Structural and functional changes in the brain observed through magnetic resonance imaging (MRI) have been linked to fatigue in patients with neuromyelitis optica spectrum disorder (NMOSD), according to a study published in BMC Neurology.

Changes in the volume of the bilateral pallidum and left nucleus accumbens were observed between low fatigue and high fatigue in patients with NMOSD and healthy controls. High fatigue patients had larger left pallidum (P =.009) than healthy controls after correction for age, sex, years of education, and scores on the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Scale for Depression (HRSD).

It was also observed that both low fatigue and high fatigue patients had smaller nucleus accumbens than healthy controls (P =.009 and P =.013, respectively). No significant differences were observed in the volumes of the caudate nucleus, putamen, amygdala, hippocampus, thalamus, or right nucleus accumbens.

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Functional connectivity was different between the left pallidum and bilateral cerebellar posterior lobes in both patient subgroups and healthy controls (P <.05). High fatigue patients also had significantly decreased functional connectivity between the left pallidum and the bilateral cerebellar posterior lobes compared to low fatigue patients. These results were present both with and without correction for age, sex, years of education, and scores on the HAMA and HRSD.

“This prospective pilot study provides the first evidence linking structural and functional alterations in the brain to fatigue in NMOSD, which should be further explored in more advanced MRI longitudinal studies,” the authors said.

A total of 33 patients with NMOSD of Chinese Han descent and 20 healthy controls were included in the study. All healthy controls and all but 2 patients were female.

Of the patients with NMOSD, 16 were classified as high fatigue while the remaining 17 were low fatigue. The 3 groups (high fatigue, low fatigue, and healthy control) did not differ significantly in age, sex, or years of education. The high fatigue group did have significantly more severe anxiety (based on HAMA scores) and depression (based on the HRSD scale) compared to the low fatigue group.


Zhang Y, Chen HX, Shi ZY, et al. Brain structural and functional connectivity alterations are associated with fatigue in neuromyelitis optica spectrum disorder. BMC Neurol. 2022;22(1):235. doi:10.1186/s12883-022-02757-4