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Is central fatigue in multiple sclerosis a disorder of movement preparation?

Francesca Morgante1, Vincenzo Dattola, Domenica Crupi

  • 1Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Via Consolare Valeria 1, 98125, Messina, Italy.

Journal of Neurology
|September 23, 2010
PubMed

Insights

Fatigue in multiple sclerosis (MS) may stem from impaired cortical motor preparation. Patients with MS fatigue showed reduced pre-movement facilitation and increased frontal lobe lesions, correlating with fatigue severity.

Area of Science:

  • Neuroscience
  • Neurology
  • Clinical Neurophysiology

Background:

  • Fatigue is a common and disabling symptom in multiple sclerosis (MS).
  • The underlying mechanisms of MS fatigue, particularly central fatigue, remain incompletely understood.
  • This study investigates the role of cortical motor preparation dysfunction in MS fatigue.

Purpose of the Study:

  • To test the hypothesis that fatigue in MS is linked to dysfunction in cortical areas responsible for movement preparation.
  • To differentiate neurophysiological and imaging markers between MS patients with and without fatigue.

Main Methods:

  • Combined magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) in 33 MS patients (16 with fatigue, 17 without) and 12 healthy controls.
  • MRI assessed lesion load (LL) and brain volume. TMS evaluated motor pathways, intracortical inhibition/facilitation, and pre-movement facilitation.
  • Assessed the effect of 5-Hz repetitive TMS (rTMS) on motor evoked potential (MEP) size.

Main Results:

  • MS patients with fatigue (MS-F) exhibited significantly higher frontal lobe lesion load compared to those without fatigue (MS-NF).
  • No differences in short intracortical inhibition (SICI) or short intracortical facilitation (ICF) were found between groups.
  • The facilitation of MEP size by 5-Hz rTMS, observed in controls, was absent in both MS groups. MS-F patients lacked pre-movement facilitation compared to MS-NF and controls.
  • Lack of pre-movement facilitation and increased frontal LL correlated significantly with fatigue severity scores.

Conclusions:

  • Central fatigue in MS appears associated with dysfunction in cortical motor areas involved in movement preparation.
  • Frontal lobe lesion load and impaired pre-movement cortical processing are potential contributors to MS-related fatigue.

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