Contribution of Structural and Functional MRI in Predicting Response to Motor Training in People With Multiple Sclerosis
Tetsu Morozumi1, Paolo Preziosa2, Alessandro Meani4, Elisabetta Pagani4, Paola Valsasina4, Chiara Arezzo4, Francesco Romanò4, Matteo Albergoni4, Massimo Filippi3, Maria Rocca2
1Neuroimaging Research Unit, Division of Neuroscience, 2Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, 3Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University, 4Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute
Objective:
To assess whether baseline demographic, clinical, and MRI features in multiple sclerosis (MS) patients predict response to aerobic or non-aerobic training.
Background:
Aerobic training has emerged as a promising rehabilitation strategy for MS, offering the dual benefits of improved cardiorespiratory fitness and promotion of neuroplasticity. However, a certain heterogeneity in individual response to aerobic training and to general physical exercise may be observed.
Design/Methods:
Eighty-eight MS patients were randomized into aerobic (n=43) or non-aerobic (n=45) training programs, consisting of 24 training sessions (30–40 minutes/session) over 2-3 months. Patients were classified as "responders" based on a ≥21.6 meters improvement in the 6-Minute Walking Test. Baseline assessments included Expanded Disability Status Scale, Modified Fatigue Impact Scale, Timed 25-Foot Walk Test and peak oxygen consumption. Structural and functional MRI scans were also performed at baseline to evaluate various measures of lesional volume, brain volumetrics, cortical thickness, white matter (WM) microstructural integrity, and resting-state functional connectivity. Seventy healthy controls were analyzed to compare baseline measurements and determine pathological values. Baseline demographic, clinical, and MRI predictors of response to training were identified using random forest.
Results:
Post-intervention, 34 MS patients (aerobic group=20, non-aerobic group=14) were classified as responders. Independent predictors of treatment response were corticospinal tract (CST) fractional anisotropy (FA) and middle cerebellar peduncle (MCP) FA in the aerobic group (out-of-bag area under the curve [OOB-AUC]=0.682), superior cerebellar peduncle (SCP) mean diffusivity (MD) in the non-aerobic group (OOB-AUC=0.713), and SCP MD, MCP MD, CST MD, CST FA, and MCP FA in the whole MS cohort (OOB-AUC=0.734).
Conclusions:
Response to motor training in MS patients is predicted by microstructural integrity of key WM tracts essential for motor functions, independently from the training strategy employed. These findings underscore the potential of neuroimaging in identifying MS patients most likely to benefit from rehabilitation.
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