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Mezini S, Soundy A. A Thematic Synthesis Considering the Factors which Influence Multiple Sclerosis Related Fatigue during Physical Activity. Behav Sci (Basel) 2019; 9:E70. [PMID: 31266231 PMCID: PMC6680722 DOI: 10.3390/bs9070070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/04/2019] [Accepted: 06/21/2019] [Indexed: 01/18/2023] Open
Abstract
The purpose of this study is to consider the factors that influence fatigue related to physical activity in patients with multiple sclerosis (PwMS) and to identify the necessary adaptations undertaken by patients to remain active. A review using a thematic synthesis methodology situated within a subtle realist paradigm was undertaken. The review was completed in three stages: 1) search of relevant studies; 2) critical appraisal of literature; and 3) thematic synthesis. Nineteen studies met the inclusion criteria. This included a total of 263 participants of whom 243 were PwMS (159 females, 70 males and 14 unknown). The aggregated mean age was 53.3 years and aggregated mean time living with MS post diagnosis 11.3 years. Following critical appraisal, no articles were excluded. Three major themes were identified: (1) fatigue-related consequences, (2) exercise related barriers affecting fatigue, and (3) factors that make fatigue bearable for MS individuals. The thematic synthesis identified the cycle of activity and inactivity as a result of fatigue perception. Exercise experience, professional and social support, as well as the necessary adaptation of a training programme empower PwMS to adopt a more active coping strategy and enjoy the benefits of exercise. Clinicians could consider the implementation of a suitable, individualised exercise programme to reduce PwMS's stress during physical activities.
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Affiliation(s)
- Sofia Mezini
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
- Stratford Hospital, Arden Street, Stratford, Warwickshire CV37 6NX, UK.
| | - Andrew Soundy
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Capone F, Collorone S, Cortese R, Di Lazzaro V, Moccia M. Fatigue in multiple sclerosis: The role of thalamus. Mult Scler 2019; 26:6-16. [DOI: 10.1177/1352458519851247] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fatigue is very common in multiple sclerosis (MS) and is often considered as its most disabling symptom. Over the last 20 years, an increasing number of studies have evaluated the pathogenetic bases of MS-related fatigue. Converging evidence from neurophysiology and neuroimaging research suggests that a dysfunction in a cortico-subcortical pathway, centered on thalamus, is involved in the pathogenesis of fatigue. However, type and significance of such dysfunction remain unknown, and some studies reported an increase in the activity and connectivity within the thalamic network, whereas others suggested its reduction. Hereby, we review the results of neuroimaging studies supporting the different hypotheses about the role of thalamic network in the pathophysiology of MS-related fatigue and discuss limitations and shortcomings of available data, highlighting the key challenges in the field and the directions for future research.
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Affiliation(s)
- Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy/NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, Rome, Italy
| | - Sara Collorone
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Rosa Cortese
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marcello Moccia
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University, Naples, Italy
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53
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Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review. Mult Scler Int 2019; 2019:2027947. [PMID: 31016045 PMCID: PMC6448334 DOI: 10.1155/2019/2027947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background. Fatigue is one of the most invalidant symptoms of Multiple Sclerosis (MS) that negatively affects occupational and work performance and social participation. Occupational therapy (OT) assessment and treatment of impairments related to fatigue can have a significant and positive impact on the quality of life. Methods. An umbrella review has been carried out to provide rehabilitative decision makers in healthcare with insight into the role of OT in fatigue management in Multiple Sclerosis. The question is, what type of treatment provided by occupational therapist is more effective in reducing fatigue in Multiple Sclerosis? A search of literature published until June 2018 was undertaken by three independent reviewers using PubMed, PEDro, and Cochrane Library database including systematic reviews and meta-analyses of the last 10 years. Results. 10 studies were selected (5 systematic reviews, 1 meta-analysis, 3 reviews, and 1 guideline). Conclusions. Fatigue management programs have moderate evidence; other strategies such as OT strategies and telerehabilitation show low evidence.
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Adamopoulou F, Alikari V, Zyga S, Tsironi M, Tzavella F, Giannakopoulou N, Theofilou P. The Effect of Fatigue and Pain Self- Efficacy on Health-Related Quality of Life Among Patients with Multiple Sclerosis. Mater Sociomed 2019; 31:40-44. [PMID: 31213954 PMCID: PMC6511379 DOI: 10.5455/msm.2019.31.40-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Health-related quality of life is a major issue among patients with Multiple sclerosis (MS). Aim: To explore the effect of fatigue and pain self-efficacy on health-related quality of life among patients with MS. Methods: Between March and May 2018, 85 MS patients from a large Hospital of Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001. Results: Fatigue might predict the dimension of quality of life “Function” while Pain Self-Efficacy might, also, predict the dimension of quality of life “Interpersonal”. A strong correlation was found between the dimensions of quality of life “Well-being” and “Transcendent” and between “Interpersonal” and Pain Self-Efficacy. The total score of fatigue was strongly correlated with Physical Fatigue and very strongly correlated with Mental Fatigue. Conclusion: Fatigue and Pain Self-Efficacy are important predictors of the dimensions of quality of life among patients with MS. Pain in MS has to be taken into serious consideration in every patient with MS.
