Modified Fatigue Impact Scale Score Research Articles

Rasagiline for the symptomatic treatment of fatigue in Parkinson's disease.

Fatigue affects 40% to 50% of all PD patients and is a leading cause of disability, with no clearly established or efficacious established treatments. In this double-blinded, placebo-controlled, pilot trial, we investigated whether rasagiline improved fatigue among PD patients. Subjects were randomized to 1 mg daily of rasagiline or placebo for 12 weeks. The primary endpoint was a change in the Modified Fatigue Impact Scale from baseline to week 12. Thirty PD subjects (16 men), with Modified Fatigue Impact Scale baseline score of 67 ± 15, were randomized (16 to rasagiline vs. 14 to placebo). Significant improvement was noted in the mean Modified Fatigue Impact Scale score of the rasagiline group (12 points) as compared to placebo (8.5 points) from baseline to week 12 (P = 0.003). In this pilot study, rasagiline at a dose of 1 mg per day improved fatigue. Larger randomized studies are needed to confirm this finding.

Longitudinal associations between brain structural changes and fatigue in early MS

BackgroundFatigue is a common and disabling symptom of multiple sclerosis (MS) patients. Structural changes in several brain areas have been reported to correlate with fatigue in MS patients but none consistently. ObjectiveTo study the association between global and regional measures of brain atrophy and fatigue in patients with early relapsing MS. MethodsClinically isolated syndrome and relapsing MS patients within 12 months of clinical onset were enrolled in a neuroprotection trial of riluzole versus placebo with up to 36 months of follow-up. MRI metrics included brain volumes measured by SIENAX normalized measurements [normalized brain parenchymal volume (nBPV), normalized normal-appearing white and gray matter volume (nNAWMV and nGMV)] and T2 lesion volume (T2LV). Cortical thickness, thalamic volume and cerebellar cortical volume were measured using Freesurfer's longitudinal pipeline (v5.3) and a lesion inpainting approach. Fatigue was evaluated using the Modified Fatigue Impact Scale (MFIS). Mixed model regression measured time trends and associations between imaging and fatigue severity, adjusting for age and sex. ResultsForty-three patients (mean age 36 years; 31 females) were enrolled within 7.5±4.9 months of symptom onset. Baseline and change over baseline in lesion volumes, grey matter, white matter, basal ganglia and total parenchymal volumes were not associated with change in MFIS score over time. Lower thalamic volume at baseline predicted increasing physical subscale of MFIS score during the study (p=0.017). There was a trend toward baseline thalamic volume and cerebellar cortical volume predicting subsequent change in total MFIS score (p=0.055 and 0.082 respectively). On-study change in thalamic or cerebellar cortical volume was not associated with on-study change in MFIS score. ConclusionGlobal measures of tissue loss are not strongly associated with fatigue in patients with early MS. However, thalamic and cerebellar cortical atrophy may be predictive of subsequent changes in fatigue in these patients.

P037. Headache in multiple sclerosis: prevalence and clinical features in a case control-study.

Methods One hundred and fifty adults (F/M = 98/52; mean age 40 years) with a diagnosis of MS and 150 sex and agematched controls (F/M = 101/49; mean age 40 years) from the general population were evaluated by means of an ad hoc semi-structured interview according to the International Classification Headache Disorders (ICHD-3-beta) criteria. All subjects filled out validated questionnaires about fatigue, Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). The c2 and Kruskal-Wallis tests were used when appropriate. Results The two groups differed significantly for education level and employment. Among the 150 patients with MS, 1 (0.7%) presented a radiologically isolated syndrome (RIS), 17 (11.3%) a clinically isolated syndrome (CIS), 20 (13.3%) a primary progressive form (PPMS), 96 (64%) a relapsing remitting form (RR), and 16 (10.7%) a secondary progressive form (SPMS). Headache was reported by 80 (53.3%) MS cases and 71 controls (47.3%), (p = 0.356); migraine was reported by 47 (31.33%) cases and 51 (34%) controls, tension-type headache was present in 21 (14%) MS affected vs 14 (9.33%) controls (p = 0.245). The simultaneous presence of migraine and tension-type headache was statistically higher (p = 0.002) in MS (28.8%) compared to controls (8.5%). Women with MS presented a low correlation between migraine and menstruation compared to controls while migraine normally improves during pregnancy as much as in controls (p = 0.65). The preliminary analysis of FSS and MFIS scores showed that fatigue resulted overall higher in MS patients with or without headache. Conclusions

