Fatigue in multiple sclerosis and its relationship to depression and neurologic disability

2000 ◽  
Vol 6 (3) ◽  
pp. 181-185 ◽  
Author(s):  
R Bakshi ◽  
Z A Shaikh ◽  
R S Miletich ◽  
D Czarnecki ◽  
J Dmochowski ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Physical Disability ◽  
Depression Severity ◽  
Severity Scale ◽  
Severity Scores ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Neurologic Disability ◽  
Fatigue Severity ◽  
Improve Fatigue

We studied multiple sclerosis fatigue (MSF) and its relationship to depression and disability. Seventy-one patients [50 relapsing-remitting, 21 secondary progressive] were grouped by Fatigue Severity Scale (FSS) into MS-fatigue (MSF) (FSS55; n=46) or MS-nonfatigue (MSNF) (FSS44; n=20). Forty-one patients were grouped into MS-depression (MSD) (n=15) or MS-nondepression (MSND) (n=26) by interview. Higher expanded disability status scale (EDSS) scores were noted in MSF than MSNF patients (P=0.0003); EDSS scores correlated with FSS scores (rho=0.43, P=0.003). However, fatigue was present in 58% (n=29) of relapsing-remitting patients and in 52% (n=26) of patients with mild physical disability (EDSS53.5). Hamilton/Beck depression severity scores were higher in MSF than MSNF patients and correlated with FSS scores (P50.05). MSD had higher FSS scores than MSND patients (P=0.008). After controlling for EDSS, depression severity continued to correlate with FSS scores (rho=0.37, P=0.02). After controlling for depression, FSS scores no longer correlated with EDSS scores (rho=0.27, P=0.09). Thus, MSF is independent of physical disability, but is associated with depression, suggesting that common mechanisms play a role in MSF and MSD including psychological factors or brain lesions in specific neuroanatomic pathways. Further study is warranted to determine if antidepressant medications improve fatigue in MS.

scholarly journals Restless Leg Syndrome in Patients with Multiple Sclerosis and its Effect on Frequency of Daytime Sleepiness and Fatigue of the Patients

2016 ◽  
Vol 5 (1) ◽  
pp. 7-12
Author(s):  
Nahid Ashjazadeh ◽  
Zahra Shamszadeh
Keyword(s):  
Multiple Sclerosis ◽  
Daytime Sleepiness ◽  
Study Group ◽  
Expanded Disability Status Scale ◽  
Restless Leg Syndrome ◽  
Severity Scale ◽  
Medical Sciences ◽  
Disability Status ◽  
Fatigue Severity ◽  
Study Participants

Background: Restless leg syndrome (RLS), fatigue and daytime sleepiness are three known co-morbidities in patients with multiple sclerosis (MS). The aim of this study was to evaluate the frequency of RLS in patients with MS and its effect on the frequency of fatigue and daytime sleepiness in these patients. Material and Methods: One hundred twenty patients who referred to the Inpatients Neurology Ward of Chamran hospital, affiliated with the Shiraz University of Medical Sciences, from June 2014 to March 2015, were selected as the study participants. The patients with clinically definite MS, according to the 2010 Revised Mc-Donald criteria, and expanded disability status scale (EDSS) ≤5.5 were included. RLS, fatigue and daytime sleepiness were assessed by the criteria of the International RLS study group (IRLSSG), fatigue severity scale (FSS) and Epworth sleepiness scale (ESS) respectively and the related statistical analyzes were conducted. Results: Seventy eight patients (65%) met all the four IRLSSG criteria, 77 patients (64.1%) suffered from fatigue and only 36 patients (30%) had excessive daytime sleepiness. RLS was not significantly linked to mean age, sex, MS duration, and daytime sleepiness of the studied MS patients, but fatigue was more frequent in MS patients with RLS, which was statistically significant (P=0.018). Conclusion: The main result of this study is that RLS is a common comorbidity in MS and the patients with MS, who also suffer from RLS. They have frequently experienced higher fatigue symptoms than those without RLS. Therefore, the appropriate diagnosis and management of RLS may improve both RLS and fatigue in these patients. [GMJ. 2016;5(1):7-12]

Glatiramer acetate (Copaxone): comparison of continuous versus delayed therapy in a six-year organized multiple sclerosis trial

2003 ◽  
Vol 9 (6) ◽  
pp. 585-591 ◽  
Author(s):  
K P Johnson ◽  
B R Brooks ◽  
C C Ford ◽  
A D Goodman ◽  
R P Lisak ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Glatiramer Acetate ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Neurological Improvement ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Neurologic Disability

