Il ruolo dell’Interocezione nella Sclerosi Multipla: Evidenze Cliniche e Implicazioni Riabilitative

Autori

  • Elena Piscopo Dipartimento di Psicologia, Università degli Studi della Campania “Luigi Vanvitelli”, Caserta, Italia. Autore responsabile per la corrispondenza: ele_piscopo@outlook.it

Parole chiave:

Sclerosi Multipla, Interocezione, Fatica, Metacognizione, Riabilitazione

Abstract

La sclerosi multipla (SM) è una malattia demielinizzante cronica del sistema nervoso centrale che colpisce le aree motorie, cognitive ed emotive, e la fatica è tra i sintomi più debilitanti. Recenti evidenze suggeriscono che un'alterata interocezione – la capacità di percepire e interpretare i segnali corporei interni – possa svolgere un ruolo chiave nella fisiopatologia della fatica nella SM. Questo articolo offre una revisione integrata dei processi interocettivi nella SM, concentrandosi sulle loro basi neuroanatomiche, sui correlati cognitivi e sulle implicazioni per la sintomatologia. Infine, è stato esplorato il potenziale terapeutico di nuovi interventi, tra cui approcci basati sull'embodiment, la stimolazione transcranica a corrente continua (tDCS) e la realtà virtuale (VR), incentrati sull'elaborazione interocettiva e sensomotoria per supportare la riabilitazione nella SM. Queste intuizioni sottolineano la necessità di considerare l'interocezione come un ambito promettente per la valutazione clinica e l'intervento nella sclerosi multipla.

 

doi: 10.53240/2025topic4n2.2.001

Riferimenti bibliografici

Baron, Y. J., Hatton, A., McKeon, P. O., Rome, K., Martin, D., & Dixon, J. (2019). Experiences of people with Multiple Sclerosis using textured insoles: an interpretive phenomenological exploration.

Barrett, L. F., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature reviews neuroscience, 16(7), 419-429.

Bonaz, B., Lane, R. D., Oshinsky, M. L., Kenny, P. J., Sinha, R., Mayer, E. A., & Critchley, H. D. (2021). Diseases, disorders, and comorbidities of interoception. Trends in neurosciences, 44(1), 39-51.

Craig, A. D. (2009). How do you feel—now? The anterior insula and human awareness. Nature reviews neuroscience, 10(1), 59-70.

Critchley, H. D., & Garfinkel, S. N. (2017). Interoception and emotion. Current opinion in psychology, 17, 7-14.

Damasio, A. R. (1999). How the brain creates the mind. Scientific American, 281(6), 112-117.

Danciut, I., Rae, C. L., Rashid, W., Scott, J., Bozzali, M., Iancu, M., ... & Cercignani, M. (2024). Understanding the mechanisms of fatigue in multiple sclerosis: linking interoception, metacognition and white matter dysconnectivity. Brain Communications, 6(5), fcae292.

Duan, H., Jing, Y., Li, Y., Lian, Y., Li, J., & Li, Z. (2023). Rehabilitation treatment of multiple sclerosis. Frontiers in immunology, 14, 1168821.

Eboni, A. C. B., Cardoso, M., Dias, F. M., Gama, P. D. D., Gomes, S., Goncalves, M. V. M., ... & Fragoso, Y. D. (2018). High levels of alexithymia in patients with multiple sclerosis. Dementia & neuropsychologia, 12(2), 212-215.

Fermin, A. S., Sasaoka, T., Maekawa, T., Chan, H. L., Machizawa, M. G., Okada, G., ... & Yamawaki, S. (2023). Insula neuroanatomical networks predict interoceptive awareness. Heliyon, 9(8).

Fischer, M. T., Wimmer, I., Höftberger, R., Gerlach, S., Haider, L., Zrzavy, T., ... & Lassmann, H. (2013). Disease-specific molecular events in cortical multiple sclerosis lesions. Brain, 136(6), 1799-1815.

