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Consequently, we used a functional MRI (fMRI) backward masking task to study visual information processing stratifying unconscious and conscious in MS. Specifically, 30 persons with MS (pwMS) and 34 healthy controls (HC) were shown target stimuli followed by a mask presented 8\u2013150\u2009ms later and had to compare the target to a reference stimulus. Retinal integrity (via optical coherence tomography), optic tract integrity (visual evoked potential; VEP) and whole brain structural connectivity (probabilistic tractography) were assessed as complementary structural brain integrity markers. On a psychophysical level, pwMS reached conscious access later than HC (50 vs. 16\u2009ms, <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001). The delay increased with disease duration (<jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001, \u03b2\u00a0=\u00a0.37) and disability (<jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001, \u03b2\u00a0=\u00a0.24), but did not correlate with conscious information processing speed (Symbol digit modality test, \u03b2\u00a0=\u00a0.07, <jats:italic>p<\/jats:italic>\u00a0=\u2009.817). No association was found for VEP and retinal integrity markers. Moreover, pwMS were characterized by decreased brain activation during unconscious processing compared with HC. No group differences were found during conscious processing. Finally, a complementary structural brain integrity analysis showed that a reduced fractional anisotropy in corpus callosum and an impaired connection between right insula and primary visual areas was related to delayed conscious access in pwMS. Our study revealed slowed conscious access to visual stimulus material in MS and a complex pattern of functional and structural alterations coupled to unconscious processing of\/delayed conscious access to visual stimulus material in MS.<\/jats:p>","DOI":"10.1002\/hbm.25440","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T10:29:09Z","timestamp":1617791349000},"page":"3379-3395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Delayed access to conscious processing in multiple sclerosis: Reduced cortical activation and impaired structural connectivity"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4609-0956","authenticated-orcid":false,"given":"Arzu C.","family":"Has Silemek","sequence":"first","affiliation":[{"name":"Institut f\u00fcr Neuroimmunologie und Multiple Sklerose (INIMS) Universit\u00e4tsklinikum Hamburg\u2010Eppendorf (UKE)  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8073-102X","authenticated-orcid":false,"given":"Jean\u2010Philippe","family":"Ranjeva","sequence":"additional","affiliation":[{"name":"Aix\u2010Marseille University CNRS, CRMBM  Marseille Cedex France"},{"name":"APHM Hopital de la Timone, CEMEREM  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertrand","family":"Audoin","sequence":"additional","affiliation":[{"name":"Aix\u2010Marseille University CNRS, CRMBM  Marseille Cedex France"},{"name":"APHM Hopital de la Timone, CEMEREM  Marseille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Heesen","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Neuroimmunologie und Multiple Sklerose (INIMS) Universit\u00e4tsklinikum Hamburg\u2010Eppendorf (UKE)  Hamburg Germany"},{"name":"Klinik und Poliklinik f\u00fcr Neurologie Universit\u00e4tsklinikum Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan M.","family":"Gold","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Neuroimmunologie und Multiple Sklerose (INIMS) Universit\u00e4tsklinikum Hamburg\u2010Eppendorf (UKE)  Hamburg Germany"},{"name":"Charit\u00e9 \u2010 Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin Humboldt Universit\u00e4t zu Berlin, and Berlin Institute of Health (BIH), Klinik f\u00fcr Psychiatrie &amp; Psychotherapie und Medizinische Klinik m.S. 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