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Journal of Neurology

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01-11-2006 | ORIGINAL COMMUNICATION

Fatigue in multiple sclerosis persists over time

A longitudinal study

Authors: N. Téllez, J. Río, MD, M. Tintoré, MD, C. Nos, MD, I. Galán, MD, X. Montalban, MD

Published in: Journal of Neurology | Issue 11/2006

Abstract

Background and objective

Fatigue is one of the most frequent symptoms in multiple sclerosis (MS) but there is a lack of knowledge about its behaviour over time. The aim of our study was to investigate changes in fatigue in a large cohort of MS patients and to determine the relationship between changes in disability and depression with changes in fatigue severity.

Methods

We studied fatigue in 227 MS consecutive patients and again after one year. During the clinical interview, we recorded the patient’s degree of disability using the Expanded Disability Status Scale and relapses; fatigue was measured by means of the Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS) and depression was measured by the Beck Depression Inventory (BDI).

Results

After a mean follow-up of 18 months, 86.8% of patients who were fatigued at study onset remained in a fatigued status, whereas 25% of those without fatigue at onset had become fatigued at the end of follow-up. We observed that only variations on BDI scores positively correlate with variations on fatigue scales, mainly with MFIS (r = 0.49, p < 0.0001). An increase of BDI score was the factor that best predicted the increase of fatigue over time. No differences in the increase of fatigue were found between patients with and without progression of disability during the follow-up period, or between patients with or without relapses.

Conclusions

Fatigue in MS persists over time. Changes in mood status but not in disability are related to changes in fatigue in MS patients.

Bakshi R, Czarnecki D, Shaikh ZA, Priore RL, Janardhan V, Kaliszky Z, Kinkel PR (2000) Brain MRI lesions and atrophy are related to depression in multiple sclerosis. Neuroreport. 11:1153–1158PubMedCrossRef

Bakshi R, Shaikh ZA, Miletich RS, Czarnecki D, Dmochowski J, Henschel K, Janardhan V, Dubey N, Kinkel PR (2000) Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler 6:181–185CrossRefPubMed

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh Jk (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–57PubMed

Bergamaschi R, Romani A, Versino M, Poli R, Cosi V (1997) Clinical aspects of fatigue in multiple sclerosis. Funct Neurol 12:247–251PubMed

Calabrese VP, Isaacs ER, Regelson W (1990) Dedydroepiandrosterone in multiple sclerosis: positive effects on the fatigue syndrome in a non-randomized study. In: Kalimi M, Regelson W (eds), The biological role of dedydroepiandrosterone (DHEA). Walter de Gruyter, New York 95–100

Colosimo C, Millefiorini E, Grasso MG, Vinci F, Fiorelli M, Koudriavtseva T, Pozzilli C (1995) Fatigue in MS is associated with specific clinical features. Acta Neurol Scand 92:353–355PubMedCrossRef

Cookfair DL, Fisher J, Rudick R, Jacobs L, Herndon R, Richert J (1997) Fatigue severity in low disability MS patients participating in a phase III trial of Avonex (IFNβ-1a) for relapsing multiple sclerosis. Neurology 48:A173CrossRef

Fatigue Guidelines Development Panel of the Multiple Sclerosis Council for Clinical Practice Guidelines (1998) Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Paralyzed Veterans of America. Washington, DC

Filippi M, Rocca MA, Colombo B, Falini A, Codella M, Scotti G, Comi G (2002) Functional magnetic resonance imaging study correlates of fatigue in multiple sclerosis. NeurImage 15:559–567CrossRef

10.

Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ (1994) The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 21:9–14PubMed

11.

Flachenecker P, Rufer A, Bihler I, Hippel C, Reiners K, Toyka KV, Kesselring J (2002) Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler 8:523–526CrossRefPubMed

12.

Freal JE, Kraft GH, Coryell JK (1984) Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 65:135–138PubMed

13.

Geisser B (1985) Multiple sclerosis: current concepts in management. Drugs 29:88–95

14.

Honer W G, Hurwitz T, Li D K, Palmer M, Paty D W (1987) Temporal lobe involvement in multiple sclerosis patients with psychiatric disorders. Arch Neurol 44:187–190PubMed

15.

