Fatigue in Multiple Sclerosis

Abstract

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.

Inflammation and the Silent Sequelae of Stroke

“…First, it is a common symptom in patients with immune-mediated diseases [42][43][44][45][46]. Second, Fig.…”

“…The FAS has been validated in healthy cohorts [71]. FAS scores of 10-21 indicate that the patient is "not tired", scores of 22-34 indicate that the patient is "tired", and scores of [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] indicate that the patient is "very tired" [72]. We evaluated the relationship between the biomarkers of inflammation shown in Fig.…”

Is Iron Deficiency in the Absence of Anemia Associated With Fatigue in Inflammatory Bowel Disease?

“…(2)(3)(4)(5)(6). It is also quite prevalent in inflammatory bowel disease (IBD) (7)(8)(9)(10)(11) and has been shown to adversely affect quality of life (9).…”

The Perceived Deficits Questionnaire

“…Fatigue is one of the most frequently reported symptoms in MS, 17,18 and it has been shown to be related to self-reported cognitive concerns. Specifically, in a recent investigation, Kinsinger et al 19 found that changes in depression and fatigue after treatment were associated with fewer perceived deficits after treatment.…”