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Review
. 2022 Oct 17:13:983643.
doi: 10.3389/fneur.2022.983643. eCollection 2022.

How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis?

Nicolas Royer  1 , Kyla Coates  2 , Saied Jalal Aboodarda  3 , Jean-Philippe Camdessanché  4 , Guillaume Y Millet  1   5
Affiliations
Review

How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis?

Nicolas Royer et al. Front Neurol. .

Abstract

Whereas fatigue is recognized to be the main complaint of patients with multiple sclerosis (PwMS), its etiology, and particularly the role of resistance to fatigability and its interplay with disability level, remains unclear. The purposes of this review were to (i) clarify the relationship between fatigue/disability and neuromuscular performance in PwMS and (ii) review the corticospinal and muscular mechanisms of voluntary muscle contraction that are altered by multiple sclerosis, and how they may be influenced by disability level or fatigue. Neuromuscular function at rest and during exercise are more susceptible to impairement, due to deficits in voluntary activation, when the disability is greater. Fatigue level is related to resistance to fatigability but not to neuromuscular function at rest. Neurophysiological parameters related to signal transmission such as central motor conduction time, motor evoked potentials amplitude and latency are affected by disability and fatigue levels but their relative role in the impaired production of torque remain unclear. Nonetheless, cortical reorganization represents the most likely explanation for the heightened fatigability during exercise for highly fatigued and/or disabled PwMS. Further research is needed to decipher how the fatigue and disability could influence fatigability for an ecological task, especially at the corticospinal level.

Keywords: corticospinal responses; disability; fatigability; fatigue; multiple sclerosis; muscle weakness.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of fatigability between healthy subjects and patients with multiple sclerosis in function of fatigue and disability levels for isometric and intermittent fatiguing task. Bold, stimulated contraction; PwMS, Patient with multiple sclerosis; NF, Non-fatigued; F, Fatigued; LD, Low disability; HD, High disability.
Figure 2
Figure 2
Differences in neurophysiological parameters within the neuromuscular system between fatigued and non-fatigued patients with multiple sclerosis. MRI, Magnetic Resonance Imagery; fMRI, functional Magnetic Resonance Imagery; DTI, Diffusion tension imaging; EEG, Electroencephalogram; TMS, Transcranial Magnetic Stimulation; SICI, Short Interval Cortical Inibition; ICF, Intracortical Facilitation; SP, Silent Period; NMES, Neuromuscular Electrical Stimulation; ES, Electrical Stimulation; MEP, Motor Evoked Potential.
See this image and copyright information in PMC

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