Neurophysiological alterations in multiple sclerosis patients during acute disease acivity

复发缓解型多发性硬化症（RRMS）的特征是急性疾病活动的发作，基础研究表明，在这些发作期间，GABA能过程减少，多巴胺能过程增加。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GABA能改变的证据。到目前为止，在RRMS急性疾病活动期间缺乏系统的纵向研究，特别是当比较两种方法时。在本项目中，复发缓解型多发性硬化患者在急性疾病活动时，定义为急性复发或MRI上的新的对比增强病变，在疾病活动时、治疗3天和42天后记录GABA能和GABA能参数（TMS：GABA能短皮质内抑制SICI，多巴胺能皮质内易化ICF; MRS：GABA和谷氨酸浓度）并与一组病程稳定而无疾病活动迹象的RRMS患者进行比较。该方案首次使用这些方法系统记录了RRMS在疾病活动时的GABA能和谷氨酸能变化，为了更好地理解体内的病理生理过程，也为了在TMS和MRS之间比较它们，并且为神经生理学调节疗法的介入性使用创造基础。

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.