The aim of this study was to assess the long-term safety and efficacy of glatiramer acetate (GA) for patients with multiple sclerosis (MS) who received active treatment versus those on placebo for approximately 30 months (24-35 months) before receiving GA during a six-year organized, prospective open label study. Entry required two relapses in the previous two years and an Expanded Disability Status Scale (EDSS) score of 0-5. Patients (251) were equally randomized to daily subcutaneous G A, 20 mg, or to placebo. A fter approximately 30 months, 208 patients continued in an open label study: 101 continued on G A and 107 switched from placebo to active drug. Groups were well matched at randomization and entry to the open label study. Patients always on G A showed a steady decline in relapses: a mean of 1.5 per year at entry, a mean of 0.42 over the entire six years (95% C I=0.34-0.51), a 72% reductio n (P =0.0001). They averaged a relapse every four+ years (yearly rate 0.23 in year six) and 26/101 remain relapse free. Patients did less well if on placebo for 30 months, but relapses then declined, and by year six the rates were similar. O f patients always on GA, 69% showed neurological improvement of > 1 EDSS steps or remained stable compared with 57% if G A treatment was delayed. O f relapse-free patients always on G A over six years, only three of 26 (11%) were worse by]-1 EDSS steps, whereas nine of 21 (43%) in the placebo/active group were worse (P B-0.03). Disability, measured every six months, showed that the group of patients always on G A was relatively stable over the six years, while the group who received placebo for the first two-and-a-half years did significantly less well. Daily injections of GA were well tolerated. This longest ever organized MS treatment trial shows that delaying therapy with GA increases the risk of neurologic disability, reinforcing the rationale for using G A as a first-line treatment early in the course of relapsing-remitting MS.

Cytokine mRNA expression in patients with multiple sclerosis and fatigue

2004 ◽  
Vol 10 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Peter Flachenecker ◽  
Irene Bihler ◽  
F Weber ◽  
M Gottschalk ◽  
Klaus V Toyka ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mrna Expression ◽  
Serum Levels ◽  
Severity Scale ◽  
Cytokine Mrna ◽  
Sympathetic Function ◽  
Relapsing Remitting ◽  
Autonomic Tests ◽  
Fatigue Severity

Background: Fatigue is one of the most common disabling symptoms in patients with multiple sclerosis (MS), but the putative role of proinflammatory cytokines remains to be elucidated. Methods: Thirty-seven patients (27 women, 10 men) with relapsing-remitting (n =29) and secondary progressive (n =8) MS, aged 41.0 ± 10.2 years, were studied. Fatigue was assessed by Krupp’s Fatigue Severity Scale (FSS). C ytokine mRNA expression for interferon (IFN)-g, tumor necro sis factor (TNF)-a and interleukin (IL)-10 were measured by real time RT PC R. A utonomic function was evaluated by standard tests for parasympathetic and sympathetic function, as well as by serum levels of norepinephrine and epinephrine. Results: Median levels of TNF-a mRNA expression were significantly higher in MS patients with (FSS]-4.0 and]-5.0, n=26 and n=14, respectively) than in those without fatigue (FSSB-4.0, n =11). No differences were seen for IFN-g and IL-10 mRNA expression. C ytokine levels were not correlated to autonomic tests or to serum catecho lamine levels. Conclusions: These results suggest that TNF-a, as a principal proinflammatory mediator, is associated with MS-related fatigue. This is in support of a patho genic role of the MS-related inflammatory process in the development of fatigue.

Correlation of self-assessed fatigue and alertness in multiple sclerosis

2010 ◽  
Vol 16 (9) ◽  
pp. 1134-1140 ◽  
Author(s):  
Nicholetta Weinges-Evers ◽  
Alexander U Brandt ◽  
Markus Bock ◽  
Caspar F Pfueller ◽  
Jan Dörr ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neuropsychological Tests ◽  
Fatigue Severity Scale ◽  
Expanded Disability Status Scale ◽  
Severity Scale ◽  
Disability Status ◽  
Attentional Performance ◽  
Fatigue Severity ◽  
Repeatable Battery ◽  
Multiple Sclerosis Patients

Background: Fatigue is the most common symptom in multiple sclerosis patients, but is difficult to measure; quantification thus relies on self-assessed questionnaires. Objective: To evaluate a battery of neuropsychological tests regarding their capacity to objectify self-reported fatigue. Methods: We assessed the correlation between age, gender, education, Kurtzke’s Expanded Disability Status Scale, depression, fatigue and neuropsychological testing using a cross-sectional approach in 110 multiple sclerosis patients. Fatigue was measured with the Fatigue Severity Scale. Cognition was measured using a series of neuropsychological tests including three subtests of the Test of Attentional Performance, the Brief Repeatable Battery of Neuropsychological Tests and the Faces Symbol Test. Results: According to the Fatigue Severity Scale 51.4% of the cohort were fatigued (scores ≥4). Age, education and depression showed a significant correlation with the Fatigue Severity Scale. Only 5.5% of the cohort exhibited cognitive impairment in the Brief Repeatable Battery of Neuropsychological Tests scores. After correction for age, education, Expanded Disability Status Scale and depression, Fatigue Severity Scale scores were an independent predictor of performance in the alertness subtest of the Test of Attentional Performance (standardized coefficient beta = 0.298, p = 0.014). Conclusion: The alertness subtest of the Test of Attentional Performance may offer an objective method of evaluating self-reported fatigue, and may therefore — in addition to the Fatigue Severity Scale — be a suitable tool for the assessment of multiple sclerosis patients complaining of fatigue.

