van der Werf S P, Jongen P J, Lycklama à Nijeholt G J, Barkhof F, Hommes O R, Bleijenberg G
Department of Medical Psychology, University Hospital Nijmegen, The Netherlands.
J Neurol Sci. 1998 Oct 8;160(2):164-70. doi: 10.1016/s0022-510x(98)00251-2.
Although fatigue is a frequent complaint of patients with multiple sclerosis (MS), little is known about the origins of multiple-sclerosis-associated fatigue. Our primary focus was to study if the extent of cerebral abnormalities, as shown on magnetic resonance imaging (MRI), had any relation with the frequency and intensity of fatigue complaints of patients with a definite diagnosis of MS. Fatigue severity was rated by the patients with the use of a 2-week diary and a fatigue questionnaire, while conventional T1- and T2-weighted MRI provided several measures for cerebral abnormalities. In total, 72% of 45 patients reported to be seriously fatigued at least several times a week over the last 3-month period. Fatigue severity was not related to the total extent of cerebral abnormalities, or to MRI-based atrophy measures. Regional lesion load did not differ between fatigued and non-fatigued subjects. Although neurological disability, as measured by the Expanded Disability Status Scale (EDSS) and Neurological Rating Scale (NRS), did correlate significantly with most MRI measures, it showed no relation with fatigue severity. Neurological progression rates and number of exacerbations in the 2-year period prior to assessment were not significantly associated with the fatigue measures. Therefore, our findings suggest that differences in levels of self-reported fatigue in patients with multiple sclerosis cannot merely be explained by the degree of clinical disease activity, neurological disability or the extent of MRI abnormalities. These results are compared to other research findings and the possible role of alternative factors influencing fatigue in multiple sclerosis are discussed.
尽管疲劳是多发性硬化症（MS）患者常见的主诉，但对于多发性硬化症相关疲劳的根源却知之甚少。我们的主要研究重点是，研究磁共振成像（MRI）显示的脑部异常程度是否与明确诊断为MS的患者疲劳主诉的频率和强度存在任何关联。患者通过使用为期两周的日记和疲劳问卷对疲劳严重程度进行评分，而传统的T1加权和T2加权MRI提供了几种脑部异常的测量方法。在45名患者中，总计72%的患者报告在过去3个月中每周至少有几次严重疲劳。疲劳严重程度与脑部异常的总体程度或基于MRI的萎缩测量无关。疲劳组和非疲劳组之间的局部病灶负荷没有差异。尽管通过扩展残疾状态量表（EDSS）和神经功能评分量表（NRS）测量的神经功能障碍与大多数MRI测量结果显著相关，但它与疲劳严重程度无关。评估前2年的神经功能进展率和病情加重次数与疲劳测量结果无显著关联。因此，我们的研究结果表明，多发性硬化症患者自我报告的疲劳程度差异不能仅仅通过临床疾病活动程度、神经功能障碍或MRI异常程度来解释。将这些结果与其他研究结果进行了比较，并讨论了影响多发性硬化症疲劳的其他因素的可能作用。
