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CC BY-NC-ND 4.0 · Neurology International Open 2017; 01(02): E79-E85
DOI: 10.1055/s-0043-104752
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© Georg Thieme Verlag KG Stuttgart · New York

Assessment of Fatigue in Multiple Sclerosis

Carina Sander
1   Department of Psychology, University of Oldenburg, Germany
2   Rehazentrum Wilhelmshaven, Wilhelmshaven, Germany
,
Hans-Ulrich Voelter
3   Neurologische Klinik, Klinikum Bremen-Ost, Germany
,
Hans-Peter Schlake
2   Rehazentrum Wilhelmshaven, Wilhelmshaven, Germany
,
Paul Eling
4   Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
,
Helmut Hildebrandt
1   Department of Psychology, University of Oldenburg, Germany
3   Neurologische Klinik, Klinikum Bremen-Ost, Germany
› Author Affiliations
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Publication History

Publication Date:
11 May 2017 (online)

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Abstract

One of the most frequent symptoms in multiple sclerosis (MS) is fatigue. It has a major impact on quality of life as well as on professional activity. Even nowadays it is still unclear what constitutes an adequate assessment of the perceived fatigue.

The following overview will discuss different possibilities to assess fatigue with the help of questionnaires, clinical interviews or the objective measurement of cognitive performance. Furthermore, a structured guideline for the assessment of fatigue will be proposed. Clinical criteria for MS related fatigue include the main symptoms, their everyday relevance, the possible causal relation with the cause of disease (the underlying MS), as well as an exclusion of other possible somatic or psychological reasons. It is recommended to use the “Würzburger Erschöpfungs-Inventar bei Multipler Sklerose (WEIMUS)” (English: Würzburg Fatigue Inventory for Multiple Sclerosis) and especially the “Fatigue Scale for Motor and Cognitive Functions” (FSMC), as these questionnaires distinguish between motor and cognitive fatigue and due to the larger number of research studies using the FSMC. Moreover, the presence of depression, quality of sleep and daytime sleepiness should be assessed. In addition, general cognitive performance as well as performance during monotonous stimulation (vigilance) should be assessed. This may be relevant for the evaluation of a patient’s capacity to work, and for determining prognosis, as there are indications for a relation to relapse frequency, a change from a clinically isolated syndrome (CIS) to an MS diagnosis with an increase of brain atrophy.

All in all, it can be said, that despite the growing convergence of diagnostic criteria, the available studies of the objective as well as the subjective assessment of fatigue are still not sufficient and further research is needed.

 