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Affiliation(s)
| | - Victoria Alikari
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Maria Tsironi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Fotini Tzavella
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | | | - Paraskevi Theofilou
- Ministry of Health, Athens, Greece.,Institution for Counseling & Psychological Studies, Athens, Greece
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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Svolgaard O, Andersen KW, Bauer C, Madsen KH, Blinkenberg M, Selleberg F, Siebner HR. Cerebellar and premotor activity during a non-fatiguing grip task reflects motor fatigue in relapsing-remitting multiple sclerosis. PLoS One 2018; 13:e0201162. [PMID: 30356315 PMCID: PMC6200185 DOI: 10.1371/journal.pone.0201162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/10/2018] [Indexed: 02/07/2023] Open
Abstract
Fatigue is a common and highly disabling symptom of multiple sclerosis. Patients experience an effort-independent general subjective feeling of fatigue as well as excessive fatigability when engaging in physical or mental activity. Previous research using functional magnetic resonance imaging (fMRI) has revealed heterogeneous findings, but some evidence implicates the motor system. To identify brain correlates of fatigue, 44 mildly impaired patients with relapsing-remitting multiple sclerosis and 25 age- and gender-matched healthy controls underwent functional magnetic resonance imaging at 3 Tesla, while they performed alternating blocks of rest and a non-fatiguing precision grip task. We investigated neural correlates of fatigue using the motor subscore of Fatigue Scale for Motor and Cognitive Functions (FSMCMOTOR) using the bilateral motor cerebellum, putamen, and dorsal premotor cortex as regions of interest. Patients and healthy controls performed the grip force task equally well without being fatigued. In patients, task-related activity in lobule VI of right motor cerebellum changed in proportion with individual FSMCMOTOR scores. In right dorsal premotor cortex, linear increases in activity across consecutive task blocks scaled with individual FSMCMOTOR scores in healthy controls, but not in patients. In premotor and dorsomedial prefrontal areas, patients were impaired at upscaling task-related activity the more they were affected by motor fatigue. The results support the notion that increased sensorimotor processing in the cerebellum contributes to the experience of motor fatigue and fatigability in multiple sclerosis. Additionally, downscaling of motivational input or sensorimotor processing in prefrontal and premotor areas may constitute an additional pathophysiological factor.
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Affiliation(s)
- Olivia Svolgaard
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- * E-mail: (OS); (HRS)
| | - Kasper Winther Andersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christian Bauer
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Metropolitan University College, Copenhagen, Denmark
| | - Kristoffer Hougaard Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Selleberg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- * E-mail: (OS); (HRS)
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57
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Hulme K, Safari R, Thomas S, Mercer T, White C, Van der Linden M, Moss-Morris R. Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews. PLoS One 2018; 13:e0203367. [PMID: 30312325 PMCID: PMC6193578 DOI: 10.1371/journal.pone.0203367] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions. METHODS Scoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed. RESULTS Of 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. 'Complementary medicine' interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered. CONCLUSIONS Further research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.
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Affiliation(s)
- Katrin Hulme
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Health Psychology Department, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Sarah Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Claire White
- Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Marietta Van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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58
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Giboin LS, Gruber M, Kramer A. Additional Intra- or Inter-session Balance Tasks Do Not Interfere With the Learning of a Novel Balance Task. Front Physiol 2018; 9:1319. [PMID: 30283361 PMCID: PMC6157309 DOI: 10.3389/fphys.2018.01319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/31/2018] [Indexed: 11/23/2022] Open
Abstract
Background: It has been shown that balance training induces task-specific performance improvements with very limited transfer to untrained tasks. Thus, regarding fall prevention, one strategy is to practice as many tasks as possible to be prepared for a multitude of situations with increased fall risk. However, it is not clear whether the learning of several different balance tasks interfere with each other. A positive influence could be possible via the contextual interference (CI) effect, a negative influence could be induced by the disruption of motor memory during consolidation or retrieval. Methods: In two 3-week training experiments, we tested: (1) whether adding an additional balance task in the same training session would influence the learning of a balance task [first task: one-leg stance on a tilt-board (TB), six sessions, 15 × 20 s per session; additional task: one-leg stance on a slack line (SL), same amount of additional training]; (2) whether performing a different balance task (SL) in between training sessions of the first task (TB) would influence the learning of the first task. Twenty-six healthy subjects participated in the first experiment, 40 in the second experiment. In both experiments the participants were divided into three groups, TB only, TB and SL, and control. Before and after the training period, performance during the TB task (3 × 20 s) was recorded with a Vicon motion capturing system to assess the time in equilibrium. Results: Analyses of variance revealed that neither the additional intra-session balance task in experiment 1 nor the inter-session task in experiment 2 had a significant effect on balance performance improvement in the first task (no significant group × time interaction effect for the training groups, p = 0.83 and p = 0.82, respectively, only main effects of time). Conclusion: We could not find that additional intra- or intersession balance tasks interfere with the learning of a balance task, neither impairing it nor having a significant positive effect. This can also be interpreted as further evidence for the specificity of balance training effects, as different balance tasks do not seem to elicit interacting adaptations.
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Affiliation(s)
| | - Markus Gruber
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
| | - Andreas Kramer
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
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59
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Foley FW, Portnoy JG. Neuropsychology in the Integrated MS Care Setting. Arch Clin Neuropsychol 2018; 33:330-338. [PMID: 29718075 DOI: 10.1093/arclin/acy003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/01/2018] [Indexed: 11/13/2022] Open
Abstract
The goal of this paper is to describe the role of the neuropsychologist in a Multiple Sclerosis clinic setting. A brief overview of the pathophysiology and neuropsychological deficits in MS is presented. Practical details regarding relations with the neurology team, and the neuropsychologist's focus on assessment are described. Recommendations regarding necessary training and skills, as well as typical clinical practice routines are described. The neuropsychologist's communication with internal and external providers and family members in order to assist implementation of recommendations is described.
