Recovery from an acute relapse is associated with changes in motor resting-state connectivity in multiple sclerosis

Resting-state functional MRI (rs-fMRI) of the brain has been successfully used to identify altered functional connectivity in the motor network in multiple sclerosis (MS).1 In clinically stable patients with MS, we recently demonstrated increased coupling between the basal ganglia and the motor network.1 Accordingly, rs-fMRI in MS is particularly suited to investigate functional reorganisation of the motor network in the remission phase after a relapse because the resting-state connectivity pattern is not influenced by interindividual differences in motor ability and task performance. In this prospective rs-fMRI study, we mapped acute changes in resting-state motor connectivity in 12 patients with relapsing forms of MS presenting with an acute relapse involving an upper limb paresis. Previous functional MRI (fMRI) studies have shown that the activation of sensorimotor areas was stronger and more widespread in the brain of patients with MS compared to healthy controls and increased proportionally with the extent of MS-related brain damage.2 We therefore hypothesised that a motor relapse involving paresis of the upper limbs would trigger an acute compensatory increase in motor resting-state connectivity and that the compensatory increase in functional connectivity would decrease over the following days or weeks in proportion to the degree of clinical remission.