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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

The Berlin Treatment Algorithm. Please note: Restless legs syndrome can be diagnosed on the basis of the following four minimal criteria: an urge to move the legs (usually accompanied by uncomfortable sensations), which begin or worsen during rest and are relieved by movement predominantly in the evening or night. Depression can be diagnosed by structured interviews. Self-report scales (e.g., Beck Depression Inventory (BDI)) can be useful to screen for depression. Abbreviations: MFIS Modified Fatigue Impact Scale, PSQI Pittsburgh Sleep Quality Index, ESS Epworth Sleepiness Scale, COPD chronic obstructive pulmonary disease, SSRIs selective serotonin reuptake inhibitors, CBT cognitive behavioral therapy
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Fig2: The Berlin Treatment Algorithm. Please note: Restless legs syndrome can be diagnosed on the basis of the following four minimal criteria: an urge to move the legs (usually accompanied by uncomfortable sensations), which begin or worsen during rest and are relieved by movement predominantly in the evening or night. Depression can be diagnosed by structured interviews. Self-report scales (e.g., Beck Depression Inventory (BDI)) can be useful to screen for depression. Abbreviations: MFIS Modified Fatigue Impact Scale, PSQI Pittsburgh Sleep Quality Index, ESS Epworth Sleepiness Scale, COPD chronic obstructive pulmonary disease, SSRIs selective serotonin reuptake inhibitors, CBT cognitive behavioral therapy

Mentions: It is one thing to recommend the treatment of underlying sleep disorders in this issue in general, but another to say which patient has to be sent to the sleep specialist or sleep laboratory. Because of the complexity of the issue and due to the fact that clinicians need some practical instructions, the discussion of the different treatment options does not replace the need for a practical guide with specific procedures and measures. We would like to take the opportunity to introduce our Berlin Treatment Algorithm of MS fatigue, which we developed in the last years. FigureĀ 2 outlines the treatment algorithm.Fig. 2


The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue
The Berlin Treatment Algorithm. Please note: Restless legs syndrome can be diagnosed on the basis of the following four minimal criteria: an urge to move the legs (usually accompanied by uncomfortable sensations), which begin or worsen during rest and are relieved by movement predominantly in the evening or night. Depression can be diagnosed by structured interviews. Self-report scales (e.g., Beck Depression Inventory (BDI)) can be useful to screen for depression. Abbreviations: MFIS Modified Fatigue Impact Scale, PSQI Pittsburgh Sleep Quality Index, ESS Epworth Sleepiness Scale, COPD chronic obstructive pulmonary disease, SSRIs selective serotonin reuptake inhibitors, CBT cognitive behavioral therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: The Berlin Treatment Algorithm. Please note: Restless legs syndrome can be diagnosed on the basis of the following four minimal criteria: an urge to move the legs (usually accompanied by uncomfortable sensations), which begin or worsen during rest and are relieved by movement predominantly in the evening or night. Depression can be diagnosed by structured interviews. Self-report scales (e.g., Beck Depression Inventory (BDI)) can be useful to screen for depression. Abbreviations: MFIS Modified Fatigue Impact Scale, PSQI Pittsburgh Sleep Quality Index, ESS Epworth Sleepiness Scale, COPD chronic obstructive pulmonary disease, SSRIs selective serotonin reuptake inhibitors, CBT cognitive behavioral therapy
Mentions: It is one thing to recommend the treatment of underlying sleep disorders in this issue in general, but another to say which patient has to be sent to the sleep specialist or sleep laboratory. Because of the complexity of the issue and due to the fact that clinicians need some practical instructions, the discussion of the different treatment options does not replace the need for a practical guide with specific procedures and measures. We would like to take the opportunity to introduce our Berlin Treatment Algorithm of MS fatigue, which we developed in the last years. FigureĀ 2 outlines the treatment algorithm.Fig. 2

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