Fatigue and progression of corpus callosum atrophy in multiple sclerosis
Fatigue is one of the most disabling symptoms in multiple sclerosis (MS) patients. There is no or only weak correlation between conventional magnetic resonance imaging (MRI) parameters and level of fatigue. The aim of this study was to investigate the relationship between progression of corpus callosum (CC) atrophy and fatigue in MS patients. This was a cohort study in 70 patients with relapsing form of MS (RRMS) and serial MRIs over a mean follow-up of 4.8 years [67% female, mean age 42 ± 11 years, mean disease duration 9.7 ± 7.6 years, mean Expanded Disability Status Scale (EDSS) 2.8 ± 1.6]. Fatigue was assessed by the Fatigue Severity Scale (FSS). CC size was measured with the CC index (CCI). In total, 40% of the patients suffered from fatigue (mean FSS score 5.3 ±1.1) and 60% patients had no fatigue (mean FSS score of 2.1 ± 1). Patients with fatigue had higher EDSS scores (p = 0.01) and CC atrophy was more pronounced in patients with fatigue (−21.8 vs. −12.1%, p = 0.005). FSS correlated with CCI change over time (r = −0.33; p = 0.009) and EDSS (p = 0.008; r = 0.361). The association between annualized CCI change and FSS was independent from EDSS, disease duration, gender and age in a multivariate linear regression analysis (p < 0.001). Progression of CC atrophy may play a role in the evolution of MS-related fatigue.
KeywordsCorpus callosum index Corpus callosum atrophy Brain atrophy Fatigue Multiple sclerosis
Conflict of interest
OY reports receiving travel grants, advisory, consulting and lecture fees from Bayer Schering, Biogen Idec, Novartis and Merck Serono which are exclusively used for research at the University of Basel, department of neurology. NP reports that he is now an employee of Biogen Idec. He had previously received honoraria, travel grants, research grants and personal compensation from Bayer Healthcare, Biogen Idec, GSK, TEVA, Sanofi Aventis, Merck Serono and Novartis. BT has received travel grants and honoraria from Merck Serono, Biogen Idec and Bayer Healthcare. AG and AP had nothing to disclose.
- 25.Martola J, Stawiarz L, Fredrikson S, Hillert J, Bergstrom J, Flodmark O, Kristoffersen WM (2007) Progression of non-age-related callosal brain atrophy in multiple sclerosis: a 9-year longitudinal MRI study representing four decades of disease development. J Neurol Neurosurg Psychiatry 78:375–380PubMedGoogle Scholar
- 28.Nocentini U, Rossini PM, Carlesimo GA, Graceffa A, Grasso MG, Lupoi D, Oliveri M, Orlacchio A, Pozzilli C, Rizzato B, Caltagirone C (2001) Patterns of cognitive impairment in secondary progressive stable phase of multiple sclerosis: correlations with MRI findings. Eur Neurol 45:11–18PubMedCrossRefGoogle Scholar
- 31.Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, Lublin FD, Metz LM, McFarland HF, O’Connor PW, Sandberg-Wollheim M, Thompson AJ, Weinshenker BG, Wolinsky JS (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol 58:840–846PubMedCrossRefGoogle Scholar
- 33.Riccitelli G, Rocca M, Forn C, Colombo B, Comi G, Filippi M (2010) Definition of regional distribution of grey matter loss in multiple sclerosis patients with fatigue: a voxel-based morphometry study. J Neurol 257:S1–S246Google Scholar
- 35.Roelcke U, Kappos L, Lechner-Scott J, Brunnschweiler H, Huber S, Ammann W, Plohmann A, Dellas S, Maguire RP, Missimer J, Radu EW, Steck A, Leenders KL (1997) Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue: a 18F-fluorodeoxyglucose positron emission tomography study. Neurology 48:1566–1571PubMedGoogle Scholar