Carnitine for fatigue in multiple sclerosis

Tejani, Aaron M; Spiwak, Rae; Wasdell, Michael; Rowell, Greg; Nathwani, Shabita

doi:10.1002/14651858.cd007280

Cited by 6 publications

(6 citation statements)

References 32 publications

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“…Depression and chronic fatigue are present in most patients with multiple sclerosis (MS) and are often described as two of the most debilitating symptoms (Tomassini et al, 2004;Tejani et al, 2012). These symptoms are thought to be caused by the disseminated demyelination.…”

Section: Introductionmentioning

confidence: 99%

Depressive state and chronic fatigue in multiple sclerosis and neuromyelitis optica

Akaishi

Nakashima

Misu

et al. 2015

Journal of Neuroimmunology

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Section: Introductionmentioning

confidence: 99%

Depressive state and chronic fatigue in multiple sclerosis and neuromyelitis optica

Akaishi

Nakashima

Misu

et al. 2015

Journal of Neuroimmunology

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“…Our review of the literature found six meta-analyses of the randomized controlled trials (modafinil, amantadine, carnitine, and pemoline) [16, 128, 130, 131, 133–135, 137–140]. Whereas one meta-analysis investigating three studies published before 1996 found a significant effect of amantadine superior to placebo [141], five other meta-analyses analyzing these three studies and further recent studies did not report any significant effect of the investigated drugs [129, 136, 142–144]. One study, however, did find a significant improvement of fatigue under treatment with carnitine compared to amantadine [140].…”

Section: Treatment Of Ms Fatiguementioning

confidence: 99%

The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue

et al. 2016

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More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.

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“…[29] Both carnitine and Prokarin, considered alternative therapies, have yielded only weak support for their use in small trials. [105,106] Summary While research on fatigue in MS has made notable advances, major questions remain concerning its pathogenesis and treatment. Fatigue remains a frustrating problem for many individuals living with MS.…”

Section: Non-pharmacologic Management Approachesmentioning

confidence: 99%

Fatigue in multiple sclerosis

Charvet

Serafin

Krupp

2013

Fatigue: Biomedicine, Health & Behavior

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Background: Fatigue is the most commonly reported symptom in multiple sclerosis (MS). Purpose: This brief narrative review addresses the clinical features, pathophysiology, and management of MS fatigue, as well as the varied approaches to its definition and measurement. Methods: A literature search was conducted through Medline of studies published since 1984, with a focus on findings reported since 2008. Results: Studies of MS fatigue have primarily relied on the definition of fatigue as a subjective sense of tiredness measured through self-report. Additional studies have measured fatigability in MS, as demonstrated by a decline in cognitive or motor performance over time. The pathogenesis of fatigue remains poorly understood but disease characteristics, including structural and physiologic cerebral alterations as well as immune, endocrine, and psychological factors, may all contribute to its expression. Fatigue therapy has included pharmacologic approaches which have had either methodological limitations (e.g., small sample sizes) or inconclusive results and non-pharmacologic interventions, some of which have been effective in reducing fatigue. Conclusions: Fatigue remains a challenging symptom in MS. The most effective measurement approaches will likely be multidimensional and include both subjective and objective indicators, whereas therapy will likely require more than one type of intervention.

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Carnitine for fatigue in multiple sclerosis

Cited by 6 publications

References 32 publications

Depressive state and chronic fatigue in multiple sclerosis and neuromyelitis optica

Depressive state and chronic fatigue in multiple sclerosis and neuromyelitis optica

The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue

Fatigue in multiple sclerosis

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