American ginseng does not improve fatigue in multiple sclerosis: a single center randomized double-blind placebo-controlled crossover pilot study

2011 ◽  
Vol 17 (12) ◽  
pp. 1523-1526 ◽  
Author(s):  
E Kim ◽  
M Cameron ◽  
J Lovera ◽  
L Schaben ◽  
D Bourdette ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Crossover Trial ◽  
American Ginseng ◽  
Single Center ◽  
Severity Scale ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Fatigue Severity ◽  
Improve Fatigue

This study examined the safety and efficacy of an escalating dose (100 mg, 200 mg, 400 mg/day) of American ginseng over 6 weeks in a single-center, randomized, double-blind, placebo-controlled, crossover trial with 56 subjects with multiple sclerosis and fatigue. There were no serious adverse events but fatigue on ginseng, as assessed by the Fatigue Severity Scale, was not significantly different from fatigue on placebo.

Atrophy of reward-related striatal structures in fatigued MS patients is independent of physical disability

2015 ◽  
Vol 22 (6) ◽  
pp. 822-829 ◽  
Author(s):  
Alfredo Damasceno ◽  
Benito Pereira Damasceno ◽  
Fernando Cendes
Keyword(s):  
Gray Matter ◽  
Physical Disability ◽  
Severity Scale ◽  
Multivariate Logistic Regression ◽  
Mri Findings ◽  
Relapsing Remitting ◽  
Fatigue Severity ◽  
Reward Functions ◽  
Highly Correlated ◽  
Gray Matter Volumes

Background: MRI studies have shown gray-matter abnormalities in fatigued multiple sclerosis (MS) patients. However, given that physical disability is highly correlated to MS fatigue, it is often difficult to disentangle its effect in these MRI findings. Objective: The objective of this research paper is to investigate gray-matter damage in mildly disabled MS patients, addressing which variables were better related to fatigue while controlling for physical disability and depression. Methods: Forty-nine relapsing–remitting MS (RRMS) patients and 30 controls underwent MRI (3T). Fatigue was assessed using the Fatigue Severity Scale (FSS). Multivariate logistic regression was performed to assess the contribution of clinical and MRI metrics to fatigue. Statistical analyses were performed controlling for disability and depression. Results: Fatigue was present in 22 (44.9%) patients. FSS score was highly correlated with EDSS ( p = 0.00001). Patients with fatigue had lower brain cortical and subcortical gray-matter volumes. However, after controlling for EDSS, only the caudate and the accumbens volumes remained statistically significant. Conclusions: Fatigued MS patients have a global cortical and subcortical gray-matter atrophy that seems largely related to higher physical disability. However, striatal structures involved in effort-reward functions exhibited smaller volumes in fatigued patients, independently of physical disability and depressive symptoms, supporting the theory of cortico-striatal network impairment in MS fatigue.

scholarly journals Italian Validation of the 12-Item Multiple Sclerosis Walking Scale

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
C. Solaro ◽  
E. Trabucco ◽  
A. Signori ◽  
M. Cella ◽  
M. Messmer Uccelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Italian Population ◽  
Disease Course ◽  
Severity Scale ◽  
Italian Version ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
Fatigue Severity ◽  
The Mean

Objective. Gait impairment is commonly in people with multiple sclerosis (MS). The 12-item MS walking scale (MSWS-12) assesses patients’ measurement of walking quality. The aim of this study was to cross-culturally adapt and validate the MSWS-12 for the Italian population with MS.Methods. Six MS out-patient clinics across Italy enrolled subjects between June 2013 and December 2013. Construct validity of MSWS-12 was determined by examining correlations with the Italian version of the EDSS, the timed 25-foot walk (T25FW), and the Fatigue Severity Scale (FSS).Results. 321 MS subjects were enrolled. Mean age was 47.55 years and mean disease duration was 13.8 years. Mean EDSS score was 4.46. 185 subjects had a relapsing-remitting course, 92 were secondary progressive, 43 were primary progressive, and 1 had a clinically isolated syndrome. The mean total score of the MSWS-12 was 49.6 (SD: 31) with values ranging between 0 and 100. Correlations between the MSWS-12 with age, disease duration, and disease course were found but not with gender. Values of the MSWS-12/IT were significantly related to EDSS (0.71), to the T25FW (0.65), and to the FSS (0.51).Conclusion. MSWS-12/IT has been adapted and validated, it is a reliable and reproducible scale for Italian patients with MS.

