title: Post-stroke fatigue: a problem of altered corticomotor control?
abstract: OBJECTIVE
  We recently showed that diminished motor cortical excitability is associated with high levels of post-stroke fatigue. Motor cortex excitability impacts movement parameters such as reaction and movement times. We predicted that one or both would be influenced by the presence of post-stroke fatigue.
  
  
  METHODS
  41 first-time stroke survivors (high fatigue n=21, Fatigue Severity Scale 7 (FSS-7) score >5; low fatigue n=20, FSS-7 score <3) participated in the study. Movement times, choice and simple reaction times were measured in all participants.
  
  
  RESULTS
  A three way ANOVA with fatigue (high and low), task (movement time, simple reaction time and choice reaction time) and hand (affected and unaffected) as the three factors, revealed a significant difference between affected (but not unaffected) hand movement times in the high compared to low fatigue groups. Reaction times, however, were not different between the high-fatigue and low-fatigue groups in either the affected or unaffected hand.
  
  
  CONCLUSIONS
  Previously, we showed that motor cortex excitability is lower in patients with high post-stroke fatigue. Our current findings suggest that post-stroke fatigue (1) is a problem of movement speed (possibly a consequence of diminished motor cortex excitability) and not movement preparation, and (2) may have a focal origin confined to the lesioned hemisphere. We suggest that low motor cortex excitability in the lesioned hemisphere is a viable therapeutic target in post-stroke fatigue.
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, UCL, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kuppuswamy
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, UCL, London, UK.
authors.forename: E V
authors.initials: EV
authors.lastname: Clark
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, UCL, London, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Sandhu
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, UCL, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Rothwell
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, UCL, London, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Ward
mesh_terms: D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology; D011930:Reaction Time / Q000502:physiology; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology
keywords: STROKE