Management of multiple sclerosis fatigue in the digital age: from assessment to treatment.

Fatigue is one of the most disabling symptoms of Multiple Sclerosis (MS), affecting more than 80% of patients over the disease course. Nevertheless, it has a multi-faceted and complex nature, making its diagnosis, evaluation, and treatment extremely challenging in clinical practice. In the last years, digital supporting tools have emerged to support the care of people with MS. These include not only smartphone or table-based apps, but also wearable devices or novel techniques such as virtual reality. Furthermore, an additional effective and cost-efficient tool for the therapeutic management of people with fatigue is becoming increasingly available. Virtual reality and e-Health are viable and modern tools to both assess and treat fatigue, with a variety of applications and adaptability to patient needs and disability levels. Most importantly, they can be employed in the patient's home setting and can not only bridge clinic visits but also be complementary to the monitoring and treatment means for those MS patients who live far away from healthcare structures. In this narrative review, we discuss the current knowledge and future perspectives in the digital management of fatigue in MS. These may also serve as sources for research of novel digital biomarkers in the identification of disease activity and progression.

The importance of resource allocation for the interplay between automatic and cognitive control in response inhibition - An EEG source localization study.

Goal-directed behavior often requires the inhibition of prepotent automatic responses. Response inhibition encompasses several top-down cognitive operations embedded in a neural network extending from fronto-cortical regions to subcortical nuclei. Yet, it has remained unclear whether the early allocation of cognitive resources also modulates response inhibition performance and neural structures involved in this process. To investigate this question, we used a Simon Nogo task, which was designed to manipulate the relationship between automaticity and cognitive control during response inhibition, and combined it with an electroencephalogram (EEG) and source localization approach. We showed that the early allocation of cognitive resources, as reflected by the P2 amplitude, might be a critical determinant in the interplay between automaticity and cognitive control in response inhibition. Specifically, the obtained results demonstrated that individual variations in cognitive resource allocation modulated the need for conflict monitoring and engagement in cognitive control processes, as reflected by N2 and P3b amplitudes, respectively. Importantly, larger P2 amplitudes were associated with higher activation in cortical regions encompassing the temporo-parietal junction (TPJ). This stresses the importance of this cortical region for the encoding of relevant stimulus information to resolve conflicting contexts in response inhibition. The increased cognitive control in more automatic contexts was also reflected by higher activation of the superior and medial frontal cortices. These findings provide a new perspective on response inhibition, suggesting that early resource allocation is a central modulator of the interaction between automaticity and cognitive control.

Why Cognitive-Cognitive Dual-Task Testing Assessment Should Be Implemented in Studies on Multiple Sclerosis and in Regular Clinical Practice.

Cognitive impairment is prevalent and disabling in multiple sclerosis (MS) and is severely impacting quality of life (QoL). Aside its routine assessment in clinical care, it should more often be implemented as endpoint/outcome measure in clinical trials. However, a fundamental aspect-often neglected in clinical practice and clinical trials-is the assessment of multi-tasking and dual-tasking abilities. In this perspective article, we outline why, given the nature of MS, particularly the assessment of "cognitive-cognitive dual-tasking" is relevant in MS. We delineate how knowledge from basic cognitive science can inform the assessment of this important cognitive impairment in MS. Finally, we outline how the assessment of "cognitive-cognitive dual-tasking" can be implemented in computer-based screening tools (e-health devices) that can be used not only in clinical diagnostics but also in clinical trials.