Validation of the Japanese version of the Modified Fatigue Impact Scale and assessment of the effect of pain on scale responses in patients with multiple sclerosis

AbstractObjectiveFatigue is a major disabling symptom in multiple sclerosis (MS) patients. The Modified Fatigue Impact Scale (MFIS) is generally approved for evaluating fatigue in MS patients. However, a Japanese version of MFIS has not been established. The aims of the present study were to validate the Japanese MFIS and to investigate its relationship with pain in Japanese MS patients.MethodsThe MFIS was translated into Japanese by a professional translator. The Japanese version of MFIS was carried out for 30 relapsing–remitting MS patients during remission, and 30 age‐ and sex‐matched healthy controls. MFIS for MS patients was repeated within 4 days to show the reliability. The Japanese version of the Multidimensional Fatigue Inventory and Pain Effects Scale were also carried out.ResultsNo significant difference in MFIS score was found between the first and second assessments. Total scores were higher for the patients than for controls (P < 0.001); they correlated with those of the Kurtzke's Expanded Disability Status Scale (P < 0.001), Multidimensional Fatigue Inventory (P = 0.031) and Pain Effects Scale (P < 0.001). Positive correlations were found among subscales of the Japanese version of the MFIS in the patients.ConclusionsA Japanese version of the MFIS validated fatigue evaluation in these patients.

Tailored balance exercises on people with multiple sclerosis: A pilot randomized, controlled study

Background: Altered integration of signals from visual (VIS), somatosensory (PROP) and vestibular system (VEST) lead to balance control impairments affecting the daily living activities of patients with multiple sclerosis (PwMS). As a consequence, tailored interventions could be crucial in improving efficacy of balance rehabilitation treatments. Objective: The objective of this paper is to assess the efficacy of tailored rehabilitation treatments for balance disorders based on visual, somatosensory and vestibular deficits versus traditional rehabilitation exercises. Methods: Thirty-two PwMS were assessed with the Berg Balance Scale (BBS), the composite score (CS) obtained by computerized dynamic posturography (CDP) test and the Modified Fatigue Impact Scale (MFIS). Based on CDP analysis, prevalent VIS, PROP or VEST deficits were identified and patients randomly allocated to a personalized (PRG) or traditional (TRG) rehabilitation group. Results: BBS score showed a significant difference between pre- and post-treatment scores of 6.3 and 2.0 points respectively for PRG and TRG. CS showed a significant difference between pre- and post-treatment scores of 16.6 and 7.6 points respectively for PRG and TRG. No interaction effect was found for MFIS score. Conclusions: BBS and CS showed changes in the PRG group that met clinical relevant difference, underlining that tailored rehabilitation interventions based on patient-specific sensory system impairment could improve balance and postural control in PwMS.

49.: The fampridine upper limb study (FULS)

Modified-release 4-aminopyridine (fampridine) is licensed in Australia for the symptomatic treatment of walking disability in patients with multiple sclerosis (MS). Its potential for use in other neurological domains, its mode of action, and the reasons for widely variable responses in treated patients remain unknown. This study aims to test the following hypotheses: (1) modified-release fampridine is associated with improvements in upper limb impairment in patients with multiple sclerosis, and (2) objective electrophysiological measures differ between patients on and off treatment, and can potentially be used to differentiate clinical responders and non-responders. We conducted two substudies. Substudy 1 is a randomised, double-blind, placebo-controlled trial in patients with MS and upper limb impairment. Clinical and electrophysiological measurements are made at baseline, conclusion and on three occasions while participants are taking fampridine-modified release or placebo. Substudy 2 is a single-blind study in patients already taking fampridine for walking disability. Clinical and electrophysiological measurements are made in patients while on (twice) and off (once) the drug by a blinded assessor. Clinical measurements are nine-hole peg test, upper limb grip strength, sensory discrimination capacity, visual acuity and contrast sensitivity, and modified fatigue impact scale. Electrophysiological measurements were resting motor threshold, motor evoked potential recruitment curves, short interstimulus intervals paired pulse transcranial magnetic stimulation (TMS), median nerve somatosensory evoked potentials, visual evoked potentials, and median nerve conduction study. The primary outcome measure is clinical response to fampridine as measured by performance on the nine-hole peg test. Secondary outcome measures are correlation between clinical and electrophysiological measures in responders as compared with non-responders, changes in upper limb grip strength, visual acuity and sensory discrimination capacity, and changes in modified fatigue impact scale score. Our hypothesis is that clinical responders to fampridine will show increased motor pathway recruitment and cortical excitability with TMS measures, with improvements in latency and amplitude of evoked potential responses. This novel study seeks to determine whether fampridine can have beneficial effects in domains other than ambulation. By combining clinical and electrophysiological measures, we seek to better understand the mode of action of fampridine as a symptomatic therapy for MS and the reasons for the wide observed variation in clinical response.

