Stefan Spiteri1, Thomas Hassa1, Dolores Claros-Salinas2, Christian Dettmers3, Mircea Ariel Schoenfeld4. 1. Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany. 2. Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Konstanz, Germany. 3. Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Konstanz, Germany/Department of Psychology, University of Konstanz, Konstanz, Germany. 4. Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Heidelberg, Germany/Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany/Leibniz-Institute for Neurobiology, Magdeburg, Germany.
Abstract
BACKGROUND: Among patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom. It can be subdivided into an effort-dependent (fatigability) and an effort-independent component (trait-fatigue). OBJECTIVE: The objective was to disentangle activity changes associated with effort-independent "trait-fatigue" from those associated with effort-dependent fatigability in MS patients. METHODS: This study employed behavioral measures and functional magnetic imaging to investigate neural changes in MS patients associated with fatigue. A total of 40 MS patients and 22 age-matched healthy controls performed in a fatigue-inducing N-back task. Effort-independent fatigue was assessed using the Fatigue Scale of Motor and Cognition (FSMC) questionnaire. RESULTS: Effort-independent fatigue was observed to be reflected by activity increases in fronto-striatal-subcortical networks primarily involved in the maintenance of homeostatic processes and in motor and cognitive control. Effort-dependent fatigue (fatigability) leads to activity decreases in attention-related cortical and subcortical networks. CONCLUSION: These results indicate that effort-independent (fatigue) and effort-dependent fatigue (fatigability) in MS patients have functionally related but fundamentally different neural correlates. Fatigue in MS as a general phenomenon is reflected by complex interactions of activity increases in control networks (effort-independent component) and activity reductions in executive networks (effort-dependent component) of brain areas.
BACKGROUND: Among patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom. It can be subdivided into an effort-dependent (fatigability) and an effort-independent component (trait-fatigue). OBJECTIVE: The objective was to disentangle activity changes associated with effort-independent "trait-fatigue" from those associated with effort-dependent fatigability in MSpatients. METHODS: This study employed behavioral measures and functional magnetic imaging to investigate neural changes in MSpatients associated with fatigue. A total of 40 MSpatients and 22 age-matched healthy controls performed in a fatigue-inducing N-back task. Effort-independent fatigue was assessed using the Fatigue Scale of Motor and Cognition (FSMC) questionnaire. RESULTS: Effort-independent fatigue was observed to be reflected by activity increases in fronto-striatal-subcortical networks primarily involved in the maintenance of homeostatic processes and in motor and cognitive control. Effort-dependent fatigue (fatigability) leads to activity decreases in attention-related cortical and subcortical networks. CONCLUSION: These results indicate that effort-independent (fatigue) and effort-dependent fatigue (fatigability) in MSpatients have functionally related but fundamentally different neural correlates. Fatigue in MS as a general phenomenon is reflected by complex interactions of activity increases in control networks (effort-independent component) and activity reductions in executive networks (effort-dependent component) of brain areas.
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