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Affiliation(s)
- Frederick W Foley
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA.,Holy Name Medical Center Multiple Sclerosis Center, Teaneck, NJ, USA
| | - Jeffrey G Portnoy
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA.,Holy Name Medical Center Multiple Sclerosis Center, Teaneck, NJ, USA
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Miller E, Morel A, Redlicka J, Miller I, Saluk J. Pharmacological and Non-pharmacological Therapies of Cognitive Impairment in Multiple Sclerosis. Curr Neuropharmacol 2018; 16:475-483. [PMID: 29119933 PMCID: PMC6018194 DOI: 10.2174/1570159x15666171109132650] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/09/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023] Open
Abstract
Background Cognitive impairment is one of the most important clinical features of neurodegenerative disorders including multiple sclerosis (MS). Conducted research shows that up to 65 percent of MS patients have cognitive deficits such as episodic memory, sustained attention, reduced verbal fluency; however, the cognitive MS domain is information processing speed. It is the first syndrome of cognitive dysfunction and the most widely affected in MS. Occasionally these impairments occur even before the appearance of physical symptoms. Methods Therefore, this review focused on the current status of our knowledge about possible methods of treatment cognitive impairment in MS patients including novel strategies. Research and online content was performed using Medline and EMBASE databases. Results The most recent research suggests that cognitive impairment is correlated with brain lesion volume and brain atrophy. The examination of the cognitive impairment is usually based on particular neuropsychological batteries. However, it can be not enough to make a precise diagnosis. This creates a demand to find markers that might be useful for identifying patients with risk of cognitive impairment at an early stage of the disease. Currently the most promising methods consist of neuroimaging indicators, such as diffusion tensor imaging, the magnetization transfer ratio, and N-acetyl aspartate levels. Diagnosis problems are strictly connected with treatment procedures. There are two main cognitive therapies: pharmacological (disease modifying drugs (DMD), symptomatic treatments) and non-pharmacological interventions that are focused on psychological and physical rehabilitation. Some trials have shown a positive association between physical activity and the cognitive function. Conclusion This article is an overview of the current state of knowledge related to cognition impairment treatment in MS. Additionally, novel strategies for cognitive impairments such as cryostimulation and other complementary methods are presented.
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Affiliation(s)
- Elzbieta Miller
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.,Neurorehabilitation Ward, 3rd General Hospital in Lodz, Lodz, Milionowa 14, Poland
| | - Agnieszka Morel
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, Lodz, Poland
| | - Justyna Redlicka
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.,Neurorehabilitation Ward, 3rd General Hospital in Lodz, Lodz, Milionowa 14, Poland
| | - Igor Miller
- Department of Physical Medicine, Medical University of Lodz, Lodz, Poland
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, Lodz, Poland
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61
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Pöttgen J, Moss-Morris R, Wendebourg JM, Feddersen L, Lau S, Köpke S, Meyer B, Friede T, Penner IK, Heesen C, Gold SM. Randomised controlled trial of a self-guided online fatigue intervention in multiple sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:970-976. [PMID: 29549193 DOI: 10.1136/jnnp-2017-317463] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Fatigue is a major disabling symptom in many chronic diseases including multiple sclerosis (MS), but treatment options are limited.Here, we tested the effectiveness of a self-guided , interactive, online fatigue management programme (ELEVIDA) based on principles of cognitive behavioural therapy (CBT) and related psychotherapeutic approaches (eg, mindfulness) for reducing fatigue in MS. METHODS Patients with MS and self-reported fatigue were recruited via the website of the German MS Society and assigned via an automated randomisation generator (1:1, no blocking or stratification) to a 12-week online intervention (ELEVIDA, n=139, 82% female, mean age 40.8, median patient determined disease steps (PDDS) 3.0) or a waitlist control group (n=136, 79% female, mean age 41.9, median PDDS 3.0). The primary outcome was the Chalder Fatigue Scale. Outcomes were assessed at baseline, at week 12 (postintervention) and at follow-up (week 24). RESULTS Compared with the control group, significantly greater reductions in Chalder Fatigue Scale scores were seen in the ELEVIDA group at week 12 (primary endpoint, intention-to-treat analysis: between-group mean difference 2.74 points; 95% CI 1.16 to 4.32; p=0.0007; effect size d=0.53), with effects sustained at week 24 (intention-to-treat analysis: between-group mean difference 2.19 points; 95% CI 0.57 to 3.82; p=0.0080). CONCLUSIONS Our trial provides evidence for the effectiveness of a self-guided , internet-based intervention to reduce fatigue in MS. Interventions such as ELEVIDA may be a suitable low barrier, cost-effective treatment option for MS fatigue. TRIAL REGISTRATION NUMBER ISRCTN registry (number ISRCTN25692173).
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Affiliation(s)
- Jana Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rona Moss-Morris
- Section of Health Psychology, Psychology Department, King's College London, London, UK
| | - Janina-Maria Wendebourg
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Feddersen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Lau
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Sektion Pflegeforschung, Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Björn Meyer
- GAIA AG, Hamburg, Germany.,Department of Psychology, City University of London, London, UK
| | - Tim Friede
- Institut für Medizinische Statistik, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Iris-Katharina Penner
- Klinik für Neurologie, Medizinische Fakultät, Heinrich Heine Universität, Düsseldorf, Germany.,COGITO Zentrum für angewandte Neurokognition und neuropsychologische Forschung, Life Science Center, Düsseldorf, Germany
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie (ZMNH), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
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62
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D'hooghe M, Van Gassen G, Kos D, Bouquiaux O, Cambron M, Decoo D, Lysandropoulos A, Van Wijmeersch B, Willekens B, Penner IK, Nagels G. Improving fatigue in multiple sclerosis by smartphone-supported energy management: The MS TeleCoach feasibility study. Mult Scler Relat Disord 2018; 22:90-96. [DOI: 10.1016/j.msard.2018.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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63
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Gümüş H. Fatigue Can Be Objectively Measured in Multiple Sclerosis: Multipl Sklerozda Yorgunluk Objektif Olarak Ölçülebilir. ACTA ACUST UNITED AC 2018; 55:S76-S79. [PMID: 30692862 DOI: 10.29399/npa.23396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Multiple Sclerosis (MS), is a chronic inflammatory demyelinating disorder affecting the white matter in the central nervous system (CNS), seen usually among young adults (20-40 years of age). Fatigue is an important symptom that affects a large portion of the patient population. The reason for fatigue seen in MS patients is still not well-known. Fatigue is a subjective and non-specific symptom; therefore, it is quite difficult to evaluate fatigue. This symptom has been reported in 75-87% of patients with multiple sclerosis (MS) and two-thirds of these patients indicated fatigue as one of the worst three common symptoms they experienced. In this review, objective measurement methods of fatigue which is a subjective complaint will be discussed.
