Fatigue as a problem in multiple sclerosis
Keywords:
multiple sclerosis, syndrome fatigue, diagnosis, treatmentAbstract
Fatigue is one of the most common symptoms of multiple sclerosis (MS). It concerns almost all patients, and in approximately 50% of cases it is a major symptom. It may occur in cases of patients with little neurological symptoms and significantly affect the quality of life. Pathophisiology of fatigue is unknown. The role of various mechanisms has been suggested, including the hypothalamic-pituitary-adrenal (HPA) axis disfunction, effect of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) on glutaminergic transmission, disturbances of astroglia metabolism and decreased levels of neuro-transmitters noradrenalin and serotonin. The diagnosis of fatigue syndrome is based on anamnesis, physical examination, screening laboratory tests and exclusion of depression or additional organic conditions (anaemia, cardiovascular disorders, kidney diseases or hypothyroidism). Treatment of fatigue is complicated and ineffective. Pharmacological treatment leads to slight improvement. Many attempts of using medications (including Amantadine, Modafinil, Pemoline) gave contradictory results. Step-by-step physical exercise programs has proven to be more effective. Physical activity, rehabilitation, psychotherapy and avoidance of factors which may increase fatigue such as fever, anxiety, depression, pain, sleep disturbances, as well as some drugs like opiates and benzodiazepines, are important.
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References
Janardhan V., Bakshi R.: Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J. Neurol. Sci. 2002; 205(1):51–8.
Schapiro R.T.: Managing symptoms of multiple sclerosis, Neurol. Clin. 2005; 23: 177 – 187.
Merkelbach S., Sittinger H., Koenig J.: Is there a differential impact of fatigue and physical disability on quality of life in multiple sclerosis?, J. Nerv. Ment. Dis. 2002; 190(6): 388–93.
Losy J.: Zmęczenie w stwardnieniu rozsianym, Farmakoter. Psychiatr. Neurolog. 2005; 3: 279–282.
Dworzańska E., Mitosek-Szewczyk K., Stelmasiak Z.: Zespół zmęczenia w stwardnieniu rozsianym, Neurol. Neurochir. Pol. 2009; 43: 71–76.
Giovanni G.: Multiple sclerosis related fatigue, J. Neurol. Neurosurg. Psychiatry 2006; 77: 2–5.
Brola W., Ziomek M., Czernicki J.: Zmęczenie w przewlekłych chorobach neurologicznych, Neurol. Neurochir. Pol. 2007; 41: 340–349.
Fisk J.D., Pontefract A., Ritvo P.G., Archibald C.J., Murray T.J.: The impact of fatigue on patients with multiple sclerosis, Can. J. Neurol. Sci. 1994; 21:9–14.
Trojan D.A., Arnold D., Collet J.P., Shapiro S., Bar-Or A., Robinson A. i wsp.: Fatigue in multiple sclerosis: association with disease related, behavioural and psycho-social factors, Mult. Scler. 2007; 13: 985–995.
Koch M., Uyttenboogaart M., van Harten A., Heerings M., De Keyser J.: Fatigue, depression and progression in multiple sclerosis, Mult. Scler. 2008; 14: 815–822.
Latash M., Kalugina E., Nicholas J., Orpett C., Stefoski D., Davis F.: Myogenic and central neurogenic factors in fatigue in MS, Mult. Scler, 1996; 1: 236–241.
Comi G., Leocani L., Rossi P., Colombo B.: Physiopathology and treatment of fatigue in multiple sclerosis, J. Neurol. 2001; 248(3): 174–179.
Krupp L.B., Alvarez L.A., LaRocca N.G., Scheinberg L.C.: Clinical characteristics of fatigue in multiple sclerosis, Arch. Neurol. 1988; 45: 435–437.
Ford H., Trigwell P., Johnson M., The nature of fatigue in multiple sclerosis, J. Psychosom. Res. 1998; 45: 33– 38.
Comi G., Leocani L., Rossi P., Colombo B.: Pathophysiology and treatment of fatigue in multiple sclerosis, J. Neurol. 2001; 248: 174–79.
Scott L.V., Dinan T.G.: The neuroendocrinology of chronic fatigue syndrome: focus on the hypothalamic-pituitary-adrenal axis. Funct. Neurol. 1999; 14: 3–11.
Téllez N., Comabella M., Julià E., Río J., Tintoré M., Brieva L. i wsp.: Fatigue in progressive multiple sclerosis is associated with low lewels of dehydroepiandrosterone. Mult. Scler. 2006; 12: 487–494.
Kelley K.W., Bluthé R.M., Dantzer R., Zhou J.H., Shen W.H., Johnson R.W., Broussard S.R.: Cytokine-induced sickness behavior, Brain Behav. Immun. 2003; 17 (Suppl 1): S112 – 118.
Heesen C., Nawrath L., Reich C., Bauer N., Schulz K.H., Gold S.M.: Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour?, J. Neurol. Neurosurg. Psychiatry 2006; 77: 34–39.
