Regional microglial activation in the substantia nigra is linked with fatigue in MS, 2020, Singhal et al.

The suggestion here is that the fatigue in MS and in ME/CFS are both due to inflammation in the basal ganglia (and, to a lesser extent, connected regions of the brain) and low dopamine levels (though which comes first isn't clear). However, as I understand it, those with MS do not get PEM so that difference would have to be explained.

Also, there was no association found of fatigue with nerve lesions, in pwMS. There is the well-known phenomena of a reduction of relapses in wwMS during pregnancy but I don't know whether that includes the fatigue. But it begs the question of whether any wwME/CFS have observed any relief due to pregnancy. I've not heard of it. And if there is no such phenomena, what does that say about ME/CFS being, at least in part, an auto-immune disease?
 
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Remission in MS during pregnancy is said to be due to the immune system being supressed to protect the foreign body that is the foetus.

Though the people I know are not the sickest, obviously, fatigue in MS doesn't seem to be like ours. When people have spoke about it, it is more like tired all the time; they have lost a spark, sort of, rather than unable to get out of bed. It makes them not feel like doing things and they tire easily but they are limited in what they do by obvious physical disability rather than fatigue.

An article in the MS society newsletter about fatigue made the point that a lot of the fatigue was the simple consequence of things being harder to do with a disability. When it takes 2 or 3 times the normal effort to lift unresponsive legs up a flight of stairs, feeling fatigue is a natural consequence.

There may well be a physical source of fatigue as well but it highlights that using one word for so many things just causes confusion.
 
MS fatigue is usually spit into two things: 'nerve fiber fatigue' caused by the disease process itself and 'lassitude'.

I guess lassitude might fit with the low energy fatigue identified in Jason's theory of five main ME fatigue types. Different websites seem contradictory about the distinct features of each: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Fatigue
 
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