Fleming, S. M., Dolan, R. J., & Frith, C. D. (2012). Metacognition: computation, biology and function. Philosophical transactions of the royal society B: Biological sciences, 367(1594), 1280-1286.

Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological psychology, 104, 65-74.

Giurgola, S., Casati, C., Stampatori, C., Perucca, L., Mattioli, F., Vallar, G., & Bolognini, N. (2022). Abnormal multisensory integration in relapsing–remitting multiple sclerosis. Experimental Brain Research, 240(3), 953-968.

Gonzalez Campo, C., Salamone, P. C., Rodríguez-Arriagada, N., Richter, F., Herrera, E., Bruno, D., ... & Sedeño, L. (2020). Fatigue in multiple sclerosis is associated with multimodal interoceptive abnormalities. Multiple Sclerosis Journal, 26(14), 1845-1853.

Haider, L., Fischer, M. T., Frischer, J. M., Bauer, J., Höftberger, R., Botond, G., ... & Lassmann, H. (2011). Oxidative damage in multiple sclerosis lesions. Brain, 134(7), 1914-1924.

Haider, L., Zrzavy, T., Hametner, S., Höftberger, R., Bagnato, F., Grabner, G., ... & Lassmann, H. (2016). The topograpy of demyelination and neurodegeneration in the multiple sclerosis brain. Brain, 139(3), 807-815.

Herbert, B. M. (2021). Interoception and its role for eating, obesity, and eating disorders. European Journal of Health Psychology.

Herbert, B. M., Pollatos, O., & Klusmann, V. (2021). Interoception and health. European Journal of Health Psychology.

Kalron, A. (2016). Gait variability across the disability spectrum in people with multiple sclerosis. Journal of the neurological sciences, 361, 1-6.

Khalsa, S. S., & Verdonk, C. (2024). Interoception and Mental Health. In Interoception: A Comprehensive Guide (pp. 265-316). Cham: Springer International Publishing.

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., et al. (2018a). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513.

Khalsa, S. S., Berner, L. A., & Anderson, L. M. (2022). Gastrointestinal interoception in eating disorders: charting a new path. Current psychiatry reports, 24(1), 47-60.

Kluger, B. M., Krupp, L. B., & Enoka, R. M. (2013). Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology, 80(4), 409-416.

Lassmann, H., Brück, W., & Lucchinetti, C. F. (2007). The immunopathology of multiple sclerosis: an overview. Brain pathology, 17(2), 210-218.

Maggio, M. G., De Luca, R., Manuli, A., Buda, A., Foti Cuzzola, M., Leonardi, S., ... & Calabrò, R. S. (2022). Do patients with multiple sclerosis benefit from semi-immersive virtual reality? A randomized clinical trial on cognitive and motor outcomes. Applied Neuropsychology: Adult, 29(1), 59-65.

Maggio, M. G., Russo, M., Cuzzola, M. F., Destro, M., La Rosa, G., Molonia, F., ... & Calabrò, R. S. (2019). Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes. Journal of Clinical Neuroscience, 65, 106-111.

Manjaly, Z. M., Harrison, N. A., Critchley, H. D., Do, C. T., Stefanics, G., Wenderoth, N., ... & Stephan, K. E. (2019). Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 90(6), 642-651.

Marotta, N., de Sire, A., Marinaro, C., Moggio, L., Inzitari, M. T., Russo, I., ... & Ammendolia, A. (2022). Efficacy of transcranial direct current stimulation (tdcs) on balance and gait in multiple sclerosis patients: a machine learning approach. Journal of Clinical Medicine, 11(12), 3505.

Paolucci, T., de Sire, A., Agostini, F., Bernetti, A., Salomè, A., Altieri, M., ... & Paoloni, M. (2022). Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial. Frontiers in Neurology, 13, 1095180.

Parma, C., Doria, F., Zulueta, A., Lanzone, J., Boscarino, M., Giani, L., ... & Sattin, D. (2024). An overview of the Bodily awareness representation and interoception: insights and progress in the field of Neurorehabilitation Research. Brain Sciences, 14(4), 386.