Pilot Randomized Trial of Progressive Resistance Exercise Augmented by Neuromuscular Electrical Stimulation for People With Multiple Sclerosis Who Use Walking Aids

ObjectiveTo investigate the feasibility and preliminary outcomes of a home progressive resistance training (PRT) program augmented by neuromuscular electrical stimulation (NMES). DesignRandomized controlled pilot trial. SettingParticipant homes. ParticipantsPeople with multiple sclerosis (MS) (N=37) who use a walking aid. InterventionsA 12-week home PRT program or the same program augmented by NMES. Main Outcome MeasuresStrength using hand-held dynamometry; repeated sit to stand test; Berg Balance Scale; timed Up & Go test; 12-Item Multiple Sclerosis Walking Scale; Multiple Sclerosis Impact Scale-29, version 2; and Modified Fatigue Impact Scale (MFIS). The NMES group also completed a device usability questionnaire. ResultsOnly change in MFIS score was significantly greater in the NMES group than the PRT group (P=.012). The NMES group improved significantly in quadriceps endurance (median of change, 8.5; P=.043), balance (median of change, 3.5; P=.001), physical impact of MS (median of change, −8.3; P=.001), and impact of fatigue (median of change, −17; P=.001). Participants rated the device as highly usable. ConclusionsThis pilot study suggests that a home PRT program with NMES is feasible, and the neuromuscular electrical stimulation device is usable by this population. Only reduction in impact of fatigue was greater in the NMES than the PRT group.

Validity and reliability of the Greek version of the Modified Fatigue Impact Scale in multiple sclerosis patients

Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological factors. Scales addressing the multidimensionality of fatigue are used in MS evaluation, although adequacy of data on their reliability and validity is questionable. The aim of the present study was to provide evidence for the validity and reliability of the Greek version of the Modified Fatigue Impact Scale (MFIS). The MFIS was translated into Greek and administered to 99 MS patients and 75 controls. Exploratory factor analysis was carried out and reliability measures were calculated. Discriminant validity was also assessed. The mean MFIS score was 33.8 (SD 17.8). Two factors (physical and cognitive) were extracted through factor analysis; a psychosocial factor was not identified. Reliability measures (intraclass correlation coefficient, Cronbach's α, Pearson's correlation) yielded high values. Patients and nonpatients differed statistically significantly in the MFIS scores; no statistically significant differences in MFIS score according to the type of MS were observed. It can be concluded that the Greek version of MFIS is valid and reliable, although questions about the scale dimensions remain. Further modifications and cultural adaptation of the scale may help create a useful tool for screening and assessment of fatigue in MS patients.

B-61 * Impact of Sleep Quality, Depression, Daytime Sleepiness, and Fatigue on Cognition in Multiple Sclerosis

