The point is to solve the fatigue problem! HOW EXACTLY ARE YOU GOING TO ACCOMPLISH THAT?
Survivors don't want correlates that do nothing to get fatigue cured. They want to have fatigue cured! GET THERE!
Neuroimaging correlates of post-stroke fatigue: A systematic review and meta-analysis
Abstract
Background:
Fatigue
is a common and disabling symptom following stroke, but its underlying
mechanisms are unknown. Associations with a number of imaging features
have been proposed.
Aims:
We
aimed to assess whether neuroimaging parameters could better inform our
understanding of possible causes of post-stroke fatigue (PSF) through
systematic review and meta-analysis.
Methods:
Using
a predefined protocol registered with PROSPERO (ID: CRD42022303168), we
searched EMBASE, MEDLINE, PubMed, and PsycInfo for studies assessing
PSF and computerized tomography (CT), magnetic resonance (MR), positron
emission tomography (PET) imaging, or diffusion tensor imaging (DTI). We
extracted neuroimaging parameters and narratively analyzed study
results to assess any association with PSF. Where there were 3+ similar
studies, we carried out a meta-analysis using inverse-variance
random-effects model to estimate the total association of each
neuroimaging parameter on PSF. The risk of bias was assessed using the
Newcastle and Ottawa Scale.
Results:
We identified 46 studies (N = 6543);
in many studies, associations with fatigue were secondary or
subanalyses (28.3%). Imaging parameters were assessed across eight
variables: lesion lateralization, lesion location, lesion volume, brain
atrophy, infarct number, cerebral microbleeds, white matter
hyperintensities (WMHs), and network measures. Most variables showed no
conclusive evidence for any association with fatigue. Meta-analysis,
where possible, showed no association of the following with PSF; left
lesion lateralization (OR: 0.88, 95% CI (0.64, 1. 22) (p = 0.45)), infratentorial lesion location (OR: 1.83, 95% CI (0.63, 5.32) (p = 0.27)), and WMH (OR: 1.21, 95% CI (0.84, 1.75) (p = 0.29)).
Many studies assessed lesion location with mixed findings; only one
used voxel-symptom lesion-mapping (VSLM). Some small studies suggested
an association between altered functional brain networks, namely
frontal, fronto-striato-thalamic, and sensory processing networks, with
PSF.
Conclusion:
There
was little evidence for the association between any neuroimaging
parameters and PSF. Future studies should utilize advanced imaging
techniques to fully understand the role of lesion location in PSF, while
the role of altered brain networks in mediating PSF merits further
research.
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