Multiple sclerosis-related fatigue lacks a unified definition

Abstract

Fatigue is the most common symptom in multiple sclerosis (MS). Although MS-related fatigue (MS-F) strongly affects quality of life and social performance of patients, there is currently a lack of knowledge about its pathophysiology, which in turns leads to poor objective diagnosis and management. Recent studies have attempted to explain potential etiologies as well as treatments for MS-F. However, it seems that without a consensus on its nature, these data could not provide a route to a successful approach. In this Article, we review definitions, epidemiology, risk factors and correlated comorbidities, pathophysiology, assessment methods, neuroimaging findings, and pharmacological and nonpharmacological treatments of MS-F. Further studies are warranted to define fatigue in MS patients more accurately, which could result in precise diagnosis and management.

Non-invasive brain stimulation therapy on neurological symptoms in patients with multiple sclerosis: A network meta analysis

“…Previous study noted MS fatigue may relate to functional imbalance between homologous sensorimotor regions of the two hemispheres, and thus the effect of rTMS over M1 for the treatment of fatigue may be credited to the changes of neuromodulation to the inter-hemispheric interaction of primary sensorimotor areas of the brain ( 49 ). Pathogenesis of fatigue in PwMS may also include changes in cortico-striato-thalamo-cortical loops, increased energy demand, structural and functional neurological alterations and Adibi et al ( 50 ). The mechanism behind the role of F3 in fatigue relief remains to be elucidated.…”

The role of clinical neurophysiology in the definition and assessment of fatigue and fatigability

“…Fatigue is actually the most frequent symptom in those with multiple sclerosis, with a prevalence of between 52 % − 88 % depending on the variety of studies’ population and the definition of fatigue ( Adibi et al, 2022 , Leocani et al, 2008 ). Fatigue also affects more than 50 % of those with Parkinsońs disease ( Siciliano et al, 2018 ) and involves predominantly supraspinal fatigability, and is linked to the cognitive and attention deficits.…”

Fatigue: Physiology and Pathology

“…Finally, some factors responsible for secondary fatigue are depression, sleep deprivation, infections, pain, and adverse reactions to medications (Kluger et al, 2013;Khan et al, 2014;Adibi et al, 2022). Identifying and ruling out these concurring conditions is necessary for the differential diagnosis of primary MS and secondary fatigue (Kluger et al, 2013).…”