Abstract
Aim: The aim was to objectify neuroplasticity after physiotherapy using an innovative method of functional magnetic resonance imaging data analysis (determination of effective connectivity) in multiple sclerosis patients. Material and methods: Twelve patients (mean: age 44.3 +- 9.2 years, EDSS 3.7 +- 0.9, disease duration 9.3 +- 6.0 years underwent Motor program activation therapy (one hour therapy, twice a week).
Clinical and fMRI examination during a motoric task for fingers was carried out before and after the therapy. The clinical examination focused on the upper extremity function (evaluation of tremor, diadochokinesis, ataxia, muscle strength and spasticity).
Effective connectivity between supplementary motor and right and left primary motor areas was determined using the Statistical Parametric Mapping software. A control group consisted of 12 healthy controls (mean age 39.4 +- 12.2).
Results: The analysis of effective connectivity showed strong connection between the supplementary motor area and both primary motor areas (patients had stronger connection in more cases than healthy controls, significant between the supplementary motor area and the left primary motor area, p = 0.005). Effective connectivity between the right and left primary motor areas was significantly weaker.
After the therapy, improvement occurred in all the clinical tests (right hand index p < 0.001, left hand index p < 0.001) but no changes were observed in effective connectivity. Conclusion: Effective connectivity represents a possible approach to objectification of brain plasticity.
Facilitation physiotherapy had a significant effect on clinical function while significant changes of effective connectivity were not demonstrated.