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.

Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

“…For example, trials of modafinil for fatigue management have shown mixed results with some trials failing to show a statistically significant effect on fatigue, and despite successful drug trials, no treatment is in routine clinical use. 4,10 While more studies are needed, these data present very promising signals for RS-tDCS as a non-pharmacological treatment for MS fatigue.…”

“…7 Multiple factors are thought to contribute to fatigue 8,9 with no specific biomarker or etiology yet confirmed. 10 …”

Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis

“…MS is associated with a high (>70%) rate of cognitive impairment. Those with MS also suffer from other symptoms including mood, fatigue, sensory and motor problems that may respond to tDCS as well .…”

Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

“…1 Fatigue is one of the most common and debilitating symptoms of MS; affecting up to 86% of people with MS, with two-thirds considering it to be one of their three worst symptoms. [2][3][4][5][6][7] In the UK it has been reported that the prevalence of MS is increasing with an estimated 126 669 people living with MS in the UK in 2010 (203.4 per 100 000 population) and 6003 new cases diagnosed that year (9.64 per 100 000/year). 8 Fatigue often occurs on a daily basis 2 and its invisible and unpredictable nature makes it a particularly frustrating symptom to cope with.…”