Fatigue in neuroimmunological diseases

Abstract

Fatigue is a widespread symptom in numerous neuroimmunological diseases like multiple sclerosis (MS), myasthenia gravis, morbus Behcet, neurosarcoidosis, neuroborreliosis or immune vasculitis. This phenomenon is best investigated in MS. The complex mechanisms underlying fatigue in MS are still poorly understood; alterations in immune system activation, central nervous system dysregulation, impaired nerve conduction, and neuroendocrine dysregulation have to be considered. These immune and neural mechanisms may cause the initial symptoms of fatigue; however, the fatigue symptom may be exacerbated by secondary overlapping factors (e. g. depressive mood, sleep disturbances, unhealthy life style) which are likely associated with the feeling of fatigue. Wessely conceptualised four components of fatigue: behaviour (effects of fatigue), feeling (subjective experience), mechanisms, and context (e. g. environment, attitudes). So far most examinations have dealt with the first or the second component of the multidimensional construct fatigue, either concentrating on the behavioural aspect in the physical or in the cognitive sphere or on the subjective aspect. The Rostock Fatigue Study investigated two of the components: objective performance and subjective fatigue estimation in the cognitive and in the physical sphere. MS patients showed a reversed relationship between below-average objective performance in the cognitive and in the physical sphere and high subjective feeling of tiredness when compared to healthy individuals. The clinical management of fatigue should include an assessment of the various factors that can cause fatigue as well as a step-wise treatment approach that encompasses nonpharmacological approaches and pharmacological interventions.

The psychology of fatigue in patients with multiple sclerosis: A review

“…Other studies found significant but small relationships using functional neuroimaging techniques [22][23][24][25][26]. Because fatigue often occurs during disease exacerbations and is also reported to be a side effect of disease-modifying medications such as interferon-β, a relationship with autoimmune dysregulation has been suggested [14,27]. However, the results of studies concerning the relationship between MS-related fatigue and pathophysiological mechanisms, including autoimmune and neuroendocrine dysregulation, autonomic system dysfunction, and peripheral muscular mechanisms, are contradictory [28][29][30][31][32][33] (see Kos et al [13] for a review of the biological mechanisms of MS-related fatigue).…”

Correlation between Cognitive Functions, Fatigue, Depression and Disability Status in a Cohort of Multiple Sclerosis Patients

“…The BDI-II is a 21-item self-report measure designed to assess DSM-IV depressive symptomatology in adolescents and adults. It is a revised version of the amended DI [1]. Respondents are asked to rate each of the depression symptoms, ranging from 0 (not present) to 3 (severe), in terms of how they have been feeling during the past two weeks, recording the date of completing the questionnaire.…”

“…Fatigue has been identified in a broad range of neuroimmunological disorders like multiple sclerosis (MS) [1]. Fatigue is considered an important symptom in MS patients because it affects patients' social lives, occupation, overall quality of life, and mood.…”

“…Several areas of the CNS (e.g. the premotor cortex, the limbic system, the basal ganglia, and the brainstem) are believed to be involved in the pathophysiology of MS fatigue [1]. According to fMRI fatigue may be related to impaired interactions between functionally related cortical and subcortical areas [3].…”

Kognitive Teilleistungsstörungen und Demenz bei Patienten mit Multipler Sklerose: Status quo und offene Fragen

“…Dies mag dadurch bedingt sein, dass die Fähigkeiten, die für eine unauffällige Gesprächsführung notwendig sind (Sprache, Orientierung, verbalauditive Merkspanne), häufig unbeeinträchtigt sind und daher möglicherweise bestehende kognitive Beeinträchtigungen im "kurzen" Arzt-Patienten-Gespräch nicht auffallen. Es hat sich jedoch gezeigt, dass Gedächtnis-und Aufmerksamkeitsstörungen die Lebensqualität von MS-Patienten in klinisch relevanter Weise beeinflussen [20,21]. So sind MS-Patienten mit kognitiven Beeinträchtigungen häufiger in der routinemäßigen Haushaltsfüh-rung und in der sexuellen Funktionalität beeinträchtigt.…”