Multiple sclerosis (MS) is an inflammatory-demyelinating disease of the central nervous system that may entail severe levels of disability in the long term. However, independently of the level of disability, MS patients frequently experience severe fatigue that can be as disabling as objective neurological deficits. For that reason, it is mandatory to perform an early diagnosis of MS-related fatigue and start a suitable treatment as soon as possible. In clinical practice, MS-related fatigue should be assessed and managed by a multidisciplinary team involving neurologists, MS nurses, occupational therapists, and physiotherapists. When assessing a person with MS-related fatigue, the first step is to rule out potential triggers or causes of fatigue, which may be related to MS, such as urinary dysfunction, pain, or muscular spasms leading to a sleep disorder, or unrelated to it. Once these causes have been ruled out and appropriately tackled, a careful therapeutic intervention needs to be decided. Therapeutic interventions for MS-related fatigue can be pharmacological or non-pharmacological. Regarding the pharmacological treatments, although many drugs have been tested in clinical trials, only amantadine is currently recommended for this indication. Regarding the non-pharmacological approaches, they can be broadly divided into physical, psychological, and mixed physical/psychological interventions. Several studies, many of them randomised clinical trials, support the use of all these types of non-pharmacological interventions to treat MS-related fatigue. Recent publications suggest that the implementation of mixed approaches, which have a naturally comprehensive nature, may have excellent results in clinical practice, in relation not only to fatigue levels but also to more general aspects of MS.
Keywords: Cognitive behavioural therapy; Disability; EXIMS; Energy conservation education programmes; Exercise; FACETS; FSS; Fatigue; MFIS; Mindfulness intervention; Multidisciplinary approach; Multiple sclerosis; NICE guidelines; VAS.
The Pharmacological and Non-Pharmacological Interventions for the Management of Fatigue Related Multiple SclerosisP Miller et al. J Neurol Sci 381, 41-54. PMID 28991714. - ReviewFurther research into Pharmacological interventions for MSRF is required notably considering the potential of Modafinil. Yoga and energy conservation/fatigue management p …
The Effectiveness of Aerobic Training, Cognitive Behavioural Therapy, and Energy Conservation Management in Treating MS-related Fatigue: The Design of the TREFAMS-ACE ProgrammeH Beckerman et al. Trials 14, 250. PMID 23938046. - Randomized Controlled TrialCurrent Controlled Trials ISRCTN69520623, ISRCTN58583714, and ISRCTN82353628.
Does the Modified Fatigue Impact Scale Offer a More Comprehensive Assessment of Fatigue in MS?N Téllez et al. Mult Scler 11 (2), 198-202. PMID 15794395.Fatigue is a frequent symptom found in MS patients and clearly related with depression. Each fatigue scale correlates with one another, indicating that they are measuring …
The Berlin Treatment Algorithm: Recommendations for Tailored Innovative Therapeutic Strategies for Multiple Sclerosis-Related FatigueC Veauthier et al. EPMA J 7 (1), 25. PMID 27904656. - ReviewMore than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are l …
Fatigue in Multiple Sclerosis: A Comparison of Different Rating Scales and Correlation to Clinical ParametersP Flachenecker et al. Mult Scler 8 (6), 523-6. PMID 12474995.The association of fatigue and depression suggests that there might be either common underlying mechanisms or interdependence by a cause-and-effect relationship that requ …
Cited by 11 PubMed Central articles
Recent Clinical Advances in Pharmacotherapy for Levodopa-Induced DyskinesiaT Müller et al. Drugs 79 (13), 1367-1374. PMID 31332769.Onset of involuntary movement patterns of the face, body and limbs are known as dyskinesia. They mostly appear in association with long-term levodopa (L-dopa) therapy in …
Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella ReviewA Salomè et al. Mult Scler Int 2019, 2027947. PMID 31016045. - ReviewBackground. Fatigue is one of the most invalidant symptoms of Multiple Sclerosis (MS) that negatively affects occupational and work performance and social particip …
Coenzyme Q10 Supplementation Reduces Peripheral Oxidative Stress and Inflammation in interferon-β1a-treated Multiple SclerosisM Moccia et al. Ther Adv Neurol Disord 12, 1756286418819074. PMID 30815035.CoQ10 supplementation improved scavenging activity, reduced oxidative damage, and induced a shift towards a more anti-inflammatory milieu, in the peripheral blood of rela …
Pathophysiological and Cognitive Mechanisms of Fatigue in Multiple SclerosisZM Manjaly et al. J Neurol Neurosurg Psychiatry 90 (6), 642-651. PMID 30683707. - ReviewFatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error …
Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis?B Willekens et al. Front Behav Neurosci 12, 103. PMID 29872382.Mindfulness was introduced in the Western world by Jon Kabat-Zinn in 1979. He defined it as "awareness that arises through paying attention, on purpose, in the present mo …
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance