“…The occurrence of the latter could be explained by studies documenting Na + /K + ATPase failure [51,118,239], reverse action of Na + -Ca 2+ exchanger, intra-axonal calcium accumulation, and a subsequent Ca 2+ -dependent apoptosis [10,77,218]. In addition, other inflammatory mediators such as TNF-␣, IFN-␥, and IL-1 are abundant in the cerebrospinal fluid (CSF) of MS patients [8,97,186] and can provide a second route toward neurodegeneration: the so-called inflammationinduced synaptopathy [23]. In fact, these molecules can act by upregulating the excitatory glutamatergic transmission [109,132,215], a phenomenon that is already documented in MS patients [32,196,210,216] or downregulating the inhibitory GABAergic transmission [215]; both of which could be the final pathway toward an aberrant synaptic transmission and irreversible neurodegenerative damage [32,210] and may contribute to fatigue perception.…”