Correlation between fatigue and brain atrophy and lesion load in multiple sclerosis patients independent of disability.
BACKGROUND
Fatigue is a major problem in multiple sclerosis (MS), and its association with MRI features is debated.


OBJECTIVE
To study the correlation between fatigue and lesion load, white matter (WM), and grey matter (GM), in MS patients independent of disability.


METHODS
We studied 222 relapsing remitting MS patients with low disability (scores <or=2 at the Kurtzke Expanded Disability Status Scale). Lesion load, WM and GM were measured by fully automated, operator-independent, multi-parametric segmentation method. T1 and T2 lesion volume were also measured by a semi-automated method. Fatigue was assessed by the Fatigue Severity Scale (FSS), and patients divided in high-fatigue (FSS>or=5; n=197) and low-fatigue groups (FSS<or=4; n=25).


RESULTS
High-fatigue patients showed significantly higher abnormal white matter fraction (AWM-f), T1 and T2 lesion loads, and significant lower WM-f, and GM-f. Multivariate analysis showed that high FSS was significantly associated with lower WM-f, and GM-f. Females and highly educated patients were significantly less fatigued.


CONCLUSIONS
These results suggest that among MS patients with low disability those with high-fatigue show higher WM and GM atrophy and higher lesion load, and that female sex and higher levels of education may play a protective role towards fatigue. Furthermore, they suggest that in MS, independent of disability, WM and GM atrophy is a risk factor to have fatigue.
Department of Neurological Sciences, Second University of Naples, Naples, Italy. gioacchino.tedeschi@unina2.it
Gioacchino
G
Tedeschi
Daria
D
Dinacci
Luigi
L
Lavorgna
Anna
A
Prinster
Giovanni
G
Savettieri
Aldo
A
Quattrone
Paolo
P
Livrea
Corrado
C
Messina
Arturo
A
Reggio
Giovanna
G
Servillo
Vincenzo
V
Bresciamorra
Giuseppe
G
Orefice
Marcantonio
M
Paciello
Arturo
A
Brunetti
Andrea
A
Paolillo
Gabriella
G
Coniglio
Simona
S
Bonavita
Alfonso
A
Di Costanzo
Alessandra
A
Bellacosa
Paola
P
Valentino
Mario
M
Quarantelli
Francesco
F
Patti
Giuseppe
G
Salemi
Enrico
E
Cammarata
Isabella
I
Simone
Marco
M
Salvatore
Vincenzo
V
Bonavita
Bruno
B
Alfano
D000328:Adult; D000704:Analysis of Variance; D001284:Atrophy; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D001931:Brain Mapping; D004185:Disability Evaluation; D005221:Fatigue / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D010100:Oxygen / Q000097:blood; D013223:Statistics as Topic
D010100:Oxygen