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Affiliation(s)
- Haluk Gümüş
- Department of Neurology, Selçuk University School of Medicine, Konya, Turkey
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64
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Henze T, Feneberg W, Flachenecker P, Seidel D, Albrecht H, Starck M, Meuth SG. Neues zur symptomatischen MS-Therapie: Teil 5 – Fatigue. DER NERVENARZT 2017; 89:446-452. [DOI: 10.1007/s00115-017-0442-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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65
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Charvet LE, Dobbs B, Shaw MT, Bikson M, Datta A, Krupp LB. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial. Mult Scler 2017; 24:1760-1769. [PMID: 28937310 DOI: 10.1177/1352458517732842] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). OBJECTIVE To evaluate whether tDCS can reduce fatigue in individuals with MS. METHODS Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition ( n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham ( n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue Short Form. RESULTS AND CONCLUSION In Study 1, there was modest fatigue reduction in the active group (-2.5 ± 7.4 vs -0.2 ± 5.3, p = 0.30, Cohen's d = -0.35). However, in Study 2 there was statistically significant reduction for the active group (-5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen's d = -0.71). tDCS is a potential treatment for MS-related fatigue.
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Affiliation(s)
- Leigh E Charvet
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael T Shaw
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City University of New York, New York, NY, USA
| | | | - Lauren B Krupp
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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66
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Sgoifo A, Bignamini A, La Mantia L, Celani MG, Parietti P, Ceriani MA, Marazzi MR, Proserpio P, Nobili L, Protti A, Agostoni EC. Integrated Imaginative Distention Therapy to Cope with Fatigue. DIMMI SI Study: The First Randomized Controlled Trial in Multiple Sclerosis. Neurol Ther 2017; 6:213-223. [PMID: 28795383 PMCID: PMC5700903 DOI: 10.1007/s40120-017-0081-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Fatigue is a frequent, disabling, and difficult to treat symptom in neurological disease and in other stress-related conditions; Integrated Imaginative Distention (IID) is a therapy combining muscular and imaginative relaxation, feasible also in disabled subjects; the DIMMI SI trial was planned to evaluate IID efficacy on fatigue. Methods The design was a parallel, randomised 1:1 (intervention:waiting list), controlled, open-label trial. Participants were persons with multiple sclerosis (pwMS), persons with insomnia (pwINS), and health professionals (HP) as conditions related to fatigue and stress. The primary outcome was the post-intervention change of fatigue; secondary outcomes were changes in insomnia, stress, and quality of life (QoL). Eight IID weekly training group sessions were delivered by a skilled psychotherapist. The study lasted 12 months. Results One hundred and forty-four subjects were enrolled, 48 for each condition. The mean change in Modified Fatigue Impact Scale (MFIS) score among exposed was 7.7 [95% CI 1.1, 14.4] (P = 0.023) in pwMS; 7.1 [1.9, 12.3] (P = 0.007) among pwINS, and 11.3 [4.3, 18.2] among HP (P = 0.002). At the last follow-up, the benefit was confirmed on physical fatigue for pwMS, on total fatigue for pwINS and HP. Conclusions DIMMI SI is the first randomized controlled trial evaluating the efficacy of IID on fatigue. IID resulted a complementary intervention to reduce fatigue in stress-related conditions, in both health and disease status. NCT02290990ClinicalTrials.gov. Electronic supplementary material The online version of this article (doi:10.1007/s40120-017-0081-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annalisa Sgoifo
- Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Angelo Bignamini
- Department of Pharmaceutical Sciences, School of Specialization in Hospital Pharmacy, University of Milan, Milan, Italy
| | - Loredana La Mantia
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Maria G Celani
- UOC Neurophysiopathology Division, A.O. Perugia, Perugia, Italy
| | | | | | - Maria R Marazzi
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Paola Proserpio
- Sleep Disorders Center and Claudio Munari Neurosurgery Epilepsy Center, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Lino Nobili
- Sleep Disorders Center and Claudio Munari Neurosurgery Epilepsy Center, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandra Protti
- Multiple Sclerosis Centre, Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Elio C Agostoni
- Department of Neurosciences, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
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Nantes JC, Proulx S, Zhong J, Holmes SA, Narayanan S, Brown RA, Hoge RD, Koski L. GABA and glutamate levels correlate with MTR and clinical disability: Insights from multiple sclerosis. Neuroimage 2017; 157:705-715. [DOI: 10.1016/j.neuroimage.2017.01.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 01/04/2023] Open
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Safari R, van der Linden ML, Mercer TH. Effect of exercise interventions on perceived fatigue in people with multiple sclerosis: synthesis of meta-analytic reviews. Neurodegener Dis Manag 2017. [DOI: 10.2217/nmt-2017-0009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although exercise training has been advocated as a nonpharmacological treatment for multiple sclerosis (MS) related fatigue, no consensus exists regarding its effectiveness. To address this, we collated meta-analytic reviews that explored the effectiveness of exercise training for the treatment of MS-related fatigue. We searched five online databases for relevant reviews, published since 2005, and identified 172 records. Five reviews were retained for systematic extraction of information and evidence quality analysis. Although our review synthesis indicated that exercise training interventions have a moderate effect on fatigue reduction in people with MS, no clear insight was obtained regarding the relative effectiveness of specific types or modes of exercise intervention. Moreover, Grading of Recommendation Assessment, Development and Evaluation revealed that the overall quality of evidence emanating from these five reviews was ‘very low’.