Objective: To assess the association between measures of self-reported sleep quality, depression, daytime sleepiness, fatigue, and objective cognitive performance in individuals with Multiple Sclerosis (MS). Method: Twenty-eight highly educated (M = 15.39, SD = 2.11) MS participants (Mage = 49.25, SD = 10.79) reported hours of sleep the previous night and completed the Pittsburgh Sleep Quality Index (PSQI), Quick Inventory of Depressive Symptomology (QIDS), Epworth Sleepiness Scale (ESS), Modified Fatigue Impact Scale (MFIS) and a neuropsychological battery as part of a longitudinal study examining cognitive functioning in MS. Pearson r correlations were obtained between self-report measures and cognitive variables, including verbal fluency, Texas Card Sorting Test (TCST), Oral Symbol Digit Modalities Test, Stroop Color and Word, California Verbal Learning Test-II (CVLT-II), and Brief Visuospatial Memory Test-Revised. Results: Neither hours of sleep nor PSQI global scores correlated with any neuropsychological test scores. However, daytime sleepiness (ESS) was significantly associated with verbal memory (CVLT-II r's = .52 to .60, p ≤ .01) and executive function (TCST r = .55, p = .003). QIDS was marginally associated with memory (CVLT-II total T score; r = −.39, p = .04), and MFIS only correlated with Stroop Interference T scores (r = −.39, p = .04). There was no relationship between ESS and PSQI or MFIS scores. Conclusion(s): Despite the prevalence of sleep problems in MS, data suggests subjective sleep architecture may not be related to cognition in this population. However, associations were found between daytime sleepiness and cognitive variables. Additional research is needed to better understand the mechanisms behind daytime sleepiness, as this symptom affected cognition independent of fatigue and sleep quality/quantity.

Functional limitations due to fatigue among independently ambulant stroke survivors in Osun, South-Western Nigeria.

Functional limitations in stroke survivors are sometimes associated with fatigue. This study assessed the functional limitations due to fatigue in community-dwelling stroke survivors undergoing physiotherapy. The differences in functional limitations due to fatigue were determined between sexes, stroke types, sides of affectation, age categories and levels of disability. Relationships between functional limitation due to fatigue and these variables were also determined. This was a cross-sectional study involving 63 stroke survivors (35 male survivors and 28 female survivors) with ages ranging from 45 to 79 years (mean = 53.68 ± 10.95 years). Functional limitation due to fatigue was assessed with the modified fatigue impact scale (MFIS). Modified Rankin scale was used to categorize the disability of the participants. Data were analysed using descriptive (mean, standard deviation, percentage and frequency) and inferential (Mann-Whitney U-test and Spearman correlation analysis) statistics. Significance was set at 0.05 α level. The mean MFIS score was 31.74 ± 12.39. Many participants (58.7%) had moderate functional limitations due to fatigue. The result of Mann-Whitney U-test showed significant difference in functional limitation due to fatigue between participants with slight disability and those with moderate disability (p = 0.000), with participants with moderate disability having higher MFIS scores (more functional limitations). There was also a significant correlation between functional limitation due to fatigue and level of disability (ρ = 0.625, p = 0.000). Functional limitation due to fatigue occurs frequently in stroke survivors and is related to level of disability. Functional limitations due to fatigue should be assessed frequently in all stroke survivors with varying degrees of disability and the outcome should be considered during rehabilitation and retraining of physical function.

Serum Coenzyme Q10 Levels and Oxidative Status in Patients with Fibromyalgia Syndrome

Objectives: The aim of this study was to determine the relationship between serum coenzyme Q10 [CoQ10] levels and symptoms of fatigue associated with fibromyalgia syndrome [FMS].Methods: Patients diagnosed with primary FMS and domographically matching healthy normal controls [HNCs] were sought to participate in the study. The total antioxidant status, total oxidative status, and CoQ10 levels were measured in blood samples from the patients and the controls.Results: A total of 40 patients with FMS and 30 HNCs were recruited. There were no statistically significant differences between the two groups in regard to C-reactive protein, mean erythrocyte sedimentation rate, mean age, and mean body mass index [p > 0.05]. The mean time from symptom onset to diagnosis for the FMS patients was 2.88 years, and the average number of tender points was 14. The serum CoQ10 levels were significantly lower in the FMS patients compared with the HNC group [p = 0.000]. The serum total oxidative status and oxidative stress index levels were higher, and the serum total antioxidant status levels were lower in the FMS patients compared with those of the HNC group [p < 0.05]. The visual analog scale [VAS] pain scores and the VAS fatigue scores were significantly higher in the FMS group than in the HNC group [p = 0.000]. The serum CoQ10 levels were negatively correlated with the mean Modified Fatigue Impact Scale scores [p = 0.02, r = 0.30], VAS pain scores [p = 0.00, r = 0.38], and VAS fatigue scores [p = 0.03, r = 0.28].Conclusions: The CoQ10 deficiency may contribute to the etiopathogenesis of FMS fatigue.

