Limits...
The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue

View Article: PubMed Central - PubMed

ABSTRACT

More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.

No MeSH data available.


Related in: MedlinePlus

Distinction between primary fatigue, secondary fatigue, and sleepiness. This figure displays possibilities for distinguishing the primary fatigue from secondary fatigue, tiredness, and sleepiness. Whereas primary motor fatigue can be distinguished objectively from tiredness and secondary fatigue by gait recording, primary cognitive fatigue indeed cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness can clearly be distinguished from primary and secondary fatigue and motor fatigue and tiredness—as sleepiness can be measured objectively by the multiple sleep latency test
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5121967&req=5

Fig1: Distinction between primary fatigue, secondary fatigue, and sleepiness. This figure displays possibilities for distinguishing the primary fatigue from secondary fatigue, tiredness, and sleepiness. Whereas primary motor fatigue can be distinguished objectively from tiredness and secondary fatigue by gait recording, primary cognitive fatigue indeed cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness can clearly be distinguished from primary and secondary fatigue and motor fatigue and tiredness—as sleepiness can be measured objectively by the multiple sleep latency test

Mentions: Figure 1 displays schematically the relationship between primary and secondary fatigue, tiredness, motor fatigue, and sleepiness. Whereas motor fatigue (as one aspect and a specific manifestation of primary fatigue) can be measured objectively by gait recording, mental (cognitive) primary fatigue cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness is completely different from primary or secondary fatigue or tiredness and can be measured objectively by multiple sleep latency test (MSLT) [20].Fig. 1


The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue
Distinction between primary fatigue, secondary fatigue, and sleepiness. This figure displays possibilities for distinguishing the primary fatigue from secondary fatigue, tiredness, and sleepiness. Whereas primary motor fatigue can be distinguished objectively from tiredness and secondary fatigue by gait recording, primary cognitive fatigue indeed cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness can clearly be distinguished from primary and secondary fatigue and motor fatigue and tiredness—as sleepiness can be measured objectively by the multiple sleep latency test
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121967&req=5

Fig1: Distinction between primary fatigue, secondary fatigue, and sleepiness. This figure displays possibilities for distinguishing the primary fatigue from secondary fatigue, tiredness, and sleepiness. Whereas primary motor fatigue can be distinguished objectively from tiredness and secondary fatigue by gait recording, primary cognitive fatigue indeed cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness can clearly be distinguished from primary and secondary fatigue and motor fatigue and tiredness—as sleepiness can be measured objectively by the multiple sleep latency test
Mentions: Figure 1 displays schematically the relationship between primary and secondary fatigue, tiredness, motor fatigue, and sleepiness. Whereas motor fatigue (as one aspect and a specific manifestation of primary fatigue) can be measured objectively by gait recording, mental (cognitive) primary fatigue cannot be distinguished objectively from tiredness and secondary fatigue. Sleepiness is completely different from primary or secondary fatigue or tiredness and can be measured objectively by multiple sleep latency test (MSLT) [20].Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.

No MeSH data available.


Related in: MedlinePlus