Abstract
Some evidence supports the involvement of the hypothalamic–pituitary–adrenal axis (HPA axis) with multiple sclerosis (MS)-related fatigue. In this study, we determined the relation of HPA-axis function with primary fatigue in MS patients in the longitudinal treating fatigue in a MS cohort. MS patients from the TREeating FAtigue in MS (TREFAMS) research program that consists of three randomized controlled trials to study the effects of aerobic training, energy conservation management, and cognitive behavioral therapy on MS-related fatigue were included. The HPA-axis functioning was determined at baseline, the end of treatment (16 weeks) and after 52 weeks. The cortisol awakening response (CAR) and night-time cortisol levels were analyzed. Fatigue was measured with the fatigue subscale of the Checklist Individual Strength (CIS20r fatigue). There was no relationship between CAR and night-time cortisol parameters with CIS20r fatigue scores. Neither of the treatments influenced CAR and night-time cortisol parameters, with the exception of an effect in the energy conservation management treatment group on the CAR surge increase over 52 weeks (β = −114.8, p = 0.007, 95% CI = −197.6, −31.9). Our data suggest that the diurnal cortisol secretion is not associated with MS-related fatigue. This indicates that MS-related fatigue is not attributed to diurnal cortisol secretion and is likely caused by other disease mechanisms.
Highlights
Fatigue is the most commonly reported symptom in multiple sclerosis (MS), affecting ∼80% of MS patients (1–4)
The primary aim of this study was to determine the longitudinal effect of HPA-axis function on MS-related fatigue, by assessing diurnal cortisol saliva levels in patients that participated in the TREeating FAtigue in MS (TREFAMS) research program that consisted of three randomized controlled trials to study the effects of aerobic training (AT), energy conservation management (ECM), and cognitive behavioral therapy (CBT) (17–19)
No correlations were observed between the diurnal cortisol parameters with CIS20R fatigue scores and Expanded Disability Status Scale (EDSS) at baseline
Summary
Fatigue is the most commonly reported symptom in multiple sclerosis (MS), affecting ∼80% of MS patients (1–4). MS-related fatigue is considered to be one of the main causes of impaired quality of life and is often considered to be the most debilitating symptom (4). MS-related fatigue negatively affects social participation and can lead to socioeconomic problems (5). Fatigue in MS remains poorly understood and is often underemphasized because of its subjective nature and lack of consensus on the definition of fatigue. Fatigue can be defined as an “overwhelming, debilitating, and sustained sense of exhaustion that decreases one’s ability to carry out daily activities, including the Diurnal Cortisol Secretion and Multiple Sclerosis ability to work effectively and function at one’s usual level in family or social roles” (6). The different fatigue definitions and domains indicate that fatigue is considered to be a multifaceted symptom
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