Fatigue is associated with poor sleep in people with multiple sclerosis and cognitive impairment.

Background. Fatigue is the most common symptom in people with multiple sclerosis (MS). Poor sleep also occurs in this population. Objective. The objective of this study was to determine the relationship between fatigue and sleep quality in people with MS and cognitive impairment. Method. This cross-sectional study assessed relationships among fatigue, assessed with the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS), sleep quality assessed with the Pittsburg Sleep Quality Index (PSQI), and demographics in 121 people with MS and cognitive impairment. Results. Fatigue was significantly correlated with poor sleep quality (MFIS: F = 15.60, P < 0.01; FSS: F = 12.09, P < 0.01). FSS scores were also significantly correlated with the PSQI subscore for daytime dysfunction and MFIS scores were significantly correlated with disability, age, and the PSQI subscores for sleep quality, sleep duration, and daytime dysfunction. Conclusions. This study demonstrates a relationship between fatigue and sleep quality in individuals with MS and cognitive impairment.

Evaluating the effects of amantadin, modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis – result of a pilot randomized, blind study

ObjectiveFatigue affects more than 60% of multiple sclerosis (MS) patients and is one of the most troublesome symptoms of the disease. Current treatment options for MS fatigue include amantadine, modafinil and acetyl-l-carnitine (ALCAR). The aim of our study was to compare efficacy of amantadine, modafinil and ALCAR with placebo in patients with MS. MethodsPatients with MS and a disability level ≤5.5 on the Kurtzke Expanded Disability Status Scale (EDSS) and fatigue were included in the study. Patients were assigned to a one month treatment with either amantadine 200mg, ALCAR 2g, modafinil 200mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS). ResultsSixty patients were included in the study (39 females). The mean age of patients was 38±6.7 years and the mean disease duration was 6.6±1.2 years. Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference=17.3, p=0.001). There was also a trend of a lower MFIS score in ALCAR group in comparison to placebo (mean difference=12.4, p=0.05, with Keppel-corrected alpha of 0.046). The quality of life measured as SF 36 – PCS and SF 36 – MCS proved to be significantly influenced by treatment. ConclusionOne month treatment with amantadine improved fatigue in patients with relapsing-remitting MS as evaluated by MFIS. No or only a trend of improvement was seen in patients treated with modafinil or ALCAR, respectively.

Duloxetine Is Effective in Treating Depression in Multiple Sclerosis Patients

Duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, was evaluated for its therapeutic efficacy, safety, and tolerability in the treatment of depression in patients with multiple sclerosis (MS). Lifetime depression prevalence approaches 50% in MS patients. The aim of the study was to assess the safety and efficacy of duloxetine for treatment of depression in MS patients. An open-label study evaluated the efficacy of 12 weeks of duloxetine administration (maximal dose = 60 mg/d) in MS patients with clinical depression. The Beck scale score variation after 4 (T1) and 12 (T2) weeks of treatment was used for the primary outcome measurement, whereas secondary outcome was measured using the Modified Fatigue Impact Scale. Safety was evaluated by recording treatment-related adverse events, monitoring vital signs, and recording frequency and reasons for interruption or discontinuation of treatment. Seventy-five patients were enrolled in the study. Sixty-three patients completed the study by continuing duloxetine treatment for 12 weeks (T2). Twelve subjects dropped out of the study because of adverse effects or noncompliance. Nausea was the most common adverse event reported. A significant reduction in the Beck Depression Inventory and Modified Fatigue Impact Scale scores, after both 4 and 12 weeks of therapy, was observed. The results suggest that duloxetine is well tolerated, safe, and effective in reducing depression and fatigue in MS patients.

