Fatigue is a commonly reported symptom of multiple sclerosis (MS) which may impair
function. It is thought that fatigue may be of either a central or peripheral origin. Physical and
psychosocial mechanisms have been suggested as causing fatigue. Many physical causes have
been investigated including type of MS, lesion site, inflammation, abnormal heat response,
autonomic dysfunction, ventilatory dysfunction, disturbed sleep, cortical dysfunction, altered
central activation ratio and conduction time, and changes in skeletal muscle morphology.
Potential psychosocial causes include abnormal health beliefs and behaviours, personality
changes and depression. The objective of this review was to assist health professionals to gain
a better understanding of MS fatigue and its causes in order to assist them in management
choices. It is suggested that fatigue may be multifactorial in origin as the evidence does not
strongly support any one causal mechanism. Understanding the various mechanisms
contributing to MS fatigue may assist physiotherapists and their patients to develop more
effective management strategies.
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