Kos D, Kerckhofs E, Carrea I, Verza R, Ramos M, Jansa J (2005) Evaluation of the modified fatigue impact scale in four different European countries. Mult Scler 11:76–80CrossRefPubMed

16.

Kroencke DC, Lynch SG, Denney DR (2000) Fatigue in multiple sclerosis: relationship to depression, disability, and disease pattern. Mult Scler 6:131–136CrossRefPubMed

17.

Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437PubMed

18.

Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123PubMed

19.

Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452PubMed

20.

Leocani L, Colombo B, Magnani G, Martinelli-Boneschi F, Cursi M, Rossi P, Martinelli V, Comi G (2001) Fatigue in multiple sclerosis is associated with abnormal cortical activation to voluntary movement-EEG evidence. NeuroImage 13:1186–1192CrossRefPubMed

21.

Moller A, Wiedemann G, Rohde U, Backmund H, Sonntag A (1994) Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. Acta Psychiatr Scand 89:117–121PubMed

22.

Murray TJ (1985). Amantadine therapy for fatigue in multiple sclerosis. Can J Neurol Sci 12:251–254PubMed

23.

Pujol J, Bello J, Deus J, Cardoner N, Marti-Vilalta JL, Capdevila A (1997) Lesions in the left arcuate fasciculus region and depressive symptoms in multiple sclerosis. Neurology 49:1105–1110PubMed

24.

Roelcke U, Kappos L, Lechner-Scott J, Brunnschweiler H, Huber S, Ammann W, Plohmann A, Dellas S, Maguire RP, Missimer J, Radu EW, Steck A, Leenders KL (1997) Reduced glucose metabolisme in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue. Neurology 48:1566–1571PubMed

25.

Sabatini U, Pozzilli C, Pantano P, Koudriavtseva T, Padovani A, Millefiorini E, Di Biasi C, Gualdi GF, Salvetti M, Lenzi GL (1996) Involvement of the limbic system in multiple sclerosis patients with depressive disorders. Biol Psychiatry 39:970–975CrossRefPubMed

26.

Sandyk R, Awerbuch GI (1994) Pinel calcification and its relationship to the fatigue of multiple sclerosis. Intern J Neuroscience 74:95–103CrossRef

27.

Schreurs KMG, de Ridder DTD, Bensing JM (2002) Fatigue in multiple sclerosis. Reciprocal relationships with physical disabilities and depression. J Psychosom Res 53:775–781CrossRefPubMed

28.

Téllez N, Río J, Tintoré M, Nos C, Galán I, Montalban X (2005) Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS? Mult Scler 11:198–202CrossRefPubMed

29.

van der Werf SP, Jongen PJ, Lycklama a Nijeholt GJ, Barkhof F, Hommes OR, Bleijenberg G (1998) Fatigue in multiple sclerosis: Interrelations between fatigue complaints, cerebral MRI abnormalities and neurological disability. J Neurol Sci 160:164–170CrossRefPubMed

30.

Vercoulen JH, Hommes OR, Swanink CM, Jongen PJ, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1996) The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol 53:642–649PubMed

31.

Neilley LK, Goodin DS, Goodkin DE, Hauser SL (1996) Side effect profile of interferon-beta in MS: results of an open label trial. Neurology 46:552–554PubMed

32.

Fatigue in progressive MS is associated with low levels of dehydroepiandrosterone. Téllez N, Comabella M, Julià E, Río J, Tintoré M, Brieva L, Nos C, Montalban X. Mult Scler (in press)

Title: Fatigue in multiple sclerosis persists over time
A longitudinal study
Authors: N. Téllez
J. Río, MD
M. Tintoré, MD
C. Nos, MD
I. Galán, MD
X. Montalban, MD
Publication date: 01-11-2006
Publisher: Steinkopff-Verlag
Published in: Journal of Neurology / Issue 11/2006
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-006-0247-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fatigue in multiple sclerosis persists over time

A longitudinal study

Abstract

Background and objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and objective

Methods

Results

Conclusions

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