Treatment of sleep disorders may improve fatigue in multiple sclerosis

ObjectiveIn a previous polysomnographic cross-sectional study we found a significant relationship between sleep disorders and multiple sclerosis (MS) related fatigue. The purpose of this open follow-up observation was to compare the impact of treatment of sleep disorders on MS related fatigue measured with the Modified Fatigue Impact Scale (MFIS). MethodsNon-randomized follow-up observation: treated versus untreated patients, subgroups according to compliance with sleep medical treatment recommendations (univariate, multivariate analysis, multiple logistic regression). 66 MS patients were followed after polysomnography, 49 patients with relevant sleep disorders and 17 without. ResultsMean MFIS scores decreased from 41.2 to 26.2 (p=0.025) in patients with good compliance (GC; n=18), from 42.4 to 32.1 (p=0.12) in patients with moderate compliance (MC; n=12), and from 41.6 to 35.5 (p=0.17) in non-compliant patients (NC; n=17). Mean MFIS values increased in patients without sleep disorders from 22.9 to 25.4 (NSD; n=12, p=0.56). In multiple logistic regression, treatment of sleep disorders predicted decrease of MFIS-values (GC versus NSD odds ratio 13.4; p=0.015; 95% confidence interval (CI) 1.7–107.2, MC versus NSD odds ratio 13.8; p=0.028; 95% CI 1.3–143.3). ConclusionsSleep medical treatment may improve MS related fatigue when patients adhere to treatment recommendations.

Validity and reliability of Persian version of Modified Fatigue Impact Scale (MFIS) questionnaire in Iranian patients with multiple sclerosis

Purpose: To determine the validity and reliability of the Persian version of the Modified Fatigue Impact Scale (MFIS) questionnaire for Iranian patients with multiple sclerosis (MS). Method: One hundred and twenty patients with MS and 75 age-matched healthy controls were enrolled. Participants were asked to answer the valid and reliable Persian version of the Beck depression inventory (BDI), Fatigue Severity Scale (FSS) and translated MFIS questionnaires. Twenty cases filed the questionnaire two weeks later to assess reliability. The intra-class correlation coefficient (ICC), Cronbach’s alpha and multiple regression analysis were used. Results: The total MFIS score and subscale scores differed significantly between the patients with MS and the healthy controls. The ICCs and Cronbach’s alpha values were also outstandingly high. There was a significant correlation between the FSS and MFIS scores in patients (r = 0.69, p < 0.001). Also, a significant correlation was investigated between the scores of the BDI and the MFIS (r = 0.68, p < 0.001). Multiple linear regression analysis between the MFIS as a dependent variable and Expanded Disability Status Scale (EDSS), BDI and disease duration as independent variables showed that the BDI and EDSS are dependent predictors of the MFIS. Conclusion: The results of this study indicate that the Persian version of MFIS can be regarded as a valid and reliable scale for assessing fatigue in Iranian patients with MS.Implications for RehabilitationFatigue is one of the most common, disabling and troublesome complaints of individuals with MS.Different factors such as depression and physical disability are considered to play an important role in MS-related fatigue.Fatigue evaluation by means of a valid and reliable instrument is important in individuals with MS.Persian version of MFIS provides a valid and reliable instrument for fatigue evaluation.

Falls in People With Multiple Sclerosis Who Use a Walking Aid: Prevalence, Factors, and Effect of Strength and Balance Interventions

ObjectivesTo investigate falls prevalence, factors associated with falling, and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis (MS). DesignBaseline and posttreatment data from a randomized controlled trial. SettingCommunity. ParticipantsPeople with MS (N=111) who use bilateral support for gait. InterventionsGroup and one-on-one physiotherapy. Main Outcome MeasuresFalls prevalence was assessed using retrospective recall. Demographic information was collected, impairments of body function were assessed, and results from the Berg Balance Scale, 6-minute walk test (6MWT), Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores, and the Modified Fatigue Impact Scale (MFIS) were obtained. ResultsThe prevalence of falls in a 3-month period was 50.5% among participants with MS, of whom 28% had more than 1 fall. Fallers had a greater physical (mean difference, −3.9; P=.048) and psychological (median difference, −4.5; P=.001) impact of MS and a greater impact of fatigue (mean difference, −9.4; P=.002). A logistic regression analysis found that the MFIS score made a unique, significant contribution to the model (odds ratio=1.04; 95% confidence interval, 1.018–1.079), correctly identifying 68% of fallers. A 10-week group physiotherapy intervention significantly reduced both the number of fallers (58.3% before to 22.9% after intervention, P=.005) and the number of falls (63 before to 25 after intervention, P=.001). ConclusionsThe prevalence of falls is high in this population of persons with MS, and the impact of MS and of fatigue is greater in fallers. Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required.

