Assessment, pathophysiology and treatment of fatigue in multiple sclerosis

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

This review will update current views of the physiopathology and treatment of fatigue in multiple sclerosis. Fatigue is a common symptom in multiple sclerosis, being reported by about a third of the patients. For many of them it is the most disabling symptom, with negative consequences on working activity and daily life. There are no objective measures of fatigue which is essentially based on subjective complaints. Even if fatigue may be influenced by motor disturbances and depression, it is largely independent from both. Peripheral mechanisms, such as muscular disuse and deconditioning, joint abnormalities and metabolic changes of muscular fibers, have very little role in multiple sclerosis fatigue. All the available data indicate that fatigue is a 'central' phenomenon, due to multiple causes. Neurophysiological studies revealed an impairment of volitional drive to the descending motor pathways and functional imaging studies fund a selective involvement of frontal cortex and basal ganglia. Therefore, a dysfuncfion of the circuits between thalamus, basal ganglia and frontal cortex, affected by the multiple sclerosis lesions and/or disturbed in their function by the products of inflammation could be the substrate of fatigue. No specific treatments are available - management strategies include medications, exercise and behavioral therapy - in most cases a combined approach is suitable. Enhancers of vigilance, like amantadine and modafinil, were shown to be effective in class I and II trials, however their effects are modest. Aminopyridines may indirectly influence fatigue by reducing nerve conduction block in motor fibers. Some recent studies suggest the positive effects of drugs on fatigue may be via reducing the inflammatory activity, such as for glatiramer acetate.

Original languageEnglish
Pages (from-to)867-876
Number of pages10
JournalExpert Review of Neurotherapeutics
Volume2
Issue number6
DOIs
Publication statusPublished - Nov 2002

Fingerprint

Multiple Sclerosis
Fatigue
Therapeutics
Frontal Lobe
Basal Ganglia
Aminopyridines
Efferent Pathways
Amantadine
Exercise Therapy
Nerve Block
Neural Conduction
Financial Management
Thalamus
Joints
Inflammation
Pharmaceutical Preparations

Keywords

  • Amantadine
  • Aminopyridines
  • Behavioral therapy
  • Exercise
  • Fatigue
  • Glatiramer acetate
  • Multiple sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Assessment, pathophysiology and treatment of fatigue in multiple sclerosis. / Comi, Giancarlo; Leocani, Leitizia.

In: Expert Review of Neurotherapeutics, Vol. 2, No. 6, 11.2002, p. 867-876.

Research output: Contribution to journalArticle

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