  • References

  • 1 Hadjimichael O, Vollmer T, Oleen-Burkey M. et al. Fatigue characteristics in multiple sclerosis: the North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes 2008; 6: 100
    CrossrefPubMedGoogle Scholar
  • 2 Kister I, Bacon TE, Chamot E. et al. Natural history of multiple sclerosis symptoms. Int J MS Care 2013; 15: 146-158
    CrossrefPubMedGoogle Scholar
  • 3 Krupp LB, Christodoulou C. Fatigue in multiple sclerosis. Curr Neurol Neurosci Rep 2001; 1: 294-298
    CrossrefPubMedGoogle Scholar
  • 4 Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: Proposal for a unified taxonomy. Neurology 2013; 80: 409-416
    CrossrefPubMedGoogle Scholar
  • 5 Kluger BM, Herlofson K, Chou KL. et al. Parkinson's disease-related fatigue: A case definition and recommendations for clinical research. Mov Disord 2016; 31: 625-631
    CrossrefPubMedGoogle Scholar
  • 6 Flachenecker P, Kumpfel T, Kallmann B. et al. Fatigue in multiple sclerosis: A comparison of different rating scales and correlation to clinical parameters. Mult Scler 2002; 8: 523-526
    CrossrefPubMedGoogle Scholar
  • 7 Learmonth YC, Dlugonski D, Pilutti LA. et al. Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale. J Neurol Sci 2013; 331: 102-107
    CrossrefPubMedGoogle Scholar
  • 8 Amtmann D, Bamer AM, Noonan V. et al. Comparison of the psychometric properties of two fatigue scales in multiple sclerosis. Rehabil Psychol 2012; 57: 159-166
    CrossrefPubMedGoogle Scholar
  • 9 Krupp LB, LaRocca NG, Muir-Nash J. et al. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-1123
    CrossrefPubMedGoogle Scholar
  • 10 Tellez N, Rio J, Tintore M. et al. Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS?. Multiple Scler 2005; 11: 198-202
    CrossrefPubMedGoogle Scholar
  • 11 Penner IK, Raselli C, Stocklin M. et al. The Fatigue Scale for Motor and Cognitive Functions (FSMC): Validation of a new instrument to assess multiple sclerosis-related fatigue. Mult Scler 2009; 15: 1509-1517
    CrossrefPubMedGoogle Scholar
  • 12 Guidelines MSCP . Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Washington D.C.: Paralyzed Veterans of America; 1998
    Google Scholar
  • 13 Khan F, Amatya B, Galea M. Management of fatigue in persons with multiple sclerosis. Front Neurology 2014; 5: 177
    PubMedGoogle Scholar
  • 14 Flachenecker P, Muller G, Konig H. et al. Fatigue bei Multipler Sklerose: Validierung des "Würzburger Erschöpfungs-Inventar bei Multipler Sklerose (WEIMUS). Nervenarzt 2006; 77: 165-166 168–170, 172–164
    CrossrefPubMedGoogle Scholar
  • 15 Sander C, Eling P, Hanken K. et al. The impact of ms-related cognitive fatigue on future brain parenchymal loss and relapse: A 17-month follow-up Study. Front Neurol 2016; 7: 155
    PubMedGoogle Scholar
  • 16 Flachenecker P, Muller G, Konig H. et al. "Fatigue" in multiple sclerosis. Development and and validation of the "Wurzburger Fatigue Inventory for MS". Nervenarzt 2006; 77: 165-166 168–170, 172–164
    CrossrefPubMedGoogle Scholar
  • 17 Johansson S, Ytterberg C, Hillert J. et al. A longitudinal study of variations in and predictors of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2008; 79: 454-457
    CrossrefPubMedGoogle Scholar
  • 18 Svenningsson A, Falk E, Celius EG. et al. Natalizumab treatment reduces fatigue in multiple sclerosis. Results from the TYNERGY trial; a study in the real life setting. PloS one 2013; 8: e58643
    CrossrefPubMedGoogle Scholar
  • 19 Moller F, Poettgen J, Broemel F. et al. HAGIL (Hamburg Vigil Study): A randomized placebo-controlled double-blind study with modafinil for treatment of fatigue in patients with multiple sclerosis. Mult Scler 2011; 17: 1002-1009
    CrossrefPubMedGoogle Scholar
  • 20 Lehmann P, Eling P, Kastrup A. et al. Self-reported sleep problems, but not fatigue, lead to decline in sustained attention in MS patients. Mult Scler 2013; 19: 490-497
    CrossrefPubMedGoogle Scholar
  • 21 Hanken K, Eling P, Hildebrandt H. Is there a cognitive signature for MS-related fatigue?. Mult Scler 2015; 21: 376-381
