Predictors of training-related improvement in visuomotor performance in patients with multiple sclerosis: A behavioural and MRI study

Mult Scler. 2021 Jun;27(7):1088-1101. doi: 10.1177/1352458520943788. Epub 2020 Aug 4.


Background: The development of tailored recovery-oriented strategies in multiple sclerosis requires early identification of an individual's potential for functional recovery.

Objective: To identify predictors of visuomotor performance improvements, a proxy of functional recovery, using a predictive statistical model that combines demographic, clinical and magnetic resonance imaging (MRI) data.

Methods: Right-handed multiple sclerosis patients underwent baseline disability assessment and MRI of the brain structure, function and vascular health. They subsequently undertook 4 weeks of right upper limb visuomotor practice. Changes in performance with practice were our outcome measure. We identified predictors of improvement in a training set of patients using lasso regression; we calculated the best performing model in a validation set and applied this model to a test set.

Results: Patients improved their visuomotor performance with practice. Younger age, better visuomotor abilities, less severe disease burden and concurrent use of preventive treatments predicted improvements. Neuroimaging localised outcome-relevant sensory motor regions, the microstructure and activity of which correlated with performance improvements.

Conclusion: Initial characteristics, including age, disease duration, visuo-spatial abilities, hand dexterity, self-evaluated disease impact and the presence of disease-modifying treatments, can predict functional recovery in individual patients, potentially improving their clinical management and stratification in clinical trials. MRI is a correlate of outcome, potentially supporting individual prognosis.

Keywords: MRI; Multiple sclerosis; brain plasticity; cognition; disease-modifying treatment; functional recovery; predictors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain
  • Hand
  • Humans
  • Magnetic Resonance Imaging
  • Multiple Sclerosis* / diagnostic imaging
  • Neuroimaging