Fatigue in patients with neuromyelitis optica spectrum disorder and its impact on quality of life.

Jin Myoung Seok,Byoung Joon Kim,Hye Lim Lee,Eun Yeon Joo,Misong Choi,Kwang Ho Lee,Pamela Song,Eun Bin Cho,Ju-Hong Min,Friedemann Paul

doi:10.1371/journal.pone.0177230

Abstract

Fatigue is a prevalent symptom and major burden in neuroimmunological diseases. In neuromyelitis optica spectrum disorder (NMOSD), a severe autoimmune central nervous system (CNS) inflammatory disease with autoantibodies reactive to aquaporin-4, there are few reports about fatigue and quality of life (QOL). We aimed to evaluate the severity of fatigue and its relationship with QOL in patients with NMOSD. We prospectively studied patients with NMOSD who were in remission and seropositive for anti-aquaporin-4 antibody, and they were divided into 2 groups based on the presence of fatigue assessed using the Functional Assessment of Chronic Illness Therapy-fatigue score. Sleep quality, depression, pain, and QOL were also evaluated. A total of 35 patients were enrolled (mean age, 46.5 ± 14.1 years; female: male = 29:6), and the median Expanded Disability Status Scale (EDSS) score was 2.0 (range, 0 to 8.0). The patients with fatigue (N = 25, 71.4%) had poorer sleep quality and more severe depression than those without fatigue (p = 0.009 and p = 0.001). Both the physical and mental QOL scores were lower in patients with fatigue than in those without fatigue (p = 0.033 and p = 0.004). Multiple linear regression analyses showed that the degree of fatigue with EDSS score and pain were independent predictors of physical aspects of QOL (B = 0.382, p = 0.001), whereas depression was the only predictor of the mental components of QOL (B = -0.845, p = <0.001). Fatigue is a common symptom and an important predictor of QOL in patients with NMOSD.

Highlights

Introduction[1] There has been many studies on the impairment of quality of life (QOL) in multiple sclerosis (MS) in which fatigue, depression, and sleep disorder were considerable predictors of low QOL scores.[3,4,5] fatigue was reported as one of the most frequent and disabling symptom in MS, and the improvement of fatigue is being considered as an important treatment target in patients with MS.[6, 7] In Neuromyelitis optica (NMO), a recent study showed that the disease had a strong negative impact on health-related QOL in patients;[8] there are only a few reports on the relationship of fatigue and QOL in NMO
Patients were enrolled if they met the revised criteria for Neuromyelitis optica (NMO) or the suggestion of NMO spectrum disorder (NMOSD) with positive anti-AQP4,[1, 10] which is in agreement with the diagnosis of NMOSD with anti-AQP4 based on the International Consensus Diagnostic Criteria,[11] and they were during remission for at least 6 months
A total of 35 patients who were seropositive for anti-AQP4 were enrolled (Table 1). 5 patients were excluded; two patients with recurrent optic neuritis and two patients with LETM were seronegative for anti-AQP4 antibody, and one patient was diagnosed as multiple sclerosis

Summary

Introduction

[1] There has been many studies on the impairment of quality of life (QOL) in MS in which fatigue, depression, and sleep disorder were considerable predictors of low QOL scores.[3,4,5] fatigue was reported as one of the most frequent and disabling symptom in MS, and the improvement of fatigue is being considered as an important treatment target in patients with MS.[6, 7] In NMO, a recent study showed that the disease had a strong negative impact on health-related QOL in patients;[8] there are only a few reports on the relationship of fatigue and QOL in NMO. We aimed to evaluate the severity of fatigue and its relationship with QOL in patients with NMO spectrum disorder (NMOSD)

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Conclusion