In response to the lesions caused by multiple sclerosis, the brain does not remain passive. It has an extraordinary ability to reorganize, create new connections, and find alternative pathways to maintain its functions: this is called brain plasticity or neuroplasticity. This capacity for adaptation is a significant source of hope for people with MS, as it can be actively stimulated to compensate for damage and preserve cognitive abilities.

What is brain plasticity?

Brain plasticity refers to the brain's ability to change, reorganize, and adapt throughout life. Contrary to what was long believed, the brain is not fixed once adulthood is reached: it continues to create new connections between neurons, strengthen certain circuits, and weaken others, even generating new neurons in certain regions. This plasticity is the biological basis of learning and memory, as well as recovery after a brain injury.

In the context of multiple sclerosis, brain plasticity takes on particular importance. When an area of the brain is damaged by a demyelinating plaque, other areas can take over and ensure the disrupted function. This compensatory mechanism explains why some people maintain relatively preserved cognitive abilities despite numerous visible lesions on MRI.

Brain plasticity in MS: scientific evidence

Functional brain imaging studies have provided solid evidence of brain plasticity at work in multiple sclerosis. When people with MS are asked to perform cognitive tasks during a functional MRI, different patterns of brain activation are often observed compared to healthy individuals: more brain regions are recruited to accomplish the same task.

This expanded activation reflects the compensatory efforts deployed by the brain. In the face of lesions that slow down or block certain neural pathways, the brain recruits alternative circuits. This compensatory plasticity allows cognitive performance to be maintained despite damage, at least up to a certain point. It also explains why two individuals with a similar lesion load on MRI can have very different cognitive abilities.

Cognitive reserve: a shield against lesions

The concept of cognitive reserve is closely linked to brain plasticity. Cognitive reserve represents the brain's ability to tolerate damage before it manifests as cognitive symptoms. It is built throughout life through education, stimulating intellectual activities, a rich social life, and varied experiences.

People with high cognitive reserve have more resources to compensate for MS lesions. Their brains have developed more connections and processing strategies, offering more alternatives when certain pathways are damaged. This is why cognitive stimulation is so important: it helps build and maintain this protective reserve.

My neurologist showed me my MRIs with many lesions and told me that according to the images, I should have more difficulties than I feel. He explained that my brain was compensating remarkably well, probably thanks to my cognitive reserve. It motivated me to continue my intellectual activities and daily cognitive stimulation.

Nathalie, 44 years old, MS for 9 years

How to stimulate brain plasticity

Brain plasticity is not a passive phenomenon that can only be observed. It can be actively stimulated by our behaviors and activities. Several factors promote plasticity and the brain's ability to compensate for lesions.

Cognitive stimulation: exercising your brain

The brain operates on the principle of use it or lose it: frequently used connections are strengthened, while those that are neglected weaken. Regular cognitive stimulation with programs like EDITH and JOE keeps neural circuits active and promotes the creation of new connections. The more the brain is challenged in varied ways, the more it develops potential alternative pathways.

• Variety of exercises: Engage different cognitive functions (memory, attention, language, reasoning) to develop a versatile brain
• Progression of difficulty: A suitably challenging task stimulates plasticity, while a task that is too easy does not provoke adaptation
• Regularity: Frequent and short sessions are more effective than long but spaced-out sessions
• Novelty: Learning new things particularly stimulates brain plasticity

Physical activity: a booster of plasticity

Physical exercise is one of the most powerful stimulants of brain plasticity. It increases the production of neurotrophic factors, notably BDNF (Brain-Derived Neurotrophic Factor), a protein that promotes the survival of existing neurons and the creation of new neurons and synapses. Physical activity also improves cerebral blood flow, bringing more oxygen and nutrients to the brain.

For people with MS, adapted physical activity is doubly beneficial: it stimulates brain plasticity while improving physical abilities, sleep, mood, and fatigue. Walking, swimming, cycling, yoga: the options are numerous and can be adapted to each person's abilities.

Sleep: consolidation time

Sleep plays a crucial role in brain plasticity. It is during sleep that the learnings of the day are consolidated, synaptic connections are strengthened or pruned, and the brain cleanses itself of metabolic waste. Quality sleep is therefore essential to fully benefit from cognitive stimulation and to maintain optimal brain plasticity.

A neuroprotective diet

Some nutrients promote brain plasticity. Omega-3s, abundant in fatty fish, are essential components of neuronal membranes and promote the production of BDNF. Antioxidants found in colorful fruits and vegetables protect neurons from oxidative stress. A balanced Mediterranean-style diet provides all the necessary nutrients for the proper functioning and plasticity of the brain.

EDITH and JOE: programs designed to stimulate plasticity

The EDITH and JOE programs from DYNSEO have been designed with the principles of brain plasticity in mind. They offer varied exercises that engage different cognitive functions, with progressive difficulty that keeps the challenge at an optimal level to stimulate the brain's adaptation.

The variety of exercises

EDITH and JOE offer dozens of different games targeting memory, attention, language, reasoning, and visuospatial functions. This variety is essential to stimulate plasticity throughout the brain, not just in certain regions. By varying the exercises, you develop a more versatile brain, with more resources to compensate for potential lesions.

Adaptive difficulty

To stimulate plasticity, the exercise must represent a challenge: neither too easy (no stimulation) nor too difficult (discouragement and stress). The DYNSEO programs adapt to your level and progress with you. EDITH offers three levels of difficulty to suit your current ability, while JOE automatically adjusts the level to keep you in the optimal progression zone.

Progress tracking

Seeing your progress is motivating and reflects the plasticity at work. The detailed statistics from EDITH and JOE allow you to track your evolution over time. These improvements, even modest, reflect the strengthening of neural connections and the construction of new pathways in your brain.

When I started EDITH a year ago, some exercises seemed really difficult to me. Today, I do them easily and have progressed to higher levels. My neurologist told me that this improvement in my performance reflects the plasticity of my brain at work. It gives me hope.

Michel, 56 years old, MS for 18 years

The limits of brain plasticity

While brain plasticity is a significant source of hope, it is also important to know its limits to have realistic expectations. The brain's compensatory capacity is not infinite and depends on several factors.

The available reserve

The capacity for compensation depends on the available cognitive and brain reserve. The more lesions accumulate, the more reserve resources are called upon. At a certain point, the reserve can be depleted and cognitive symptoms appear. This is why it is important to build and maintain your reserve through cognitive stimulation, especially early in the disease.

The energy cost of compensation

Brain compensation has an energy cost. Using alternative pathways, recruiting more brain regions for the same task consumes more energy. This partly explains why people with MS become mentally fatigued more quickly: their brains work harder to maintain the same performance. Cognitive fatigue is somewhat the price to pay for this remarkable compensation.