Levocarnitine administration in multiple sclerosis patients with immunosuppressive therapy-induced fatigue

Abstract

Nutritional factors and comedications are among the postulated causes of fatigue, a highly prevalent symptom in the multiple sclerosis (MS) population, with serious impact on patients' quality of life. Deficiency of carnitine may play a role by reducing energy production through fatty acid oxidation and numerous MS therapies can induce fatigue syndrome. The aim of this prospective open-labelled study was to collect and study serum carnitine levels in MS patients with and without disease-modifying treatment-induced fatigue syndrome. We investigated whether restoration of the carnitine pool might improve treatment-induced fatigue in MS patients. In our study, there was no statistical difference in fatigue frequency between treated and untreated patients (P=0.5). Matched to age, gender and treatments, carnitine levels were lower for MS treated patients compared to untreated MS patients (P <0.05) or controls (P <0.001). Consecutive patients with low plasma carnitine levels who experienced fatigue were substituted. Treatment consisted of oral levocarnitine, 3-6 g daily. All patients achieved normal plasma carnitine levels. For 63% of patients treated with immunosuppressive or immunomodulatory therapies, oral levocarnitine adjunction decreased fatigue intensity, especially in patients treated with cyclophosphamide and interferon beta.

Evaluating the effects of amantadin, modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized, blind study

“…There is some evidence that treatment with ALCAR is effective in chronic fatigue syndrome and in chemotherapy induced fatigue [19,20]. This led Tomassini et al to compare efficacy of ALCAR with amantadine [18].…”

“…Treatment with acetyl-l-carnitine (ALCAR) was shown to be effective in various chronic neurological diseases [18][19][20]. Carnitine is a cellular component with a key role in energy metabolic control.…”

Depressive state and chronic fatigue in multiple sclerosis and neuromyelitis optica

“…These symptoms are thought to be caused by the disseminated demyelination. Low serum carnitine levels have been suggested to cause these symptoms, especially in MS patients treated with disease-modifying therapies (DMT) (Fukazawa et al, 1996;Lebrun et al, 2006). Carnitine is associated with transport and catabolism of fatty acids in muscle cells.…”

Modafinil effects in multiple sclerosis patients with fatigue

“…Nonpharmacological approaches are yoga, aerobic exercises, cooling therapy and energy conservation techniques [5]. Drugs applied to reduce fatigue include amantadine, pemoline [6], aminopyridines [7,8], modafinil [9][10][11][12] and levocarnitine [13,14].…”