Fatigue in MS

Factors causing/correlating with fatigue in MS
1.Depression
2. Deconditioning
3. hypothyroidism
4. anemia
5. medications
6. ambient temperature
7. relapse/exacerbation
8. psychological concerns
9. N acetylaspartate-creatine ratio in MR spectroscopy (indicates axonal damage)

NOT correlated
1. T2 lesion volume on MRI
2. Gad lesions
3. C reactive protein
4. transcranial magnetic stimulation response (measure of motor conduction) not difference in larger fibers (may not be the ones involved in fatugue)

Source-- editorial Arch Neurol 2004Feb pp.176-177 Michael Racke Kathleen Hawker and Eliot Frohman, Fatigue in multiple Sclerosis: is the picture getting simpler or more complex