Abstract

Objective
Fingolimod is an effective disease modifying therapy for multiple sclerosis (MS). Beyond its main action on peripheral lymphocytes, several noteworthy side effects have been demonstrated in vitro, among which modulation of neural excitability. Our aim was to explore cortical excitability in vivo in patients treated with fingolimod 0.5 mg/day.

Methods
Paired-pulse TMS was applied on the left primary motor cortex in 13 patients affected by relapsing–remitting MS, the day before the first dose of fingolimod (T0) and 60 days later (T1). Resting motor threshold, baseline motor evoked potentials, short interval intracortical inhibition (at 1, 3, 5 ms) and intracortical facilitation (at 7, 9, 11 and 13 ms) were estimated at T0 and T1.

Results
Intracortical facilitation was reduced at T1, without any changes in short interval intracortical inhibition.

Conclusions
Fingolimod selectively reduced intracortical facilitation, which is mainly mediated by glutamate.

Labels: Study