scholarly journals Depression and Cognitive Impairment in Disability-Free Early Multiple Sclerosis

2003 ◽  
Vol 14 (1-2) ◽  
pp. 39-45 ◽  
Author(s):  
Claus G. Haase ◽  
Michael Tinnefeld ◽  
Marc Lienemann ◽  
Reinhard E. Ganz ◽  
Pedro M. Faustmann
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Physical Disability ◽  
Neuropsychological Tests ◽  
Short Term Memory ◽  
Clinical Signs ◽  
Depression Scale ◽  
Diagnostic Tools ◽  
Disability Status ◽  
Relapsing Remitting

Cognitive and emotional capabilities were evaluated in 73 female patients with stable relapsing-remitting definite, and/or laboratory-supported multiple sclerosis (MS) and were compared with 32 matched healthy controls. Patients were categorized according to their score in the expanded disability status scale (EDSS) to either no (EDSS 0,n= 33) or few clinical signs (EDSS 1–2,n= 40) of MS without physical disability. Patients with EDSS > 0 were characterized by significantly (p These results indicate that depression may present as an early sign in MS followed by cognitive impairment, in particular visuo-spatial short-term memory, before physical disability appears. Neuropsychological tests as mentioned here could serve as early diagnostic tools to detect subtle disease progression and to initiate and monitor disease modifying therapies.Patients with EDSS > 0 were characterized by significantly (p< 0.001) higher scores on “von Zerssen’s“ depression scale, compared to controls. Patients with higher EDSS scores (1–2) showed significantly decreased performance with respect to the total score of Kimura’s Recurring-Figures-Test (p< 0.001), in addition. Regarding visuo-constructive functioning, patients with EDSS = 0 performed to a significantly lower level (p< 0.001), compared to controls.

scholarly journals Treatment of Fatigue in Multiple Sclerosis Patients: A Neurocognitive Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Mauro Catalan ◽  
Alessandra De Michiel ◽  
Alessio Bratina ◽  
Susanna Mezzarobba ◽  
Lorella Pellegrini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Motor Planning ◽  
Rehabilitation Program ◽  
Severity Scale ◽  
Impact Scale ◽  
Disability Status ◽  
Neurocognitive Rehabilitation ◽  
Fatigue Severity ◽  
Fatigue Impact Scale ◽  
Multiple Sclerosis Patients

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 () and MFIS (). MSFC () and MSQoL54 () scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, ; MFIS ) and for the physical subscale of MSQoL54 (). 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.

Quantifying cognition and fatigue to enhance the sensitivity of the EDSS during relapses

2020 ◽  
pp. 135245852097361
Author(s):  
Sarah A Morrow ◽  
Devon Conway ◽  
Tom Fuchs ◽  
Curtis Wojcik ◽  
Mahmut Unverdi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Functional System ◽  
Expanded Disability Status Scale ◽  
Severity Scale ◽  
Stable Group ◽  
Cognitive Changes ◽  
Full Cohort ◽  
Disability Status ◽  
Fatigue Severity ◽  
Relapse Group

Background: Cognition is affected by relapses in persons with multiple sclerosis (PwMS), yet the Expanded Disability Status Scale (EDSS) does not readily detect cognitive changes. Objective: The objective of this study is to improve the detection of cognitive decline during relapses, by incorporating the Symbol Digit Modalities Test (SDMT) into the cerebral Functional System Score (CFSS) of the EDSS. Methods: This prospective study recruited PwMS from three dedicated MS centers. All subjects had EDSS, SDMT, and Fatigue Severity Scale (FSS) administered. Subjects experiencing a relapse were assigned to the relapse group (RG). Matched controls from the larger cohort were assigned to the stable group (SG). RG and SG subjects underwent the same evaluation at relapse and 3 months later. Our main outcomes were a modified CFSS (m-CFSS) and modified EDSS (m-EDSS), incorporating SDMT and FSS, accounting for cognitive performance and fatigue rating, during relapse. Results: The full cohort included 592 subjects; 80 qualified for RG and 72 were matched to the SG. The m-CFSS was significantly higher than CFSS at baseline (median = 2 vs. median = 0, p < 0.001) and relapse (median = 2 vs. median = 1, p < 0.001). The m-EDSS was higher than EDSS (median 3.0 vs. 2.5, p = 0.02) at relapse, where 35 RG subjects (43.8%) had higher m-EDSS than EDSS at relapse. Conclusion: This study demonstrates that incorporating the SDMT and FSS improves the accuracy of the EDSS, by accounting for cognitive changes, during relapse activity.

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