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Affiliation(s)
- Reza Safari
- Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK
- Centre for Health, Activity & Rehabilitation Research, School of Health Sciences, Queen Margaret University, Musselburgh, EH21 6UU, UK
| | - Marietta L van der Linden
- Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK
| | - Tom H Mercer
- Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK
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69
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Reen GK, Silber E, Langdon DW. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1031-1048. [PMID: 28108125 DOI: 10.1016/j.pec.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/29/2016] [Accepted: 12/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS). METHODS A systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings. RESULTS Interventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified. CONCLUSION Interventions designed to improve understanding of DMD risk and benefit information are moderately successful. PRACTICE IMPLICATIONS Additional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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70
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van den Akker LE, Beckerman H, Collette EH, Twisk JWR, Bleijenberg G, Dekker J, Knoop H, de Groot V. Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial. Mult Scler 2017; 23:1542-1553. [DOI: 10.1177/1352458517709361] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
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Affiliation(s)
- Lizanne E van den Akker
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Heleen Beckerman
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Emma H Collette
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos WR Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans Knoop
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands/Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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71
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Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci 2017; 375:107-122. [DOI: 10.1016/j.jns.2016.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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72
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Tai chi for health benefits in patients with multiple sclerosis: A systematic review. PLoS One 2017; 12:e0170212. [PMID: 28182629 PMCID: PMC5300172 DOI: 10.1371/journal.pone.0170212] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS). After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL) and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients.
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73
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Reider N, Salter AR, Cutter GR, Tyry T, Marrie RA. Potentially Modifiable Factors Associated With Physical Activity in Individuals With Multiple Sclerosis. Res Nurs Health 2017; 40:143-152. [DOI: 10.1002/nur.21783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Nadia Reider
- Department of Community Health Sciences; University of Manitoba; Health Sciences Centre, GF 533; 820 Sherbrook Street Winnipeg MB R3A 1R9 Canada
| | - Amber R. Salter
- Department of Biostatistics; School of Public Health; University of Alabama at Birmingham; Birmingham AL
| | - Gary R. Cutter
- Department of Biostatistics; School of Public Health; University of Alabama at Birmingham; Birmingham AL
| | - Tuula Tyry
- Dignity Health St. Joseph's Hospital and Medical Center; Phoenix AZ
| | - Ruth Ann Marrie
- Department of Community Health Sciences and Department of Internal Medicine; University of Manitoba; Winnipeg Manitoba Canada
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74
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Miller E, Kostka J, Włodarczyk T, Dugué B. Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study. Acta Neurol Scand 2016; 134:420-426. [PMID: 26778452 DOI: 10.1111/ane.12557] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To study the effects of whole-body cryostimulation (WBC) on fatigue and functional status in multiple sclerosis (MS) patients with different levels of fatigue. SUBJECTS AND METHODS Two groups of 24 MS patients with fatigue were studied. At the beginning of the study, the first group presented a Fatigue Severity Scale (FSS) score between 38 and 42 (low-fatigue (LF) group), and the second group had an FSS score between 48 and 52 (high-fatigue (HF) group). Both groups were matched for age and sex. All patients were exposed to 10.3-min session of WBC (one exposure per day at -110°C or lower). Functional status was assessed before and after the series of WBC exposures using the Rivermead Motor Assessment (RMA), the Multiple Sclerosis Impact Scale (MSIS-29), and the Expanded Disability Status Scale (EDSS). The RMA was estimated in three sections: gross function (RMA1), leg and trunk (RMA2), and arm (RMA3). MSIS-29 consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) status. RESULTS In both groups, the WBC sessions induced a significant improvement in the functional status and in the feeling of fatigue. However, the changes observed in HF patients were significantly greater than those observed in LF patients, especially in the MSIS-29-PHYS, MSIS-29-PSYCH, RMA1, and RMA3. The changes observed in the EDSS, RMA2, and FSS were similar in both groups. CONCLUSIONS WBC appears to be effective in improving functional status and the feeling of fatigue in patients with MS and especially in those who are the most fatigued.
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Affiliation(s)
- E. Miller
- Department of Physical Medicine; Medical University of Lodz; Lodz Poland
- Neurorehabilitation Ward; III General Hospital in Lodz; Lodz Poland
| | - J. Kostka
- Department of Physical Medicine; Medical University of Lodz; Lodz Poland
| | - T. Włodarczyk
- Ophthalmology Department; Warminski Hospital; Bydgoszcz Poland
| | - B. Dugué
- Laboratoire “Mobilité Vieillissement Exercice”; Faculty of Sport Sciences; University of Poitiers; Poitiers France
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75
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Newton G, Griffith A, Soundy A. The experience of fatigue in neurological patients with Multiple Sclerosis: a thematic synthesis. Physiotherapy 2016; 107:306-316. [PMID: 32430188 DOI: 10.1016/j.physio.2016.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/18/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To identify the experiences that result from MS-related fatigue (MSRF) through a systematic review and thematic synthesis of qualitative literature. DESIGN The thematic synthesis was undertaken in three stages: (1) a systematic review of the literature, searching relevant databases from their inception to March 2016. (2) A critical appraisal of included studies, and (3) a double blind 2-phase synthesis of results was undertaken. SETTING Participants were included from articles using primary and secondary care settings. PARTICIPANTS The synthesis included nine articles that incorporated a total of one hundred and fifty two participants (103 females and 49 males) in the review. RESULTS No articles were excluded following critical appraisal. Two major themes were synthesised: (1) biopsychosocial experiences of fatigue, which illustrated the physical, cognitive and social challenges patients experience and (2) experiences that alter the impact of fatigue including the strategies individual employ to help manage fatigue. These major themes were further split into five subthemes. LIMITATIONS Only the most common experiences of MSRF were identified. Findings did not break down results by key demographics e.g. disease type. Only English language studies were included. CONCLUSION Physiotherapists are able to support the management by: (a) having a greater understanding of MSRF and (b) being able to help patients manage the factors that influence it.
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Affiliation(s)
- Georgina Newton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, B15 2TT, UK
| | - Amy Griffith
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, B15 2TT, UK
| | - Andy Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, B15 2TT, UK.