    CrossrefPubMedGoogle Scholar
  • 22 DeLuca J. Fatigue, cognition, and mental effort. In: Fatigue as a window to the brain. Cambridge: MIT Press; 2005: 37-57
    Google Scholar
  • 23 Morrow SA, Weinstock-Guttman B, Munschauer FE. et al. Subjective fatigue is not associated with cognitive impairment in multiple sclerosis: Cross-sectional and longitudinal analysis. Mult Scler 2009; 15: 998-1005
    CrossrefPubMedGoogle Scholar
  • 24 Bol Y, Duits AA, Hupperts RM. et al. The psychology of fatigue in patients with multiple sclerosis: a review. J Psychosom Res 2009; 66: 3-11
    CrossrefPubMedGoogle Scholar
  • 25 Pierard C, Liscia P, Chauveau F. et al. Differential effects of total sleep deprivation on contextual and spatial memory: Modulatory effects of modafinil. Pharmacol Biochem Behav 2011; 97: 399-405
    CrossrefPubMedGoogle Scholar
  • 26 Neumann M, Sterr A, Claros-Salinas D. et al. Modulation of alertness by sustained cognitive demand in MS as surrogate measure of fatigue and fatigability. J Neurol Sci 2014; 340: 178-182
    CrossrefPubMedGoogle Scholar
  • 27 Weinges-Evers N, Brandt AU, Bock M. et al. Correlation of self-assessed fatigue and alertness in multiple sclerosis. Mult Scler 2010; 16: 1134-1140
    CrossrefPubMedGoogle Scholar
  • 28 Claros-Salinas D, Bratzke D, Greitemann G. et al. Fatigue-related diurnal variations of cognitive performance in multiple sclerosis and stroke patients. J Neurol Sci 2010; 295: 75-81
    CrossrefPubMedGoogle Scholar
  • 29 Claros-Salinas D, Dittmer N, Neumann M. et al. Induction of cognitive fatigue in MS patients through cognitive and physical load. Neuropsychological rehabilitation 2013; 23: 182-201
    CrossrefPubMedGoogle Scholar
  • 30 Hildebrandt H, Hahn HK, Kraus JA. et al. Memory performance in multiple sclerosis patients correlates with central brain atrophy. Mult Scler 2006; 12: 428-436
    CrossrefPubMedGoogle Scholar
  • 31 Flachenecker P. Fatigue bei Multipler Sklerose. Nervenheilkunde 2015; 34: 685-689
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Claros-Salinas D. Zurück in den Beruf-subjektive und objektive Perspektiven berufsorientierter Neurorehabilitation. Neurol Rehabil 2012; 18: 275-290
    PubMedGoogle Scholar
  • 33 Rotstein D, O'Connor P, Lee L. et al. Multiple sclerosis fatigue is associated with reduced psychomotor vigilance. Can J Neurol Sci 2012; 39: 180-184
    CrossrefPubMedGoogle Scholar
  • 34 Walker LA, Berard JA, Berrigan LI. et al. Detecting cognitive fatigue in multiple sclerosis: method matters. J Neurol Sci 2012; 316: 86-92
    CrossrefPubMedGoogle Scholar
  • 35 Beck AT, Ward CH, Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571
    CrossrefPubMedGoogle Scholar
  • 36 Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003; 1: 29
    CrossrefPubMedGoogle Scholar
  • 37 Buysse DJ, Reynolds 3rd CF, Monk TH. et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213
    CrossrefPubMedGoogle Scholar
  • 38 Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540-545
    CrossrefPubMedGoogle Scholar
  • 39 Sehle A, Vieten M, Sailer S. et al. Objective assessment of motor fatigue in multiple sclerosis: The Fatigue index Kliniken Schmieder (FKS). J Neurol 2014; 261: 1752-1762
    CrossrefPubMedGoogle Scholar
  • 40 Runia TF, Jafari N, Siepman DA. et al. Fatigue at time of CIS is an independent predictor of a subsequent diagnosis of multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86: 543-546
    CrossrefPubMedGoogle Scholar
  • 41 Yaldizli O, Atefy R, Gass A. et al. Corpus callosum index and long-term disability in multiple sclerosis patients. J Neurol 2010; 257: 1256-1264
    CrossrefPubMedGoogle Scholar
  • 42 Marrie RA, Fisher E, Miller DM. et al. Association of fatigue and brain atrophy in multiple sclerosis. J Neurol Sci 2005; 228: 161-166
    CrossrefPubMedGoogle Scholar
  • 43 Voelter HUHH, Kastrup A. MS-assoziierte Fatigue – Welche Immuntherapie hilft?. Akt Neurol 2016; 43: 511-518
    Article in Thieme ConnectPubMedGoogle Scholar