Capturing fatigue parameters: The impact of vagal processing in multiple sclerosis related cognitive fatigue

Fatigue is a very common symptom among people with multiple sclerosis (MS), but its management in clinical practice is limited by the lack of clear evidence about the pathogenic mechanisms, objective tools for diagnosis, and effective pharmacological treatments. In this scenario, neurophysiology could play a decisive role, thanks to its ability to provide objective measures and to explore the peripheral and the central structures of the nervous system. We hereby review and discuss current evidence about the potential role of neurophysiology in the management of MS-related fatigue. In the first part, we describe the use of neurophysiological techniques for exploring the pathogenic mechanisms of fatigue. In the second part, we review the potential application of neurophysiology for monitoring the response to pharmacological therapies. Finally, we show data about the therapeutic implications of neurophysiological techniques based on non-invasive brain stimulation.

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“…On the contrary, other studies found that fatigued PwMS have a reduction in vagal activity compared to controls (77)(78)(79).…”

Section: Neurophysiology As Investigating Tool For the Pathogenic Mecmentioning

confidence: 77%

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

et al. 2020

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“…In addition, cognitive impairment was associated with a decreased HR reactivity (p = 0.02) [58]. A recent investigation of behavioural performance (response bias) and autonomic functioning (HRV and skin conductance level) during an acoustic vigilance task in 53 MS patients suggested that cognitive fatigue in MS is related to parasympathetic activity and reduced responsiveness [59]. Finally, a UK study in 26 MS patients (17 with fatigue) and nine age-and sex-matched controls found that patients with fatigue had reduced levels of alertness and cardiovascular sympathetic activation compared with patients without fatigue and healthy controls.…”

Section: Association With Fatigue and Cognitive Impairmentmentioning

confidence: 96%

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Findling

Hauer

Pezawas

et al. 2020

JCM

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Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case-control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing-remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.

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“…Additionally, Mirhosseini et al [ 40 ] investigated the effect of BRT on fatigue among MSPs and found that BRT exercises significantly reduced the average fatigue severity, which may contribute to decreased DAS, and thus improved QoL. These positive outcomes in the intervention group could be attributed to the fact that BRT improves parasympathetic activity and calmness, reducing levels of neurotransmission through the body and negative disease impacts [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Benson Relaxation Technique on Depression, Anxiety, and Stress of Jordanian Patients Diagnosed with Multiple Sclerosis: A Cross-Sectional Study

Saifan

AbuRuz

Dhaher

et al. 2021

Depression Research and Treatment

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Depression, anxiety, and stress (DAS) are common symptoms of multiple sclerosis (MS) patients and are highly correlated with poor quality of life. Managing DAS among such patients can improve their quality of life (QoL), empowering them with improved autonomy, self-care, independency, and ability to perform daily activities. This study is aimed at examining the effectiveness of the Benson Relaxation Technique (BRT) on reducing DAS among patients diagnosed with MS in Jordan. This quasiexperimental study of 105 Jordanian patients diagnosed with multiple sclerosis tested an intervention group (60 patients) who received BRT and a control group (45 patients) who received normal treatment. Data were collected from January 2021 to April 2021, using the Arabic version of the Depression Anxiety Stress Scale (DASS21). The intervention group was instructed to perform the BRT two times a day for 10 minutes at home for eight weeks at two specific times, with 7-8-hour intervals between each episode. STROBE guidelines were followed in reporting the review. At the baseline comparison, there was no statistical difference between the interventional and control groups with regard to DAS. The levels of DAS between the two groups after three months of the last sessions of the intervention (postintervention) were compared. The results showed that the intervention group had significantly lower levels of DAS compared to the control group. The levels of the DAS were significantly lower for the intervention group postintervention. Adding relaxation techniques to the therapeutic routine is a cost-effective complementary treatment to decrease DAS among MS patients and improve their QoL. Relevance to Practice. This study provides a baseline of data that could facilitate further investigations in the future to improve the quality of services delivered to such patients and thus their QoL and satisfaction.

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Capturing fatigue parameters: The impact of vagal processing in multiple sclerosis related cognitive fatigue

Cited by 25 publications

References 38 publications

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

The Effect of Benson Relaxation Technique on Depression, Anxiety, and Stress of Jordanian Patients Diagnosed with Multiple Sclerosis: A Cross-Sectional Study

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