Petzschner, F. H., Weber, L. A., Gard, T., & Stephan, K. E. (2017). Computational psychosomatics and computational psychiatry: toward a joint framework for differential diagnosis. Biological psychiatry, 82(6), 421-430.

Pinilla, A., Garcia, J., Raffe, W., Voigt-Antons, J. N., Spang, R. P., & Möller, S. (2021). Affective visualization in virtual reality: An integrative review. Frontiers in Virtual Reality, 2, 630731.

Prakash, R. S., Schirda, B., Valentine, T. R., Crotty, M., & Nicholas, J. A. (2019). Emotion dysregulation in multiple sclerosis: Impact on symptoms of depression and anxiety. Multiple sclerosis and related disorders, 36, 101399.

Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in psychology, 9, 798.

Rouault, M., Pereira, I., Galioulline, H., Fleming, S. M., Stephan, K. E., & Manjaly, Z. M. (2023). Interoceptive and metacognitive facets of fatigue in multiple sclerosis. European Journal of Neuroscience, 58(2), 2603-2622.

Sagliano, L., Magliacano, A., Parazzini, M., Fiocchi, S., Trojano, L., & Grossi, D. (2019). Modulating interoception by insula stimulation: A double-blinded tDCS study. Neuroscience letters, 696, 108-113.

Salamone, P. C., Esteves, S., Sinay, V. J., García‐Cordero, I., Abrevaya, S., Couto, B., ... & Sedeño, L. (2018). Altered neural signatures of interoception in multiple sclerosis. Human brain mapping, 39(12), 4743-4754.

Stefancin, P., Govindarajan, S. T., Krupp, L., Charvet, L., & Duong, T. Q. (2019). Resting-state functional connectivity networks associated with fatigue in multiple sclerosis with early age onset. Multiple Sclerosis and Related Disorders, 31, 101-105.

Stephan, K. E., Manjaly, Z. M., Mathys, C. D., Weber, L. A., Paliwal, S., Gard, T., ... & Petzschner, F. H. (2016). Allostatic self-efficacy: A metacognitive theory of dyshomeostasis-induced fatigue and depression. Frontiers in human neuroscience, 10, 550.

Strigo, I. A., & Craig, A. D. (2016). Interoception, homeostatic emotions and sympathovagal balance. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1708), 20160010.

Ware, M., O’Connor, P., Bub, K., Backus, D., & McCully, K. (2023). Investigating relationships among interoceptive awareness, emotional susceptibility, and fatigue in persons with multiple sclerosis. International Journal of MS Care, 25(2), 75-81.

Wiebking, C., de Greck, M., Duncan, N. W., Tempelmann, C., Bajbouj, M., & Northoff, G. (2015). Interoception in insula subregions as a possible state marker for depression—an exploratory fMRI study investigating healthy, depressed and remitted participants. Frontiers in behavioral neuroscience, 9, 82.

Zhang, Y., Zhang, Q., Wang, J., Zhou, M., Qing, Y., Zou, H., ... & Yao, S. (2023). “Listen to your heart”: A novel interoceptive strategy for real-time fMRI neurofeedback training of anterior insula activity. Neuroimage, 284, 120455.

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Pubblicato

2025-10-20

Come citare

Piscopo, E. (2025). Il ruolo dell’Interocezione nella Sclerosi Multipla: Evidenze Cliniche e Implicazioni Riabilitative. TOPIC - Temi Di Psicologia dell’Ordine Degli Psicologi Della Campania, 4(2). Recuperato da https://topic.oprc.it/index.php/topic/article/view/99

Fascicolo

V. 4 N. 2 (2025): TOPIC - Temi di Psicologia dell’Ordine degli Psicologi della Campania

Sezione

Neuropsicologia e neuroscienze

Licenza

Copyright (c) 2025 TOPIC - Temi di Psicologia dell'Ordine degli Psicologi della Campania

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