Does the severity of fatigue in multiple sclerosis patients have a relationship with their temperament?

Objective: The objective of this paper is to investigate the relationship between total and regional corpus callosum (CC) atrophy, neuropsychological test performance and fatigue in multiple sclerosis (MS) patients. Methods: We conducted a cross-sectional study in 113 MS patients: mean age 48±11 years, 75/113 women, 84/113 relapsing–remitting MS, mean disease duration 21±9 years, mean Expanded Disability Status Scale (EDSS) score 3.2±1.7. All patients underwent brain magnetic resonance imaging, standardised neurological assessment and comprehensive cognitive testing including assessments for fatigue and depression. Total and regional CC atrophy was assessed using the corpus callosum index (CCI). Results: CCI correlated more strongly with T2- and T1-lesion volume and whole brain volume than with disease duration or EDSS score. CCI correlated strongly with the verbal fluency test (VFT), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT). Multivariate regression analysis revealed that atrophy of the posterior CC segment was significantly associated with poor outcome in the PASAT, VFT and SDMT. In contrast, atrophy of the anterior CC segment was significantly associated with fatigue severity and poor outcome in the long-term memory test. Conclusions: Atrophy of the CC is associated with cognitive impairment and fatigue. Regional CCI results indicate that these associations are partially spatially segregated.

Background and aim: Multiple sclerosis (MS) is a chronic inflammatory disease accompanied with lower quality of life due to disabling symptoms such as depression and fatigue. The pathologic basis of such symptoms is still unknown. This study was performed to assess pro-inflammatory and anti-inflammatory cytokine levels as well as oxidative stress (OS) biomarkers in MS patients with and without fatigue and depression in the remission course of disease. Material and methods: Forty eight patients with a definite diagnosis of relapsing –remitting MS were studied. All the patients have not experienced relapses at least for 6 months. We scored Expanded Disability Status Scale (EDSS) as well as the Beck depression inventory (BDI) questionnaire and Fatigue severity scale (FSS) to assess depressionrelated symptoms and fatigue severity in the participants, respectively. Furthermore, we analyzed fasting blood samples to determine serum TNF-α, IL-4, IL-6, TGF-β, INF-γ and MMP-9 levels as well as OS parameters including serum superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC) and malondialdehyde (MDA). Results: No significant differences were observed in the levels of inflammatory and OS biomarkers in depressed and non-depressed MS patients. The same was noted for fatigued and non-fatigued patients. However, the EDSS score for fatigued and depressed patients was higher than the control group. Conclusion: Our study results indicated that the activation of inflammatory pass ways or OS stress cannot be regarded as the primary cause of depression and fatigue in MS patients with mild disability. This is the first report to assess the primary pathogenesis of fatigue and depression in MS patients.

Although fatigue is common among multiple sclerosis (MS) patients, evaluation of this symptom is difficult due to the subjectivity and variability of the complaint. We proposed the Fatigue Descriptive Scale (FDS) as a tool to evaluate the severity and quality of fatigue in a group of patients suffering from MS. As a way to demonstrate the usefulness of this scale we applied the FDS in a group of 155 patients (105 women and 50 men) with clinically-definite multiple sclerosis, as outlined according to Poser's criteria. Age was 36.2 +/- 11.1 years (range 12-62) and time of evolution was 8.3 +/- 9.4 years (range 1-44). The Fatigue Severity Scale (FSS) was also used. Descriptive statistics techniques and techniques for nonparametric distribution (Spearman Rank, Kruskal-Wallis ANOVA) were used. One hundred and eighteen patients reported fatigue (73 spontaneously, 45 when questioned). All descriptions of fatigue were ranked according to FDS categories. Eighty-five patients defined the symptom as fatigue with exercise, 26 as asthenia and seven as the worsening of other symptoms. Fatigue by itself produced limited or disrupted activity in 78 patients; work-related functions were limited in 48 patients; social relations were limited in 29 patients; and self-care difficult for one patient. Fifty-six patients suffered fatigue daily. FDS score was 4.9 +/- 3.9 (range 0-13). FSS was 3.1 +/- 1.7 (range 0.2-6.6). FDS and FSS of Krupp were highly correlated (R = 0.87, p < 0.001). Therefore, in comparison with other scales, the FDS shows remarkable usefulness in classifying, periodicity, and severity of fatigue in MS patients. The high correlation with the FSS implies that it is a valid method to measure the severity of fatigue, as was demonstrated in our paper proposing the FDS. The importance of this new scale is its ability to inform the clinicians in a very quick, easy, and at the same time complete way, how severe the fatigue really is and how it affects the patient.

