Fatigue associated with multiple sclerosis: diagnosis, impact and management

Abstract

In patients with multiple sclerosis (MS) fatigue is the most common symptom and one of the most disabling features. As many as 40% have described it as the single most disabling symptom--a higher percentage than weakness, spasticity, motor problems, or bowel or bladder problems. The etiology and pathophysiology of MS-related fatigue remain unknown. Studies have failed to demonstrate an association between MS-related fatigue and the level of disability, clinical disease subtype, or gender, although recent data show an association between MS-related fatigue and depression and quality of life. Imaging studies using positron emission tomography suggest that fatigue in MS is related to hypometabolism of specific brain areas, including the frontal and subcortical circuits. The impact of fatigue on patient functioning and quality of life clearly warrants intervention. In addition to nonpharmacologic measures, such as exercise and energy conservation strategies, several pharmacologic agents have been evaluated for their ability to reduce MS-related fatigue, including amantadine, central nervous system stimulants (pemoline), and the novel wake-promoting agent modafinil.

Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis

“…18 Sutherland et al also reported that relaxation education resulted in a decrease in fatigue levels in MS patients. 17 It is reported in the literature that carefully and regularly applied exercise is one of the methods used in coping with fatigue 8,30 ; PMRT used as one of the nonpharmacological approaches to control fatigue in patients with MS yielded positive results, 7,31 and 5-20-minute PMRT sessions were as effective as 1 hour of sleep in preserving individuals' physical energy. 32 A statistically significant difference was found between the global sleep quality ( p < 0.001) score averages and the score averages the patients obtained from subjective sleep quality ( p < 0.001), sleep latency ( p < 0.001), sleep duration ( p < 0.05), sleep efficiency ( p < 0.05), sleep disorder ( p < 0.001), and daytime dysfunction ( p < 0.001) areas of sleep quality scale after PMRT.…”

Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors

“…6,7 Fatigue is the most common and one of the most disabling symptoms of multiple sclerosis, experienced by around 80% of adults with the disease. [8][9][10] Multiple sclerosis-related fatigue refers to a severe and overwhelming feeling of exhaustion and lack of energy, which may result in functional impairment.11 A growing body of evidence suggests that fatigue is also a significant problem in paediatric populations, affecting approximately 30% of the general adolescent population and a substantial proportion of children and adolescents with chronic illnesses such as cancer, rheumatoid arthritis, chronic pain, and neurological conditions. [12][13][14][15][16][17] Recent evidence of fatigue in children and adolescents with multiple sclerosis (caMS) reflects these findings, with over half reporting at least mild fatigue and approximately 40% reporting fatigue severe enough to impact on school performance and recreational activities.…”

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

“…Fatigue, another common symptom reported by people with MS [9], may also contribute to reduced walking capacity [10]. Muscle fatigue is known to worsen with physical activity [11] and is related to perceived fatigue levels in people with MS [12] .…”