Prevalence and Severity of Multiple-Sclerosis-Associated Fatigue in Treated and Untreated Patients

Abstract

Fatigue is one of the most frequent and most disabling symptoms in multiple sclerosis (MS). We investigated the possible association of the MS-related fatigue syndrome with the available disease-modifying therapies and the main disease characteristics in a cross-sectional study on 320 consecutive patients. The prevalence of severe fatigue (Fatigue Severity Scale score ≧5) was 50%. In a multivariate regression model controlling for age, disease subtype, duration and disability we did not find a significant association between the use of immunosuppressive or immunomodulatory drugs compared to no treatment (OR = 1.34, p = 0.38 for immunosuppressants; OR = 0.95, p = 0.85 for immune-modulating agents). Although all used disease-modifying agents successfully reduce disease activity and inflammation, they do not appear to exhibit a significant effect on MS-related fatigue.

Multiple Sclerosis-Associated Fatigue during Disease-Modifying Treatment with Natalizumab, Interferon-Beta and Glatiramer Acetate

“…Our results in longer-term NTZ-treated patients complement results from a previous short-term prospective study [10] . Findings for the control group were similar to previous analyses from the same database [3] . Fatigue was independent from most important patient characteristics, which underlines that we examined a common construct of fatigue [3,[8][9][10] .…”

“…Findings for the control group were similar to previous analyses from the same database [3] . Fatigue was independent from most important patient characteristics, which underlines that we examined a common construct of fatigue [3,[8][9][10] . A reduction of fatigue during NTZ treatment represents a relevant, additional treatment benefit for improved quality of life.…”

“…Fatigue is likely multidimensional but subtle central inflammatory activity may play a role [2] . Disease modifying treatment with interferon-␤ (IFN) and glatiramer acetate (GA) successfully reduces inflammatory disease activity but does not appear to reduce levels of fatigue [3] . Natalizumab (NTZ) -a monoclonal antibody against Very-Late-ActivationAntigen 4 -reduces leukocyte migration across the blood-brain barrier and thereby unfolds strong effects on central inflammation (i.e.…”

“…Levels of fatigue in IFN/GA-treated patients in the database were comparable in the control group. The literature on a potential effect of IFN or GA on levels of fatigue is controversial [9,3] . Given the marked reduction of clinical and MRI parameters for inflammatory activity in comparison to IFN and GA, this effect could be attributable to a more pronounced decrease of inflammatory CNS activity with NTZ.…”

Fatigue Is Not Associated with Impaired Function of Regulatory T Cells in Untreated Patients with Multiple Sclerosis

“…The pathogenesis of fatigue in MS is poorly understood. Fatigue can occur at all stages of MS and usually is not correlated with age, gender, disease onset, duration, course, neurological impairment or lesion load on conventional brain MRI [2]. Rarely, fatigue can even be the first symptom of MS.…”