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76
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Sebastião E, Hubbard EA, Klaren RE, Pilutti LA, Motl RW. Fitness and its association with fatigue in persons with multiple sclerosis. Scand J Med Sci Sports 2016; 27:1776-1784. [PMID: 27747926 DOI: 10.1111/sms.12752] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/28/2022]
Abstract
This study compared physical fitness components between fatigued and non-fatigued persons with MS and examined those components as correlates of fatigue. Sixty-two ambulatory persons with MS completed the Modified Fatigue Impact Scale (MFIS) and underwent assessments of cardiorespiratory capacity, lower extremity muscle strength (i.e., peak torque and asymmetry), body composition, and static balance over two different sessions 7 days apart. Participants were allocated into fatigue groups based on MFIS scores (non-fatigued group (i.e., MFIS ≤38), n = 26; and fatigued group (MFIS >38), n = 36). The fatigued group had significantly (P < 0.05) lower cardiorespiratory capacity (VO2peak ) and muscular strength (i.e., knee flexion peak torque) than the non-fatigued group. VO2peak and knee extension peak torque were the two physical fitness components significantly correlated with fatigue scores in the fatigued group (P < 0.05), and follow-up stepwise linear regression revealed that VO2peak was a significant predictor of fatigue scores (R2 = 0.13). Discriminant function analysis further identified VO2peak as a significant (P < 0.05) correlate of fatigue status. This model explained 21% of variance in group status (i.e., fatigued vs non-fatigued) and correctly classified approximately 76% of cases into fatigue status groups. The improvement of cardiorespiratory capacity should be considered in rehabilitation programs for persons with MS, especially those presenting with elevated fatigue.
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Affiliation(s)
- E Sebastião
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - E A Hubbard
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - R E Klaren
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - L A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - R W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Penner IK. Evaluation of cognition and fatigue in multiple sclerosis: daily practice and future directions. Acta Neurol Scand 2016; 134 Suppl 200:19-23. [PMID: 27580902 DOI: 10.1111/ane.12651] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/27/2022]
Abstract
The so-called hidden symptoms or soft signs of multiple sclerosis comprise cognitive dysfunction, fatigue, depression and anxiety. From a patient's perspective, these symptoms are rated as exerting much more negative impact on quality of life and daily functioning than their physical symptoms. Despite this knowledge, the symptoms remain disregarded by many neurologists in clinical practice. This missing awareness can be attributed to several reasons. First, the underlying pathophysiological mechanisms determining occurrence and severity of the different symptoms are still unclear. Second, there is uncertainty in how to reliably assess them. It is undeniable that assessment can be difficult as the hidden symptoms seldom appear isolated but more often highly interact. Third, if standardized, fast and cost-effective assessment to quantify and monitor the evolution of the hidden symptoms would be feasible, the question still remains how to treat these aspects. The present article will give an overview on symptom background and assessment strategies for clinical practice.
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Affiliation(s)
- I.-K. Penner
- COGITO Center for Applied Neurocognition and Neuropsychological Research; University Hospital Düsseldorf, Cognitive Neuroscience; Düsseldorf Germany
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78
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Wens I, Eijnde BO, Hansen D. Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review. J Neurol Sci 2016; 367:107-21. [DOI: 10.1016/j.jns.2016.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 01/03/2023]
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Giovannoni G, Butzkueven H, Dhib-Jalbut S, Hobart J, Kobelt G, Pepper G, Sormani MP, Thalheim C, Traboulsee A, Vollmer T. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord 2016; 9 Suppl 1:S5-S48. [PMID: 27640924 DOI: 10.1016/j.msard.2016.07.003] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION We present international consensus recommendations for improving diagnosis, management and treatment access in multiple sclerosis (MS). Our vision is that these will be used widely among those committed to creating a better future for people with MS and their families. METHODS Structured discussions and literature searches conducted in 2015 examined the personal and economic impact of MS, current practice in diagnosis, treatment and management, definitions of disease activity and barriers to accessing disease-modifying therapies (DMTs). RESULTS Delays often occur before a person with symptoms suggestive of MS sees a neurologist. Campaigns to raise awareness of MS are needed, as are initiatives to improve access to MS healthcare professionals and services. We recommend a clear treatment goal: to maximize neurological reserve, cognitive function and physical function by reducing disease activity. Treatment should start early, with DMT and lifestyle measures. All parameters that predict relapses and disability progression should be included in the definition of disease activity and monitored regularly when practical. On suboptimal control of disease activity, switching to a DMT with a different mechanism of action should be considered. A shared decision-making process that embodies dialogue and considers all appropriate DMTs should be implemented. Monitoring data should be recorded formally in registries to generate real-world evidence. In many jurisdictions, access to DMTs is limited. To improve treatment access the relevant bodies should consider all costs to all parties when conducting economic evaluations and encourage the continuing investigation, development and use of cost-effective therapeutic strategies and alternative financing models. CONCLUSIONS The consensus findings of an international author group recommend a therapeutic strategy based on proactive monitoring and shared decision-making in MS. Early diagnosis and improved treatment access are also key components.
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Affiliation(s)
- Gavin Giovannoni
- Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
| | - Suhayl Dhib-Jalbut
- Department of Neurology, RUTGERS-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
| | | | | | | | | | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Timothy Vollmer
- Department of Neurology, University of Colorado Denver, Aurora, CO, USA.
