LET'S - ISTC - CNR, Catholic University of the Sacred Heart, Rome, Italy.
Mult Scler. 2020 Dec;26(14):1809-1815. doi: 10.1177/1352458520912175. Epub 2020 Mar 12.
Fatigue in multiple sclerosis (MS) is a highly invalidating symptom, lacking efficacious drugs. This topical review aims at assessing the signs in the literature of functional versus structural damage prevalence at the origin of MS fatigue by focusing on papers that assessed the two counterparts in the same patients, paying attention that the fatigue levels do not correlate with clinical severity. We summarize and discuss evidence of increased levels of fatigue occurring together with the alterations of functional connectivity at multiple levels, in the absence of any relationship with lesion load and local atrophy of the involved structures. Specifically, neuronal communication mainly altered in the corticomuscular synchronizations, between hemispheric homologs and in the resting-state networks involved in emotion (cingulate cortex) and effort-reward balance (striatum and inferior parietal lobule). Finally, given the functional prevalence in neuronal network alterations at the origin of fatigue in MS, we highlight the relevance of developing treatments aiming at compensating the neuronal electric communication dysfunctions.
多发性硬化症（MS）中的疲劳是一种高度致残的症状，缺乏有效的药物。本专题综述旨在评估文献中 MS 疲劳的起源是功能性损伤还是结构性损伤更为常见的迹象，重点关注在同一患者中评估这两种损伤的论文，并注意到疲劳水平与临床严重程度无关。我们总结并讨论了证据表明，在没有任何关系到病变负荷和受累结构的局部萎缩的情况下，多发性水平的功能连接的改变与疲劳水平的增加同时发生。具体而言，神经元通信主要改变在皮质肌肉同步、半球同源物之间以及涉及情绪（扣带皮层）和努力-奖励平衡（纹状体和下顶叶小叶）的静息状态网络中。最后，鉴于 MS 疲劳起源中神经元网络改变的功能普遍性，我们强调了开发旨在补偿神经元电通信功能障碍的治疗方法的重要性。
