Multiple facets of the cerebellum in multiple sclerosis

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Multiple facets of the cerebellum in multiple sclerosis

KALRON, Alon, ACHIRON, Anat, ALLALI, Gilles

KALRON, Alon, ACHIRON, Anat, ALLALI, Gilles. Multiple facets of the cerebellum in multiple sclerosis. Journal of Neurophysiology , 2019, vol. 121, no. 1, p. 345

DOI : 10.1152/jn.00829.2018 PMID : 30657009

Available at:

http://archive-ouverte.unige.ch/unige:133142

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LETTER TO THE EDITOR

Higher Neural Functions and Behavior

Multiple facets of the cerebellum in multiple sclerosis

Alon Kalron,^1,2,3 Anat Achiron,^2,3,4 and Gilles Allali^5,6,7

1Department of Physical Therapy, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel;²Sagol School of

Neurosciences, Tel-Aviv University, Tel-Aviv, Israel;³Sackler Faculty of Medicine, Tel-Aviv University, Israel;⁴Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel;⁵Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals, Geneva, Switzerland;⁶Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; and⁷Faculty of Medicine, University of Geneva, Geneva, Switzerland Submitted 11 December 2018; accepted in final form 20 December 2018

Recently, we read the paper by Schreck et al. (2018) regarding our recent publication “Cerebellum and cognition in multiple sclerosis: the fall status matters” (Kalron et al. 2018). The authors raised important points concerning the multiple facets of cerebellum integrating cognition, behavior, and movement in people with neurological diseases and in the aging population.

The authors comment on our classification of fallers and nonfallers. Fall status was based on the patient’s response to a single question: whether he/she fell during the past year. We believe that the implementation of new digital and remote communication tools will improve reporting accuracy of the incidence of falling, not only in the people with multiple sclerosis (MS) but also in other populations with a high risk of falling. This approach has been recently discussed by Marziniak et al. (2018). Further- more, these technologies can provide crucial information on the incidence of falling, i.e., where it occurred (indoor, outdoor), during which activity (walking, cleaning, dressing, etc.), and at what hour of the day. Moreover, these technologies might confirm whether the fall occurred in cognitive overload (i.e., dual tasking) or whether it was related to an ataxic gait pattern. We are confident that the information amassed from advanced technologies will improve our awareness of the role cognition plays in the incidence of falls and the specific role of the cerebellum in these conditions. Expanding our view of falls in people with MS is particularly valuable given the fact that risk factors for falls are multidimensional.

The authors correctly noted that patients with MS, classified as fallers, were significantly older than nonfallers. Bernard and Seidler (2014) demonstrated that structural alterations occur in the cerebellum with aging. Some may argue that the decreased cerebellar volumes found in the fallers may be attributed to age as opposed to disease progression. Although our model included statistical corrections for age, the results could have been slightly distorted by age-related confounders. We agree that isolating the effects of age and disease duration is vital when examining a clinical population suffering from progressive diseases, such as MS. We therefore encourage future research to challenge our findings through prospective designs, by following changes in cerebellar properties and by cognitive performance over time via different disability groups.

From a clinical perspective, researchers are encouraged to carry out randomized controlled trials examining the effectiveness of pharmacological/nonpharmacological interventions aim at im- proving cognition and/or reducing falls and whether the success of these programs depends on cerebellar structure and/or connectiv- ity. A greater challenge would be to examine via imaging, the impact of such interventions on cerebellar characteristics through- out short- and long-term periods of time. At present, research studies in this area are limited (Thomas et al. 2012; Zheng et al. 2018).

Finally, we call for a scientific conference deliberating this topic. We are confident that forging relationships with experts from various fields and discussing topics such as gait, falls, cognition, and brain imaging in MS will encourage innovative collaborations that will not only have scientific value but also work for the benefit of the patients.

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the authors.

AUTHOR CONTRIBUTIONS

A.K. and G.A. conceived and designed research; A.K. and G.A. drafted manuscript; A.K., A.A., and G.A. edited and revised manuscript; A.K., A.A., and G.A. approved final version of manuscript.

REFERENCES

Bernard JA, Seidler RD. Moving forward: age effects on the cerebellum underlie cognitive and motor declines.Neurosci Biobehav Rev42: 193–207, 2014. doi:10.1016/j.neubiorev.2014.02.011.

Kalron A, Allali G, Achiron A.Cerebellum and cognition in multiple sclerosis: the fall status matters.J Neurol265: 809–816, 2018. doi:10.1007/s00415-018-8774-2.

Marziniak M, Brichetto G, Feys P, Meyding-Lamadé U, Vernon K, Meuth SG.The use of digital and remote communication technologies as a tool for multiple sclerosis management: narrative review. JMIR Rehabil Assist Technol5: e5, 2018. doi:10.2196/rehab.7805.

Schreck L, Ryan S, Monaghan P.Cerebellum and cognition in multiple sclerosis.J Neurophysiol120: 2707–2709, 2018. doi:10.1152/jn.00245.2018.

Thomas AG, Dennis A, Bandettini PA, Johansen-Berg H.The effects of aerobic activity on brain structure.Front Psychol3: 86, 2012. doi:10.3389/

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Zheng G, Ye B, Zheng Y, Xiong Z, Xia R, Qiu P, Tao J, Chen L.The effects of exercise on the structure of cognitive related brain regions: a meta-analysis of functional neuroimaging data.Int J Neurosci, 2018. doi:

10.1080/00207454.2018.1508135.

Address for reprint requests and other correspondence: A. Kalron, Depart- ment of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University Israel (e-mail: alonkalr@post.tau.ac.il).

J Neurophysiol121: 345, 2019.

doi:10.1152/jn.00829.2018.

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