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Characterizing Fatigue-Related White Matter Changes in MS: A Proton Magnetic Resonance Spectroscopy Study

1
The Sastry Foundation Advanced Imaging Laboratory, Wayne State School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA
2
Multiple Sclerosis Center, Department of Neurology, Wayne State School of Medicine, 4201 St Antoine, 8C-UHC Detroit, MI 48201, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(5), 122; https://doi.org/10.3390/brainsci9050122
Received: 27 March 2019 / Revised: 20 April 2019 / Accepted: 20 May 2019 / Published: 27 May 2019
(This article belongs to the Special Issue Fatigue in Multiple Sclerosis: Current Concepts and Future Challenges)
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Abstract

Few cross-sectional studies have investigated the correlation between neurochemical changes and multiple sclerosis (MS) fatigue, but little is known on the fatigue-related white matter differences between time points. We aim to investigate the longitudinal neurometabolite profile of white matter in MS fatigue. Forty-eight relapsing remitting multiple sclerosis (RRMS) patients with an expanded disability status scale (EDSS) ≤ 4 underwent high field 1H-multivoxel magnetic resonance spectroscopy (MRS) at baseline and year 1. Fatigue severity was evaluated by the fatigue severity scale (FSS). Patients were divided into low (LF, FSS ≤ 3), moderate (MF, FSS = 3.1–5), and high fatigue (HF, FSS ≥ 5.1) groups. In a two-way analysis of variance (ANOVA), we observed a decline in the ratio of the sum of N-acetylaspartate (NAA) and N-acetylaspartylglutamate (NAAG) to the sum of creatine (Cr) and phosphocreatine (PCr) in the right anterior quadrant (RAQ) and left anterior quadrant (LAQ) of the MRS grid in the HF group at baseline and year 1. This decline was significant when compared with the LF group (p = 0.018 and 0.020). In a one-way ANOVA, the fatigue group effect was significant and the ratio difference in the right posterior quadrant (RPQ) and left posterior quadrant (LPQ) of the HF group was also significant (p = 0.012 and 0.04). Neurochemical changes in the bilateral frontal white matter and possibly parietooccipital areas were noted in the HF group at two different time points. Our findings may shed some light on the pathology of MS fatigue. View Full-Text
Keywords: fatigue; multiple sclerosis; magnetic resonance spectroscopy; N-acetylaspartate; N-acetylaspartylglutamate fatigue; multiple sclerosis; magnetic resonance spectroscopy; N-acetylaspartate; N-acetylaspartylglutamate
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Yarraguntla, K.; Bao, F.; Lichtman-Mikol, S.; Razmjou, S.; Santiago-Martinez, C.; Seraji-Bozorgzad, N.; Sriwastava, S.; Bernitsas, E. Characterizing Fatigue-Related White Matter Changes in MS: A Proton Magnetic Resonance Spectroscopy Study. Brain Sci. 2019, 9, 122.

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