Fatigue in multiple sclerosis: Multidimensional assessment and response to symptomatic treatment

Alfredo Romani, Roberto Bergamaschi, Elisa Candeloro, Enrico Alfonsi, Roberto Callieco, Vittorio Cosi

Research output: Contribution to journalArticlepeer-review


Sixty relapsing-remitting multiple sclerosis (MS) patients were selected on the basis of their score on the Fatigue Severity Scale (FSS) and formed two groups: 40 patients (fatigued MS, MSf) scored above the 75th percentile of a previously assessed representative MS sample (100 patients), and 20 age- and sex-matched patients (nonfatigued MS patients; MSnf) scored below the 25th percentile. The patients underwent clinical evaluation (Expanded Disability Status Scale (EDSS)), further assessment of fatigue (Fatigue Impact Scale), scales evaluating depression (Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI)) and neuropsychological tests. All patients were evaluated for muscle fatigability and central activation by means of a biomechanical test of sustained contraction; they also underwent somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS). The patients of the MSf subgroup were then randomized to one of the following two treatments: 4-aminopyridine (4-AP) 24 mg/day and fluoxetine (FLX) 20 mg/day. After a one-week titration this treatment proceeded for 8 weeks. At the end of the treatment, EDSS, fatigue and depression scores were further evaluated. At baseline, fatigue test scores consistently correlated with depression and cognitive test scores, but not with the fatigability test. Fatigue scores decreased in both treatment groups in a similar way. Due to the design of the study, this cannot be disjoined from a placebo effect. The changes of fatigue scores could not be predicted in the FLX group, whereas in the 4-AP group higher basal fatigability test scores were associated with greater reduction in fatigue scores.

Original languageEnglish
Pages (from-to)462-468
Number of pages7
JournalMultiple Sclerosis Journal
Issue number4
Publication statusPublished - Aug 2004


  • 4-aminopyridine
  • Evoked potentials
  • Fatigability
  • Fatigue
  • Fluoxetine
  • Multiple sclerosis
  • Transcranial magnetic stimulation

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Fatigue in multiple sclerosis: Multidimensional assessment and response to symptomatic treatment'. Together they form a unique fingerprint.

Cite this