In multiple sclerosis (MS) patients, fatigue is rated as one of the most common and disabling symptoms. However, the pathophysiology underlying this fatigue is not yet clear. Several lines of evidence suggest that immunological factors, such as elevated levels of pro-inflammatory cytokines, may contribute to subjective fatigue in MS patients. Pro-inflammatory cytokines represent primary mediators of immune-to-brain-communication, modulating changes in the neurophysiology of the central nervous system. Recently, we proposed a model arguing that fatigue in MS patients is a subjective feeling, which is related to inflammation. Moreover, it implies that fatigue can be measured behaviorally only by applying specific cognitive tasks related to alertness and vigilance. In the present review, we focus on the subjective feeling of MS-related fatigue. We examine the hypothesis that the subjective feeling of MS-related fatigue may be a variant of inflammation-induced sickness behavior, resulting from cytokine-mediated activity changes within brain areas involved in interoception and homeostasis including the insula, the anterior cingulate, and the hypothalamus. We first present studies demonstrating a relationship between pro-inflammatory cytokines and subjective fatigue in healthy individuals, in people with inflammatory disorders, and particularly in MS patients. Subsequently, we discuss studies analyzing the impact of anti-inflammatory treatment on fatigue. In the next part of this review, we present studies on the transmission and neural representation of inflammatory signals, with a special focus on possible neural concomitants of inflammation-induced fatigue. We also present two of our studies on the relationship between local gray and white matter atrophy and fatigue in MS patients. Finally, we discuss some implications of our findings and future perspectives.

To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS.

Background: Patients with MS commonly report problems with walking, balance, fatigue and visual disturbances. These symptoms can appear suddenly, they have a variable course and they differ in severity. Among the frequently encountered symptoms in MS, fatigue remains the most challenging one, majorly altering the quality of life. It affects up to 80% ofMS patients. Aim of Study: The aim of this systematic review was to examine the effectiveness of physical therapy interventions for fatigue in multiple sclerosis patients. Material and Methods: Thecurrent study was made on patients with multiple sclerosis aged ³18 years. We searched the PubMed, Pedro, Cochrane and goggle scholar web site from inception up till now. Systematic review of randomized controlled trials, the intervention used was physical therapy interventions as a group programs. Nine studies were selected according to inclusive and exclusive criteria and descriptive analysis were conducted due to heterogeneity. Results: Seven studies assessed fatigue by physical therapy interventions in multiple sclerosis patients. There was very high heterogeneity in fatigue severity scale among studies (n=7 studies, n=941 participants, p < 0.00001; I2=95%). There was significant overall effect between exercise therapy group and control group in fatigue by fatigue severity scale (SMD= –1.24; 95% CI, –1.38 to –1.10; p < 0.00001), two studies assessed fatigue by physical therapy interventions in multiple sclerosis patients. There was very high heterogeneity in modified fatigue impact scale among studies (n=2 studies, n= 131 participants, p=0.004; I2=88%). There was significant overall effect between exercise therapy group and control group in fatigue by modified fatigue impact scale (SMD= –0.57; 95% CI, –0.93 to –0.22; p=0.002) three studies assessed fatigue by physical therapy interventions in multiple sclerosis patients. There was very high heterogeneity in visual analogue scale among studies (n=3 studies, n=234 participants, p <0.00001; I2=98%). There was significant overall effect between exercise therapy group and control group in fatigue by visual analogue scale (SMD=0.96; 95% CI, 0.66 to 1.27; p < 0.00001), four studies assessed fatigue by physical therapy interventions in multiple sclerosis patients. There was no heterogeneity in multiple sclerosis quality of life-54 among studies (n=4 studies, n=177 participants, p=0.62; I2=0%). There was significant overall effect between exercise therapy group and control group in fatigue by multiple sclerosis quality of life-54 (SMD=0.35; 95% CI, 0.05 to 0.65; p=0.02). Sensi-tivity analysis showed that fatigue assessed by multiple sclerosis quality of life-54 was non-significant by excluding one trial at a time from pooled effects to determine whether any one study was particularly influential. No significant or change in heterogeneity (I2=0%) among including four studies was observed after removal one study according to sensitivity analysis matrix. Conclusion: The current level of evidence supports the effectiveness of physical therapy interventions for reducing fatigue in multiple sclerosis patients.

