{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T10:19:21Z","timestamp":1780481961469,"version":"3.54.1"},"reference-count":38,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2024,9,26]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Immune-mediated processes are implicated in the pathogenesis of fatigue, a common symptom in multiple sclerosis (MS). The choroid plexus (CP) regulates central nervous system (CNS) immune homeostasis and undergoes volumetric modifications possibly contributing to MS-related fatigue. We explored the association between MS-related CP volume changes and fatigue dynamics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Eighty-five patients with MS and 68 healthy controls (HC) underwent brain 3T MRI, neurological evaluation and Modified Fatigue Impact Scale (MFIS) at two timepoints (median follow-up=1.4 years). Normalised brain and regional grey matter (GM) volumes were obtained using FSL-SIENAx, FIRST, SIENA and tensor-based morphometry. CP volumes were quantified with in-house methods, and longitudinal changes were analysed using linear mixed models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At baseline, 25 (29%) patients with MS had fatigue (f-MS) (MFIS \u226538). Compared with HC, patients with MS had significantly higher brain T2-lesion volume, lower brain, deep GM, cortical volumes and higher CP volume (false discovery rate (FDR)-p \u22640.024). Compared with non-fatigued (nf-MS) patients, f-MS were older, more disabled (FDR-p \u22640.002) and showed numerically higher CP volume (FDR-p=0.076). At follow-up, 41 (68%) nf-MS remained non-fatigued (nf-FU-MS) and 19 (32%) developed fatigue (f-FU-MS). Patients with MS showed higher brain and deep GM atrophy rates versus HC (FDR-p \u22640.048), whereas clinical, lesional and brain volumetric changes were not significantly different among MS groups (FDR-p \u22650.287). CP volume significantly increased in all MS groups compared with HC (FDR-p \u22640.043), with greater enlargement in f-FU-MS versus nf-FU-MS (FDR-p=0.048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Larger CP and greater enlargement are associated with the presence and development of fatigue in MS, likely reflecting dynamic inflammatory states within the CNS, supporting the immunological contribution to MS-related fatigue.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2024-334913","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T17:20:42Z","timestamp":1728580842000},"page":"443-452","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Dynamics of choroid plexus volume is associated with the presence and development of fatigue in multiple 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