Treatment of fatigue in multiple sclerosis patients: a neurocognitive approach.

Mauro Catalan,Gilberto Pizzolato,Marino Zorzon,Susanna Mezzarobba,Giovanna Servillo,Roberto Marcovich,Alessio Bratina,Arianna Sartori,Laura Zugna,Lorella Pellegrini,Antonio Bosco,Alessandra De Michiel,Francesca Tamiozzo

doi:10.1155/2011/670537

Mauro Catalan, Gilberto Pizzolato + Show 11 more

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https://doi.org/10.1155/2011/670537

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Journal: Rehabilitation Research and Practice	Publication Date: Jan 1, 2011
Citations: 23	License type: CC BY 3.0

Affiliation: University of Trieste

Abstract

The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS complaining of fatigue were treated for five weeks with exercises of neurocognitive rehabilitation twice a week. Patients were evaluated by Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), MSQoL54, Expanded Disability Status Scale (EDSS), and MS Functional Composite (MSFC). After treatment, a decrease in fatigue was detected with both FSS (P = 0.0001) and MFIS (P = 0.0001). MSFC (P = 0.035) and MSQoL54 (P = 0.002) scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, P = 0.0001; MFIS P = 0.01) and for the physical subscale of MSQoL54 (P = 0.049). No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on MI, could be a strategy to treat fatigue in MS patients.

Highlights

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS), affecting up to 70% of patients [1]
No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on motor imagery (MI), could be a strategy to treat fatigue in MS patients
Wrong strategies of movement planning, even if unconscious, may contribute to the development of fatigue in patients with MS. This hypothesis is mainly supported by functional neuroimaging studies, which suggested that fatigue in MS could result from altered connection between cortical and sub-cortical areas involved in motor planning [8,9,10,11]

Summary

Introduction

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS), affecting up to 70% of patients [1]. Chaudhuri and Behan hypothesized that central fatigue may be caused by a failure in the integration of the limbic input and the motor functions within the basal ganglia, affecting the striatal-thalamic-frontal cortical system [9]. This hypothesis has been supported by further studies which suggested an association between fatigue and damage in the basal ganglia or thalamus [10]. A functional magnetic resonance imaging (fMRI) study demonstrated an altered recruitment of the brain sensorimotor network (including the thalamus, the cerebellum, the frontal lobe, and the cingulum) in MS patients complaining of fatigue [11]. These studies suggest that fatigue is related to underlying MS pathology such as demyelization or axonal loss, other possible causes, Rehabilitation Research and Practice such as temperature and immune factors, may play an important role in the genesis of fatigue [12]

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