Would this possibly explain stroke fatigue? What is your doctor doing to solve stroke fatigue?
Or is stroke fatigue once again
somebody elses' problem to solve?
http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00264/full?
- 1Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- 2Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
In multiple sclerosis (MS) patients, fatigue is rated as one of
the most common and disabling symptoms. However, the pathophysiology
underlying this fatigue is not yet clear. Several lines of evidence
suggest that immunological factors, such as elevated levels of
pro-inflammatory cytokines, may contribute to subjective fatigue in MS
patients. Pro-inflammatory cytokines represent primary mediators of
immune-to-brain-communication, modulating changes in the neurophysiology
of the central nervous system. Recently, we proposed a model arguing
that fatigue in MS patients is a subjective feeling, which is related to
inflammation. Moreover, it implies that fatigue can be measured
behaviorally only by applying specific cognitive tasks related to
alertness and vigilance. In the present review, we focus on the
subjective feeling of MS-related fatigue. We examine the hypothesis that
the subjective feeling of MS-related fatigue may be a variant of
inflammation-induced sickness behavior, resulting from cytokine-mediated
activity changes within brain areas involved in interoception and
homeostasis including the insula, the anterior cingulate, and the
hypothalamus. We first present studies demonstrating a relationship
between pro-inflammatory cytokines and subjective fatigue in healthy
individuals, in people with inflammatory disorders, and particularly in
MS patients. Subsequently, we discuss studies analyzing the impact of
anti-inflammatory treatment on fatigue. In the next part of this review,
we present studies on the transmission and neural representation of
inflammatory signals, with a special focus on possible neural
concomitants of inflammation-induced fatigue.
We also present two of our
studies on the relationship between local gray and white matter atrophy
and fatigue in MS patients. Finally, we discuss some implications of
our findings and future perspectives.
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