Fatigue in multiple sclerosis is associated with the disruption of frontal and parietal pathways

• Published in: Multiple sclerosis Vol. 15; no. 3; pp. 337 - 344
• Main Authors: Sepulcre, J, Masdeu, JC, Goñi, J, Arrondo, G, Vélez de Mendizábal, N, Bejarano, B, Villoslada, P
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2009; Sage Publications; Sage Publications Ltd
• Subjects: Adult; Atrophy; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Fatigue - etiology; Fatigue - pathology; Female; Frontal Lobe - pathology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Multiple Sclerosis, Chronic Progressive - complications; Multiple Sclerosis, Chronic Progressive - pathology; Multiple Sclerosis, Relapsing-Remitting - complications; Multiple Sclerosis, Relapsing-Remitting - pathology; Neural Pathways - pathology; Neurology; Neuropsychological Tests; Parietal Lobe - pathology; gray matter atrophy; fatigue; voxel-based morphometry; white matter lesions; multiple sclerosis; Nervous system diseases; Multiple sclerosis; Fatigue; White matter; Inflammatory disease; Atrophy; Voxel; Central nervous system disease; Frontal; Parietal; Degenerative disease; Morphometry
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458508098373

Background Fatigue is one of the most frequent and disturbing symptoms in multiple sclerosis (MS), directly affecting the patient’s quality of life. However, many questions remain unclear regarding the anatomic brain correlate of MS-related fatigue. Objective To assess the relationship between fatigue and white matter lesion location and gray matter atrophy. Methods In this study, 60 patients with MS were evaluated with the Modified Fatigue Impact Scale and magnetic resonance imaging. Location of white matter lesion was analyzed using a voxel-by-voxel lesion probability mapping approach and gray matter atrophy degree and location using an optimized voxel-based morphometry method. Results We found a correlation between lesion load and fatigue score (T2 lesion load: r = 0.415, P = 0.001; T1 lesion load r = 0.328, P = 0.011). Moreover, fatigue correlated with lesions in the right parietotemporal (periatrial area, juxtaventricular white matter deep in the parietal lobe and callosal forceps) and left frontal (middle-anterior corpus callosum, anterior cingulum and centrum semiovale of the superior and middle frontal gyri) white matter regions (P < 0.001 in all cases). Finally, fatigue score significantly correlated with gray matter atrophy in frontal regions, specifically, the left superior frontal gyrus and bilateral middle frontal gyri (P < 0.001 in all cases). Conclusion Our results suggest that the symptom of fatigue is associated with a disruption of brain networks involved in cognitive/attentional processes.