Rönnbäck L., Hansson E.: On the potential role of glutamate transport in mental fatigue, J. Neuroinflammation 2004; 1: 22.
Krupp L.B., Elkins L.E.: Fatigue and declines in cognitive functioning in multiple sclerosis, Neurology 2000; 55: 934–39.
Filippi M., Rocca M.A., Colombo B., Falini A., Codella M., Scotti G., Comi G.: Functional magnetic resonance imaging correlates of fatigue in multiple sclerosis, NeuroImage 2002; 15: 559–67.
Dittner A.J., Wessely S.C., Brown R.G.: The assessment of fatigue: a practical guide for clinicians and researchers, J. Psychosom. Res. 2004; 56: 157 – 170.
Schwartz J., Jandorf L., Krupp L.B.: The measurement of fatigue: a new scale, J. Psychosom. Res. 1993; 37: 753–762.
Gruszczak A., Bartosik-Psujek H., Pocińska K., Stelmasiak Z.: Analiza walidacyjna wybranych aspektów psychometrycznych polskiej wersji Zmodyfikowanej Skali Wpływu Zmęczenia (Modified Fatigue Impact Scale) – wyniki wstępne, Neurol. Neurochir. Pol. 2009; 43, 2: 148–154.
Téllez N., Río J., Tintoré M., Nos C., Galán I. Montalban X.: Does the Modified Fatigue Impact scale offer a more comrehensive assessment of fatigue in MS? Mult. Scler. 2005; 11: 198–202.
Krupp L.B., LaRocca N.G., Muir-Nash J., Steinberg A.D.: The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus, Arch. Neurol. 1989; 46: 1121–1123.
Iriarte J., Katsamakis G., De Castro P.: The fatigue descriptive scale (FDS): a useful tool to evaluate fatigue in multiple sclerosis, Mult. Scler. 1999; 5: 010 – 16.
Branas P., Jordan R., Fry-Smith A., Burls A., Hyde C.: Treatment for fatigue in multiple sclerosis: a rapid and systematic review. Health. Technol. Assess. 2000; 4: 1–61.
Lee D., Newell R., Ziegler L., Topping A.: Treatment of fatigue in multiple sclerosis: a systematic review of the literature, Int. J. Nurs. Pract. 2008; 14: 81–93.
Heesen C.: Exercise and MS fatigue, Mult. Scler. 2007; 13: S7–S273.
Astrand P.O.: Exercise physiology and it is role in disease prevention and in rehabilitation, Arch. Phys. Med. Rehabil. 1987; 68: 305–309.
Petajan J.H., Gappmaier E., White A.T., Spencer M.K., Mino L., Hicks R.W.: Impact of aerobic training on fitness and quality of life in multiple sclerosis, Ann. Neurol. 1996; 39: 432–441.
Mostert S., Kesselring J.: Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis, Mult. Scler. 2002; 8: 161–168.
Johansson S., Ytterberg C., Hillert J., Widen Holmqvist L., von Koch L.: A longitudinal study of variations in and predictors of fatigue in multiple sclerosis, J. Neurol. Neurosurg. Psychiatry. 2008;79(4):454–457.
Murray T.J.: Amantadine therapy for fatigue in multiple sclerosis, Can. Neurol. Sci. 1985; 12: 251–254.
Canadian MS Research Group.: A randomized controlled trial of amantadine in fatigue associated with multiple sclerosis, Can. J. Neurol. Sci. 1987; 14: 273–78.
Geisler M.W., Sliwinski M., Coyle P.K., Masur D.M., Doscher C., Krupp L.B.: The effects of amantadine and pemoline on cognitive functioning in multiple sclerosis. Arch. Neurol. 1996; 53: 185–188.
Kraft G.H., Bowen J., Stankoff B.: Modafinil for fatigue in MS: A randomized placebo-controlled double-blind study, Neurology 2005; 65: 1995–1997.
Willoughby E.: Modafinil for fatigue in multiple sclerosis J. Neurol.,Neurosurg. Psychiatry 2002; 72: 150–150.
Zifko U.A., Rupp M., Schwarz S., Zipko H.T, Maida E.M., Modafinil in treatment of fatigue in multiple sclerosis: results of an open-label study, J. Neurol. 2002; 249: 983–87.
Stankoff B., Waubant E., Confavreux C. Edan G., Debouverie M., Rumbach L. i wsp.: Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study, Neurology 2005; 64: 1139 – 1143.
Rossini P.M., Pasqualetti P., Pozzilli C. Grasso M.G., Millefiorini E., Graceffa A. i wsp.: Fatigue in progressive multiple sclerosis: results of a randomized double-blind, placebo-controlled, crossover trial of oral 4-aminopirydine, Mult. Scler. 2001; 7: 354–8.
Wingerchuk D.M., Benarroch E.E., O'Brien P.C., Keegan B.M., Lucchinetti C.F., Noseworthy J.H. i wsp.: A randomized controlled placebo crossover trial of aspirin for fatigue in multiple sclerosis, Neurology 2005; 64: 1267 – 1269.
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