The aim of our study is to examine effects of aerobic and Pilates exercises on disability, cognition, physical performance, balance, depression and fatigue in relapsing-remitting Multiple Sclerosis (MS) patients as compared to healthy controls. The subjects were divided as aerobic exercise (n = 26), Pilates (n = 9), and the healthy control group (n = 21). We used MSFC, physical performance, Berg balance scale, Beck depression scale, fatigue impact scale. All evaluations were performed before and after exercise training. There are statistically meaningful differences between Nine hole testing, PASAT 3, physical performance and fatique impact scale before and after aerobic exercise. Also we found significant difference for physical performance in the Pilates group. There are no significant differences in measures of fatique impact scale and depression between aerobic exercise group and the healthy controls after exercise. We found significant differences between Pilates and control group's after measurements except depression. There were significant differences between the Pilates and aerobic group for cognitive tests in favor of the Pilates group. Aerobic exercise and clinical Pilates exercises revealed moderate changes in levels of cognitive, physical performance, balance, depression, fatigue in MS patients.

Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators

Multiple sclerosis (MS) is a chronic inflammatory disease of autoimmune origin for which there is currently no available cure. In the course of MS, next to neurological disorders, patients often present with chronic fatigue syndrome and depressive disorders, which impact on their daily function and quality of life. The aim of study was to analyse the relationship between serum parameters of iron metabolism and the severity of fatigue, depressive symptoms, and quality of life in MS patients. Methods: The study sample consisted of 90 people with a diagnosis of multiple sclerosis, age range 19–67 years, whose functional status evaluated using the Expanded Disability Status Scale in 90% of the participants did not exceed 3.5 points. Venous blood samples were collected for blood cell count determination and for the purposes of obtaining serum analysed for the concentrations of iron, ferritin, transferrin, transferrin saturation, unsaturated iron binding capacity (UIBC), and total iron binding capacity (TIBC). The participants were also evaluated according to the Fatigue Severity Scale, Beck Depression Inventory, and Functional Assessment of Multiple Sclerosis. Results: Ferritin levels were significantly correlated with the severity of depressive symptoms (r = −0.22; p = 0.04) and quality of life assessment (r = 0.22; p = 0.04) in the MS patients. Moreover, the severity of fatigue and depressive symptoms was significantly linked to a deterioration in quality of life. Conclusions: Ferritin deficiency in MS patients is associated with an exacerbation of depressive disorders and a decline in quality of life. Symptoms of fatigue in MS patients are inversely proportional to mood and quality of life.

Evaluation of MS related central fatigue using MR neuroimaging methods: Scoping review

Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients.

Introduction: The chronic nature of Multiple Sclerosis (MS),have can leave devastating effects on quality of life and fatigue. The present researchaimed to study the effect of group Mindfulness-based Stress Reduction (MBSR) and consciousyoga program on the quality of life and fatigue severity among patients with MS. Methods: This study was quasi-experimental with interventionand control groups. The statistical population included all members to MS Society ofTehran Province, 24 of whom diagnosed with MS were selected as the sample based on theinclusion criteria. The subjects were randomly assigned into the test group (12 patients)and the control group (12 patients). MS Quality of Life-54 (MSQOL-54) and Fatigue SeverityScale (FSS) were used for data collection. Subjects in the test group underwent a MBSR andconscious yoga program in 8 two-hour sessions. The data were analyzed using the SPSSver.13 software. Results: The study findings showed that there was asignificant difference between subjects in the experimental and control groups in terms ofmean score of some subscales of quality of life including physical health, rolelimitations due to physical and emotional problems, energy, emotional well-being, healthdistress, health perception, and satisfaction with sexual function, overall quality oflife, and fatigue severity. Conclusion: The results show that the program is effectivein reduction of fatigue severity and improving some subscales of quality of life in MSpatients. Hence, this supportive method can be used as an effective way for improvingquality of life and relieving fatigue in MS patients.

Effect of seasonal fluctuation of ambient temperature on fatigue in multiple sclerosis patients living in Attica, Greece

Longitudinal associations between brain structural changes and fatigue in early MS

Background: Aerobic capacity (VO2 max) in multiple sclerosis (MS) is considered to be a key physiological measure as it is a strong health and performance predictor. Fatigue is the common disabling symptom in MS patients. The study was done to assess correlation between aerobic capacity and fatigue in MS patients. Methodology: A study was carried on 30 patients of relapse remitting MS across Multiple Sclerosis Society of India, Pune, chapter participate in study and assess for aerobic capacity and fatigue. These patients were selected according to inclusion and exclusion criteria and were evaluated for assessing aerobic capacity (VO2 max) by 2 min walk test and fatigue by Modified Fatigue Impact Scale (MFIS). Results: Our study found aerobic capacity (VO2 max) (17.71 ± 2.966), MFIS (60.712 ± 22.191) with (P &lt; 0.0001, r = −0.7168) and very significant correlation between aerobic capacity with fatigue in MS patients. Conclusion: The study concludes that there is a significant negative correlation of aerobic capacity with fatigue in MS patients.