Frontal Networks Play a Role in Fatigue Perception in Multiple Sclerosis
Frontal Networks Play a Role in Fatigue Perception in Multiple Sclerosis
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DOI：
10.1037/a0019585
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发表时间：
2010-06-01
影响因子：
1.9
通讯作者：
Roccatagliata, Luca
中科院分区：
文献类型：
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作者：
Pardini, Matteo;Bonzano, Laura;Roccatagliata, Luca
疲劳是多发性硬化症(MS)患者的常见症状，它是一种极度缺乏体力或精神能量的症状。尽管人们提出了不同的机制来解释MS相关的疲劳，但不同解剖网络的损伤似乎与疲劳的病因学有关。特别是，理论指出额纹状体网络的病理变化可能是疲劳的神经基础。为了研究额叶-纹状体白质结构改变在疲劳感知中的作用，我们前瞻性地招募了40名复发缓解期MS患者和15名健康对照。在多发性硬化症患者中，使用修改的疲劳影响量表(MFIS；Kos等人，2005年)对疲劳进行评估。对每个登记了弥散张量成像的受试者进行脑部MRI扫描。使用分数各向异性图的体素分析和纤维束成像算法将扩散张量数据与MFIS评分相关联。在左额叶深层白质中发现了一组与疲劳评分相关的显著体素。纤维束造影术显示，该簇包括一个复杂的额额额、额纹状体、额枕叶和额缘网络。与疲劳感觉和临床相关的疲劳患者相关的被追踪的白质纤维束的结构特性被发现，与那些疲劳程度较低的患者相比，前述纤维束中的白质完整性降低。我们的观察显示，不同的额叶网络在疲劳的病理生理学中有重要的参与，因此解释了这种致残症状的多方面性质。
Fatigue, an overwhelming lack of physical or mental energy, is a common complaint in patients affected by multiple sclerosis (MS). Although different mechanisms have been proposed to explain MS-related fatigue, injury of distinct anatomical networks seems to be relevant in fatigue etiology. Particularly, theories point to fronto-striatal network pathological changes as a possible neural basis of fatigue. To investigate the role of fronto-striatal white matter structural alterations in fatigue perception we prospectively recruited 40 relapsing remitting patients with MS and 15 healthy controls. In patients with MS, fatigue was assessed using a validated measure, the Modified Fatigue Impact Scale (MFIS; Kos et al., 2005). Brain MRI scans were acquired for each subject enrolled with diffusion tensor imaging. Diffusion tensor data were correlated with MFIS scores using voxel-wise analysis of fractional anisotropy maps and fiber tractography algorithms. A significant cluster of voxels correlating with fatigue scores located in the deep left frontal white matter was identified. Fiber tractography revealed the cluster to be included in a complex fronto-frontal, fronto-striatal, fronto-occipital, and fronto-limbic network. Structural properties of the traced white matter fiber bundles correlated with fatigue perception and patients with clinically relevant fatigue were found to present reduced white matter integrity in the aforementioned tracts compared to those with lower levels of fatigue. Our observations show a significant involvement of different frontal networks in the pathophysiology of fatigue, thus accounting for the multifaceted nature of this disabling symptom.