ICM Paris Brain Institute

The ability to decide and act autonomously is a distinctive feature of human cognition. From a motor neurophysiology viewpoint, these 'voluntary' actions can be distinguished by the lack of an obvious triggering sensory stimulus: the action is considered to be a product of thought, rather than a reflex result of a specific input. A reverse engineering approach shows that such actions are caused by neurons of the primary cortex, which in turn depend on medial frontal areas, and finally a combination of prefrontal cortical connections and subcortical drive from basal ganglia loops. One traditional marker of voluntary action is the EEG readiness potential (RP), recorded over the frontal cortex prior to voluntary actions. However, the interpretation of this signal remains controversial, and very few experimental studies have attempted to link the RP to the thought process that lead to voluntary action. In this talk, I will report new studies that show learning an internal model about the optimum delay at which to act influences the amplitude of the RP. More generally, a scientific understanding of voluntariness and autonomy will require new neurocognitive paradigms connecting thought and action.

We recently analyzed a large cohort of multiple sclerosis (MS) autopsy cases of the Netherlands Brain Bank (NBB) and showed that 57% of the lesion in advanced MS is active (containing activated microglia/macrophages). These active lesions correlated with disease severity and differed between males and female MS patients.1 Already in normal appearing white matter microglia show early signs of demyelination.5 T cells are also frequently present in advanced stages of MS and have a tissue resident memory (Trm) phenotype, are more frequently CD8+ then CD4+, are located perivascular, enriched in active and mixed active/inactive MS lesions and correlated with lesion activity, lesion load and disease severity.2-4 Like Trm cells, B cells are located perivascular and were also enriched in active MS lesions but in lower numbers and a proportion of the MS patients had almost no detectable B cells in the regions analyzed. MS patients with limited presence of B cells had less severe MS, and less active and mixed active /inactive lesions. We conclude that advanced MS is characterize by a high innate and adaptive immune activity which is heterogeneous and relates to the clinical disease course.