The relationship between diffuse axonal damage and fatigue in multiple sclerosis

被引:149
作者
Tartaglia, MC
Narayanan, S
Francis, SJ
Santos, AC
De Stefano, N
Lapierre, Y
Arnold, DL
机构
[1] Montreal Neurol Hosp & Inst, Dept Neurol & Neurosurg, Montreal, PQ H3A 2B4, Canada
[2] Univ Siena, Inst Neurol Sci, I-53100 Siena, Italy
[3] Univ Siena, NMR Ctr, I-53100 Siena, Italy
关键词
D O I
10.1001/archneur.61.2.201
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Fatigue is a common and distressing symptom for patients with multiple sclerosis (MS). There is growing evidence that fatigue in MS has a central nervous system component. We hypothesized that diffuse cerebral axonal damage could be associated with fatigue and used proton magnetic resonance spectroscopy to non-invasively measure axonal damage or loss in the brains of patients with MS. Objective: To assess the strength of the relationship between central brain N-acetylaspartate and fatigue. Design: Data from 73 patients who had undergone proton magnetic resonance spectroscopy imaging and completed the Fatigue Severity Scale questionnaire were analyzed. Results: The N-acetylaspartate-creatine ratio (NAA/Cr) was significantly lower in the high-fatigue group than the low-fatigue group (mean +/-SD, 2.69+/-0.29 and 2.99+/-0.33, respectively. P=.003). Independent of the Kurtzke Expanded Disability Status Scale, T2 lesion volume, age, and disease duration, NAA/Cr was significantly lower in the high-fatigue group as compared with the low-fatigue group. There was a statistically significant linear correlation between the Fatigue Severity Scale scores and NAA/Cr (Spearman rank p=-0.361, P=.02). Conclusions: The results of this study, combined with those of others, suggest that widespread axonal dysfunction is associated with fatigue in MS. Increased recruitment of cortical areas and pathways in response to brain injury may be responsible for the patient's sense that the effort required to perform actions is disproportionately high.
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页码:201 / 207
页数:7
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