Operant Up-Conditioning of the Tibialis Anterior Motor-Evoked Potential in Multiple Sclerosis: Feasibility Case Studies

Figure 3

TA MEP (filled triangle), MVC (cross), and SP (circle) over 3.3 years of study including baseline to conditioning to follow-up periods in subject A. During the follow-up period (i.e., after 8 weeks of conditioning), her official diagnosis changed (from secondary progressive MS to relapsing-remitting MS) and so did her medication. Notable events in her life and neurological/medical history during the study period are indicated as A–J. (A) A few days after the first rituximab injection. (B) Feeling tired due to personal life issue. (C) Going through divorce. (D) Cortical mapping had been redone. TMS location was changed from “2.5 cm lateral and 1.5 cm anterior to the vertex”. (E) Kidney infection. (F) MS relapse diagnosed; started taking dimethyl fumarate (tecfidera); her gait had worsened. No visible ankle dorsiflexion. (Visible dorsiflexion returned several weeks later.) (G) Frequent urinary tract infection for the past several weeks. (H) Started taking ropinirole hydrochloride (requip). Also started on tamsulosin and oxybutynin for UTI treatment/prevention. (I) Her mother just had a stroke. (J) Started taking interferon beta Ia (avonex). Throughout this lengthy follow-up and many life events, the MEP and MVC increases and the SP decrease associated with MEP up-conditioning persisted.