Treatment of Fatigue in Multiple Sclerosis Patients: A Neurocognitive Approach

Abstract

The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS complaining of fatigue were treated for five weeks with exercises of neurocognitive rehabilitation twice a week. Patients were evaluated by Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), MSQoL54, Expanded Disability Status Scale (EDSS), and MS Functional Composite (MSFC). After treatment, a decrease in fatigue was detected with both FSS (P = 0.0001) and MFIS (P = 0.0001). MSFC (P = 0.035) and MSQoL54 (P = 0.002) scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, P = 0.0001; MFIS P = 0.01) and for the physical subscale of MSQoL54 (P = 0.049). No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on MI, could be a strategy to treat fatigue in MS patients.

Rhythmic cued motor imagery and walking in people with multiple sclerosis: a randomised controlled feasibility study

“…Participants were asked to practise six times a week for 17 min for 4 weeks. Duration of both the practice and the study were based on the current literature on motor imagery, showing an average study duration of 34 days with a practice intensity of three times a week, for 17 min [10, 6]. The frequency of six times a week was chosen according to a recommendation by Peiris et al [35] and a Cochrane review from Rietberg et al [36].…”

“…The advantage of motor imagery over actual movement practice is that it does not cause motor fatigue and the person is not at risk of falls as it can be practised while seated. Only one uncontrolled study was identified that investigated the effect of 5 weeks of motor imagery training on fatigue, walking and quality of life in 20 people with MS, with a median Expanded Disability Status Scale (EDSS) score of 2.0 (range 1.0, 6.0), corresponding with mild to moderate MS [6]. Results from their study were significant improvements in fatigue and quality of life, without effect sizes reported, but only trends for improvement in walking.…”

Exercise Approaches to Ameliorate Fatigue in People with Multiple Sclerosis

“…There was an improvement in fatigue scores as well as quality of life in these individuals after the neurocognitive therapy. Notably, this improvement was maintained during the 6 month follow-up assessment [40]. Moreover, the effects of online cognitive behavioral therapy (CBT) on reduction of fatigue were seen in the individuals with MS.…”

“…Neurocognitive therapy is based on the hypothesis that the central nervous system can improve movement in pathological conditions through correct activation of the cognitive processes of the patient including attention, memory, language and motor imagery. This therapy mainly involves exercises in which the patient has to solve cognitive or motor problems through movements of the body segments with help from the therapist [40].…”

“…The effect of neurocognitive therapy was evaluated in a group of individuals with MS (N=20) who had complaints of fatigue [40]. There was an improvement in fatigue scores as well as quality of life in these individuals after the neurocognitive therapy.…”