磁刺激 (TMS) 和磁共振波谱 (MRS) 找到这些 GABA 能和谷氨酸能改变的证据。到目前为止，RRMS 急性疾病活动期间缺乏系统的纵向研究，特别是在比较两种方法时。在该项目中，将使用 TMS 和 MRS 纵向检查急性疾病活动时的复发缓解型多发性硬化症患者（定义为急性复发或 MRI 上新的对比增强病变）。在疾病活动时、治疗三天后和治疗 42 天后记录 GABA 能和谷氨酸参数（TMS：GABA 能短皮质内抑制 SICI、谷氨酸皮质内促进 ICF；MRS：GABA 和谷氨酸浓度），并与一组病程稳定、无疾病活动迹象的 RRMS 患者进行比较。该方案是第一个系统记录 GABA 能和谷氨酸能参数的方法。使用这些方法研究疾病活动时 RRMS 的谷氨酸能变化，以便更好地了解体内的病理生理过程，在 TMS 和 MRS 之间进行比较，并前瞻性地为神经生理调节疗法的介入使用奠定基础。

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.