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Adoni T. Multiple sclerosis, fatigue and sleep disorders: beyond the clinical relapses. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:431-432. [PMID: 27332065 DOI: 10.1590/0004-282x20160079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Tarso Adoni
- Hospital Sírio-Libanês, Hospital Sírio Libanês, Centro de Esclerose Múltipla, São Paulo SP , Brasil, Hospital Sírio Libanês, Centro de Esclerose Múltipla, São Paulo SP, Brasil
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81
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Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study. BMC Neurol 2016; 16:77. [PMID: 27215274 PMCID: PMC4877819 DOI: 10.1186/s12883-016-0595-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/12/2016] [Indexed: 11/22/2022] Open
Abstract
Background Andrographis paniculata (A. paniculata), a medicinal plant, has shown anti-inflammatory, neuroprotective and antifibrotic effects in animal models as well as clinical efficacy in different studies, including an anti-fatigue effect in autoimmune diseases such as rheumatoid arthritis. In multiple sclerosis (MS), fatigue is rated as one of the most common and disabling symptoms. In the present trial, we investigated the effect of A. paniculata on relapse rate and fatigue in relapsing-remitting MS (RRMS) patients receiving interferon beta. Methods A randomised double-blind placebo-controlled trial assessed the effects of 170 mg of A. paniculata dried extract tablet b.i.d. p.o. on relapse rate and fatigue using the Fatigue Severity Scores (FSS) over 12 months in RRMS patients receiving interferon. The Expanded Disability Status Scale (EDSS) score, inflammatory parameters and radiological findings were also investigated. Twenty-five patients were enrolled, and twenty-two patients were ultimately analysed and randomised to the active or placebo group. Results Patients treated with A. paniculata showed a significant reduction in their FSS score as compared to the placebo, equivalent to a 44 % reduction at 12 months. No statistically significant differences were observed for relapse rate, EDSS or inflammatory parameters, with a trend in reducing new lesions among the A. paniculata group. One patient in the A. paniculata group presented with a mild and transient skin rash, which was alleviated with anti-histamine treatment for three weeks. Conclusion A. paniculata was well tolerated in patients and no changes in clinical parameters were observed. A. paniculata significantly reduces fatigue in patients with RRMS receiving interferon beta in comparison to placebo and only interferon beta treatment. Trial registration ClinicalTrials.gov Identifier: NCT02280876; Trial registration date: 20.10.2014.
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82
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Zion YC, Pappadopulos E, Wajnrajch M, Rosenbaum H. Rethinking fatigue in Gaucher disease. Orphanet J Rare Dis 2016; 11:53. [PMID: 27129405 PMCID: PMC4850725 DOI: 10.1186/s13023-016-0435-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/20/2016] [Indexed: 01/10/2023] Open
Abstract
Background Gaucher disease (GD) is a rare lysosomal storage disease caused by deficiency in the enzyme beta-glucocerebrosidase. Along with visceral, hematologic, and bone manifestations, patients may experience chronic fatigue resulting in functional disability and reduced quality of life. Management of the disease includes therapeutic intervention, supportive therapies, and regular monitoring of all clinically relevant disease signs and symptoms. However, current practice guidelines do not include measurement of fatigue or therapeutic goals for fatigue. Objective To provide insight regarding key considerations for fatigue in GD. Methods We conducted a systematic PubMed literature search and an exploratory, hypothesis-generating survey regarding fatigue in GD. Results Our literature search resulted in 19 publications. Of these, 6 were identified that assessed fatigue, including 2 that used specific fatigue assessment instruments. In our survey involving 14 patients with Type 1 GD and 19 physicians, patients ascribed greater importance to fatigue than other disease parameters, while physicians placed more emphasis on objective measures of visceral and hematologic disease manifestations. Conclusions Collectively, the results of our literature analysis and survey underscore the need for further investigation and in-office evaluation of fatigue in patients with GD, which will require a reliable, validated, and disease-specific instrument. Criteria for clinically significant fatigue in patients with GD should be established along with the development of a fatigue scale specifically designed for this patient population to provide a more objective means to potentially incorporate fatigue assessment into routine monitoring practices.
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Affiliation(s)
- Y Chen Zion
- Hematology Department, Rambam Health Care Campus, HaAliya HaShniya St 8, Bat Galim, Haifa, Israel
| | | | | | - H Rosenbaum
- Hematology Department, Rambam Health Care Campus, HaAliya HaShniya St 8, Bat Galim, Haifa, Israel. .,Clalit Medical Consulting Center, Nazareth Towers, 15 Marg Abu Amer str, Nazareth, Israel.
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83
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Abstract
OPINION STATEMENT Patients with progressive forms of multiple sclerosis have various symptoms which affect their quality of life significantly including depression, cognitive decline, sleep changes, bladder dysfunction, sexual dysfunction, and spasticity. Despite recent promising results on the effects of ocrelizumab on neurological disability in patients with PPMS, currently none of the immunomodulatory therapies are approved for progressive forms of multiple sclerosis. Therefore, clinicians currently mostly focus on management of well-recognized comorbidities of this disease phenotype in order to improve patients' quality of life. There are very few studies evaluating strategies of symptomatic management on progressive forms of multiple sclerosis and most of the data is derived from studies on relapsing forms of multiple sclerosis. Understanding of the risks, benefits, and limitations of these therapies can significantly affect patient care. In this article, we review common comorbidities associated with progressive forms of multiple sclerosis and outline important strategies for their symptomatic management.
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Affiliation(s)
- Divyanshu Dubey
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Sguigna
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olaf Stüve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Neurology Section, VA North Texas Health Care System, Medical Service, Dallas, TX, USA.
