Correlation between fatigue and brain atrophy and lesion load in multiple sclerosis patients independent of disability

J Neurol Sci. 2007 Dec 15;263(1-2):15-9. doi: 10.1016/j.jns.2007.07.004. Epub 2007 Aug 1.


Background: Fatigue is a major problem in multiple sclerosis (MS), and its association with MRI features is debated.

Objective: To study the correlation between fatigue and lesion load, white matter (WM), and grey matter (GM), in MS patients independent of disability.

Methods: We studied 222 relapsing remitting MS patients with low disability (scores <or=2 at the Kurtzke Expanded Disability Status Scale). Lesion load, WM and GM were measured by fully automated, operator-independent, multi-parametric segmentation method. T1 and T2 lesion volume were also measured by a semi-automated method. Fatigue was assessed by the Fatigue Severity Scale (FSS), and patients divided in high-fatigue (FSS>or=5; n=197) and low-fatigue groups (FSS<or=4; n=25).

Results: High-fatigue patients showed significantly higher abnormal white matter fraction (AWM-f), T1 and T2 lesion loads, and significant lower WM-f, and GM-f. Multivariate analysis showed that high FSS was significantly associated with lower WM-f, and GM-f. Females and highly educated patients were significantly less fatigued.

Conclusion: These results suggest that among MS patients with low disability those with high-fatigue show higher WM and GM atrophy and higher lesion load, and that female sex and higher levels of education may play a protective role towards fatigue. Furthermore, they suggest that in MS, independent of disability, WM and GM atrophy is a risk factor to have fatigue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Atrophy
  • Brain / blood supply
  • Brain / pathology*
  • Brain Mapping
  • Disability Evaluation
  • Fatigue / pathology*
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Magnetic Resonance Imaging / methods
  • Male
  • Multiple Sclerosis / complications*
  • Oxygen / blood
  • Statistics as Topic*


  • Oxygen