Fatigue, a common symptom of multiple sclerosis, could be a result of regional damage in the brain.A study published in Radiology by a group in Italy led by Massimo Filippi, MD, from Vita-Salute San Raffaele University showed that local, rather than global, atrophy is associated with fatigue.

Sixty five patients with multiple sclerosis, 31 fatigued and 32 non-fatigued, and 35 control participants were analyzed with a specialized type of brain scan: dual-echo, double inversion-recovery, high-resolution T1-weighted and diffusion-tensor magnetic resonance imaging. The degree of atrophy and damage to lesions, normal-appearing white matter, and gray matter were compared among groups.

Between both types of multiple sclerosis patients and control participants, there was more global damage to gray and white matter in multiple sclerosis patients. But compared to nonfatigued patients and control participants, fatigued multiple sclerosis patients had remarkable changes in specific regions of the brain. Regional atrophy in the right nucleus accumbens, right inferior temporal gyrus, and left frontal gyrus was associated with fatigue, measured by the Fatigue Severity Scale. Furthermore, the fatigued patients showed greater evidence of damage to the forceps major, left inferior frontoccipital fasciculus, and right anterior thalamic radiation.