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Experienced and physiological fatigue in neuromuscular disorders
M L Schillings1, J S Kalkman, H M H A Janssen
1Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Summary
Neuromuscular patients experience significant fatigue due to reduced central activation, not peripheral issues. This central activation failure (CAF) may be linked to psychological factors and could be a target for future interventions.
Area of Science:
- Neurology
- Physiology
- Muscle Diseases
Background:
- Fatigue is a common symptom in neurological disorders, potentially stemming from peripheral or central nervous system changes.
- Understanding the physiological underpinnings of fatigue is crucial for managing neuromuscular conditions.
Purpose of the Study:
- To measure experienced fatigue and its physiological correlates in facioscapulohumeral dystrophy (FSHD), myotonic dystrophy (DM), and hereditary motor and sensory neuropathy type I (HMSN).
- To investigate the differences in peripheral and central fatigue mechanisms between patients with these neuromuscular disorders and healthy controls.
Main Methods:
- Sustained maximal voluntary contraction of the biceps brachii muscle was performed by 65 FSHD, 79 DM, 73 HMSN patients, and 24 controls.
- Experienced fatigue was assessed using the abbreviated fatigue questionnaire.
- Peripheral fatigue was quantified by force response amplitudes, muscle fiber conduction velocity was measured via EMG, and central fatigue was assessed using superimposed electrical endplate stimulation.
Main Results:
- Patients reported higher levels of experienced fatigue compared to controls.
- Peripheral and total physiological fatigue were less pronounced in patients.
- A significant central activation failure (CAF) was observed in all patient groups (36-41%) compared to controls (12%), correlating slightly with experienced fatigue.
Conclusions:
- Neuromuscular patients exhibit substantial central activation failure (CAF), the exact cause of which remains unclear but may involve reduced concentration, motivation, or fear of activity.
- Clinically, experienced fatigue and reduced central activation are significant components of neuromuscular disorders, potentially exacerbating weakness and suggesting avenues for therapeutic intervention.
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