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84
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Alvarenga-Filho H, Sacramento PM, Ferreira TB, Hygino J, Abreu JEC, Carvalho SR, Wing AC, Alvarenga RMP, Bento CA. Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators. J Neuroimmunol 2016; 293:91-99. [DOI: 10.1016/j.jneuroim.2016.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 12/30/2022]
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Chalah MA, Riachi N, Ahdab R, Créange A, Lefaucheur JP, Ayache SS. Fatigue in Multiple Sclerosis: Neural Correlates and the Role of Non-Invasive Brain Stimulation. Front Cell Neurosci 2015; 9:460. [PMID: 26648845 PMCID: PMC4663273 DOI: 10.3389/fncel.2015.00460] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system (CNS) and the major cause of non-traumatic disability in young adults. Fatigue is a frequent symptom reported by the majority of MS patients during their disease course and drastically affects their quality of life. Despite its significant prevalence and impact, the underlying pathophysiological mechanisms are not well elucidated. MS fatigue is still considered the result of multifactorial and complex constellations, and is commonly classified into “primary” fatigue related to the pathological changes of the disease itself, and “secondary” fatigue attributed to mimicking symptoms, comorbid sleep and mood disorders, and medications side effects. Radiological, physiological, and endocrine data have raised hypotheses regarding the origin of this symptom, some of which have succeeded in identifying an association between MS fatigue and structural or functional abnormalities within various brain networks. Hence, the aim of this work is to reappraise the neural correlates of MS fatigue and to discuss the rationale for the emergent use of noninvasive brain stimulation (NIBS) techniques as potential treatments. This will include a presentation of the various NIBS modalities and a suggestion of their potential mechanisms of action in this context. Specific issues related to the value of transcranial direct current stimulation (tDCS) will be addressed.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Naji Riachi
- Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Rechdi Ahdab
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Neurology Division, University Medical Center Rizk Hospital Beirut, Lebanon
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France ; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
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86
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Pan J, Zhao P, Cai H, Su L, Wood K, Shi FD, Fu Y. Hypoxemia, Sleep Disturbances, and Depression Correlated with Fatigue in Neuromyelitis Optica Spectrum Disorder. CNS Neurosci Ther 2015; 21:599-606. [PMID: 26031911 DOI: 10.1111/cns.12411] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/25/2015] [Accepted: 04/30/2015] [Indexed: 01/05/2023] Open
Abstract
AIMS Among patients with neuromyelitis optica spectrum disorder (NMOSD), fatigue is commonly complained about and is one of the most debilitating symptoms. This study aimed to investigate the incidence of fatigue and explore impacting factors attributed to fatigue in NMOSD. METHODS Thirty-three patients with NMOSD and twenty matched healthy controls were enrolled. A battery of self-reported questionnaires was conducted to assess quality of sleep, daytime sleepiness, fatigue, depression, and level of activity of daily life. The structure of sleep was assessed by polysomnography with blood oxygen saturation monitored by noninvasive pulse oximeter. Brain and spinal cord lesions were evaluated by MRIs. RESULTS Fatigue was more severe and more prevalent among the patients with NMOSD compared with controls (fatigue score which ranges from 0 to 11 with higher scores indicating more severe fatigue: 6.4 ± 0.6 vs. 3.8 ± 0.4, P = 0.002; incidence, 64% vs. 35%, P = 0.043), and it was negatively associated with daily activity level (r = 0.455, P = 0.008). The patients with fatigue had higher Pittsburgh Sleep Quality Index score, higher Epworth Sleepiness Scale score, lower blood oxygen state, and higher depression score than patients without fatigue; blood oxygen was especially negatively correlated with fatigue (nadir SpO2 , r = -0.558, P = 0.001; mean SpO2 , r = -0.457, P = 0.007); depression was also positively correlated with fatigue (r = 0.599, P < 0.001). CONCLUSION Patients with NMOSD experienced significant fatigue, which had an obvious impact on their daily activity. Fatigue in these patients was related to hypoxemia, sleep disturbances, and depression.
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Affiliation(s)
- Jing Pan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Zhao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao Cai
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Su
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Kristofer Wood
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ying Fu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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87
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Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, Wahls TL. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis 2015; 5:19-35. [PMID: 30728736 PMCID: PMC6361513 DOI: 10.2147/dnnd.s76523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fatigue is a disabling symptom of multiple sclerosis (MS) and reduces quality of life. The aim of this study was to investigate the effects of a multimodal intervention, including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, and stress management on perceived fatigue and quality of life of persons with progressive MS. Methods Twenty subjects with progressive MS and average Expanded Disability Status Scale (EDSS) score of 6.2 (range: 3.5–8.0) participated in the 12-month phase of the study. Assessments were completed at baseline and at 3 months, 6 months, 9 months, and 12 months. Safety analyses were based on monthly side effects questionnaires and blood analyses at 1 month, 3 months, 6 months, 9 months, and 12 months. Results Subjects showed good adherence (assessed from subjects’ daily logs) with this intervention and did not report any serious side effects. Fatigue Severity Scale (FSS) and Performance Scales-fatigue subscale scores decreased in 12 months (P<0.0005). Average FSS scores of eleven subjects showed clinically significant reduction (more than two points, high response) at 3 months, and this improvement was sustained until 12 months. Remaining subjects (n=9, low responders) either showed inconsistent or less than one point decrease in average FSS scores in the 12 months. Energy and general health scores of RAND 36-item Health Survey (Short Form-36) increased during the study (P<0.05). Decrease in FSS scores during the 12 months was associated with shorter disease duration (r=0.511, P=0.011), and lower baseline Patient Determined Disease Steps score (rs=0.563, P=0.005) and EDSS scores (rs=0.501, P=0.012). Compared to low responders, high responders had lower level of physical disability (P<0.05) and lower intake of gluten, dairy products, and eggs (P=0.036) at baseline. High responders undertook longer duration of massage and stretches per muscle (P<0.05) in 12 months. Conclusion A multimodal intervention may reduce fatigue and improve quality of life of subjects with progressive MS. Larger randomized controlled trials with blinded raters are needed to prove efficacy of this intervention on MS-related fatigue.
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Affiliation(s)
- Babita Bisht
- Department of Internal Medicine, Carver College of Medicine, University of Iowa
| | - Warren G Darling
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa
| | | | - Susan K Lutgendorf
- Department of Psychology, College of Liberal Arts and Sciences, University of Iowa.,Department of Urology, Carver College of Medicine, University of Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa
| | - Catherine A Chenard
- Department of Internal Medicine, Carver College of Medicine, University of Iowa
| | - Terry L Wahls
- Department of Internal Medicine, Carver College of Medicine, University of Iowa.,Department of Internal Medicine, VA Medical Center, Iowa City, IA, USA
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