Trajectory of fatigue severity in natalizumab treated multiple sclerosis patients

Fatigue is one of the most debilitating symptoms in multiple sclerosis (MS). The aim of this study was to observe the severity of MS associated fatigue in a community-based sample of natalizumab (ntz) treated patients over one year. In 48 relapsing remitting MS patients (mean age=38.3 years) fatigue was longitudinally measured with the Modified Fatigue Impact Scale (MFIS) at two time points. The primary analysis of differences in MFIS was performed using non-parametric Wilcoxon test for dependent variables. Mean total MFIS Score increased significantly from 32.6±20.9 to 49.1±20.0 over the observation period of 12 months (p<0.001). 83% of patients remained clinically disease activity free (no relapse, no progression in the Expanded Disability Status Scale, EDSS) over the observation period of one year. Age, gender, disease duration, spinal involvement, Gd-enhancement, depressive symptoms and EDSS had no influence on fatigue levels as measured with MFIS. Severity of fatigue symptoms during ntz treatment might increase despite very low disease activity.

Reward responsiveness and fatigue in multiple sclerosis

Background: Fatigue is a common symptom in individuals with multiple sclerosis (MS). To date, the pathophysiology of fatigue in MS remains ill-understood; however, converging evidence seems to suggest that a key factor in fatigue development might be the dysregulation of neuropsychological processes underpinning the evaluation of the rewarding outcomes of actions. Objectives: To explore the relationship between reward-related cognition and fatigue in MS and to explore the usefulness of reward perception testing to predict the efficacy of monoamine-modulating drugs on fatigue. Methods: The study included 104 fatigued and 70 fatigue-free Relapsing–Remitting MS patients. All subjects were screened for the lack of any significant mood, cognitive, or personality disorders that could confound results. The different facets of the motivation system such as the patient’s reward perception were assessed at baseline using the Behavioural Inhibition and Behavioural Activation Scales (BIS/BAS). Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Fatigue values after three months of therapy with escitalopram or bupropion were correlated with those baseline BIS/BAS scores. Results: Fatigued patients demonstrated lower reward responsiveness compared to fatigue-free subjects. Reward responsiveness scores were found to be associated with baseline MFIS scores and with fatigue reduction after treatment with bupropion: Lower reward responsiveness at baseline predicted higher fatigue remission rates in bupropion-treated patients, as compared with escitalopram-treated patients. Discussion: Reward responsiveness was linked with MS-related fatigue and might represent one of its key cognitive underpinnings. Our results suggest that evaluation of reward responsiveness could provide useful information to guide individualized therapy of MS-related fatigue.

The association between perceived fatigue and actual level of physical activity in multiple sclerosis

Background: Both fatigue and reduced physical activity are important consequences of multiple sclerosis (MS). However, their mutual association is poorly understood. Objective: The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS. Methods: Found associations were checked for confounding by age, Expanded Disability Status Scales (EDSS), disease duration, sub-type of MS, anxiety, and depression. Forty-three ambulatory patients with MS were recruited. Ambulatory physical activity was recorded for 24 hours. Fatigue was assessed with the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS) and the Checklist Individual Strength (CIS20R). Linear regression was applied after which potential confounding factors were introduced in a multivariate regression model. Results: No significant associations between physical activity and fatigue scores were found, except for the MFIS sub-scale ‘physical activity’ (ßphysical_activity [ßpa] = −0.044; SE = 0.020). The association between physical activity and the FSS score was distorted by age, MS-type, anxiety and depression and the association between physical activity and the MFIS score by age and depression. The inverse association between MFIS sub-scale ‘physical activity’ and physical activity was significantly strengthened by adjusting for age (ßpa = − 0.052; SE = 0.019), sub-type of MS (ßpa = − 0.048; SE = 0.020), anxiety (ßpa = − 0.070; SE = 0.023) and depression (ßpa = − 0.083; SE = 0.023). Conclusions: In MS, there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.