C Veauthier1,2, F Paul3,4. 1. Interdisziplinäres Schlafmedizinisches Zentrum, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. christian.veauthier@charite.de. 2. NeuroCure Clinical Research Center und Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland. christian.veauthier@charite.de. 3. NeuroCure Clinical Research Center und Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland. 4. Experimental and Clinical Research Center (ECRC), Berlin, Deutschland.
Abstract
BACKGROUND: Fatigue is one of the most frequent symptoms of multiple sclerosis (MS) and one of the main reasons for underemployment and early retirement. The mechanisms of MS-related fatigue are unknown but comorbid disorders play a major role. Anemia, diabetes, side effects of medication and depression should be ruled out. Moreover, excessive daytime sleepiness (EDS) should be differentiated from fatigue. No approved medicinal therapy of MS fatigue is currently available. OBJECTIVE: Presentation of current treatment strategies with a particular focus on secondary fatigue due to sleep disorders. MATERIAL AND METHODS: A review of the literature was carried out. RESULTS AND CONCLUSION: All MS patients suffering from fatigue should be questioned with respect to EDS and if necessary sleep medical investigations should be carried out; however, pure fatigue without accompanying EDS can also be caused by a sleep disorder. Medications, particularly freely available antihistamines, can also increase fatigue. Furthermore, anemia, iron deficits, diabetes and hypothyroidism should be excluded. Self-assessment questionnaires show an overlap between depression and fatigue. Several studies have shown that cognitive behavioral therapy and various psychotherapeutic measures, such as vertigo training, progressive exercise training and individualized physiotherapy as well as fatigue management interventions can lead to a significant improvement of MS-related fatigue. There is currently no medication which is suitable for treatment of fatigue, with the exception of fampridine for the treatment of motor functions and motor fatigue.
BACKGROUND:Fatigue is one of the most frequent symptoms of multiple sclerosis (MS) and one of the main reasons for underemployment and early retirement. The mechanisms of MS-related fatigue are unknown but comorbid disorders play a major role. Anemia, diabetes, side effects of medication and depression should be ruled out. Moreover, excessive daytime sleepiness (EDS) should be differentiated from fatigue. No approved medicinal therapy of MS fatigue is currently available. OBJECTIVE: Presentation of current treatment strategies with a particular focus on secondary fatigue due to sleep disorders. MATERIAL AND METHODS: A review of the literature was carried out. RESULTS AND CONCLUSION: All MS patients suffering from fatigue should be questioned with respect to EDS and if necessary sleep medical investigations should be carried out; however, pure fatigue without accompanying EDS can also be caused by a sleep disorder. Medications, particularly freely available antihistamines, can also increase fatigue. Furthermore, anemia, iron deficits, diabetes and hypothyroidism should be excluded. Self-assessment questionnaires show an overlap between depression and fatigue. Several studies have shown that cognitive behavioral therapy and various psychotherapeutic measures, such as vertigo training, progressive exercise training and individualized physiotherapy as well as fatigue management interventions can lead to a significant improvement of MS-related fatigue. There is currently no medication which is suitable for treatment of fatigue, with the exception of fampridine for the treatment of motor functions and motor fatigue.
Entities:
Keywords:
Insomnia; Polysomnography; Restless legs syndrome; Sleep disorders; Sleep medicine
Authors: Donald L Bliwise; Daniel J Foley; Michael V Vitiello; Farzaneh Pour Ansari; Sonia Ancoli-Israel; James K Walsh Journal: Sleep Med Date: 2008-08-13 Impact factor: 3.492
Authors: I Côté; D A Trojan; M Kaminska; M Cardoso; A Benedetti; D Weiss; A Robinson; A Bar-Or; Y Lapierre; R J Kimoff Journal: Mult Scler Date: 2012-08-22 Impact factor: 6.312
Authors: L M Metz; S B Patten; C J Archibald; J I Bakker; C J Harris; D G Patry; R B Bell; M Yeung; W F Murphy; C A Stoian; K Billesberger; L Tillotson; S Peters; D McGowan Journal: J Neurol Neurosurg Psychiatry Date: 2004-07 Impact factor: 10.154
Authors: Angela Applebee; Andrew D Goodman; Angeli S Mayadev; Francois Bethoux; Myla D Goldman; Michael Klingler; Andrew R Blight; Enrique J Carrazana Journal: Clin Ther Date: 2015-11-10 Impact factor: 3.393
Authors: Iris-Katharina Penner; Eva Catharina Sivertsdotter; Elisabeth G Celius; Siegrid Fuchs; Karen Schreiber; Sara Berkö; Anders Svenningsson Journal: Front Neurol Date: 2015-02-23 Impact factor: 4.003
Authors: Jonathan Calkwood; Bruce Cree; Heidi Crayton; Daniel Kantor; Brian Steingo; Luigi Barbato; Ron Hashmonay; Neetu Agashivala; Kevin McCague; Nadia Tenenbaum; Keith Edwards Journal: BMC Neurol Date: 2014-11-26 Impact factor: 2.474