Intracortical inhibition abnormality during the remission phase of multiple sclerosis is related to upper limb dexterity and lesions

•Cortical silent period (CSP) prolongation is related to upper extremity impairment of people with relapsing-remitting multiple sclerosis (RRMS) in remission.•Normalized lesion volume is correlated with longer CSP duration, while cortical thickness is not.•CSP duration predicts motor impairment independently of lesion volume.

ObjectiveThe impact of inhibitory cortical activity on motor impairment of people with relapsing-remitting multiple sclerosis (RRMS) has not been fully elucidated despite its relevance to neurorehabilitation. The present study assessed the extent to which transcranial magnetic stimulation (TMS)-based metrics of intracortical inhibition are related to motor disability and brain damage.MethodsParticipants included forty-three persons with RRMS in the remitting phase and twenty-nine healthy controls. We stimulated the dominant hemisphere and recorded from the dominant hand to assess short-interval intracortical inhibition (SICI) and cortical silent period (CSP) duration. Disability was evaluated with the Multiple Sclerosis Functional Composite (MSFC). Regional cortical thickness and lesion volume were measured.ResultsRRMS participants with dominant upper limb dexterity impairments had prolonged CSP, but equivalent SICI, compared to participants with preserved function. CSP was not related to walking or cognitive performance. Higher normalized lesion volume correlated with longer CSP duration. When adjusting for normalized lesion volume, longer CSP significantly predicted worse dominant upper extremity impairment.ConclusionsHigh intracortical inhibition possibly contributes to (or prevents remission from) motor impairment. Lesions may be associated with intracortical inhibition shifts.SignificanceCSP duration and lesion burden should be considered when developing interventions aiming to mitigate motor impairment.