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Zhou X, Cao S, Hou J, Gui T, Zhu F, Xue Q. Association between myasthenia gravis and cognitive disorders: a PRISMA-compliant meta-analysis. Int J Neurosci 2023; 133:987-998. [PMID: 35285401 DOI: 10.1080/00207454.2022.2031183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/28/2021] [Accepted: 01/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This meta-analysis assessed the association between myasthenia gravis (MG) and cognitive disorders. METHODS The PubMed, Web of Science, OVID, EMBASE, CNKI and Wanfang electronic databases were comprehensively searched from inception to October 2020 for relevant studies. The primary outcomes were scores of the cognitive function battery. A random effects model was used to evaluate the cognitive function of patients with MG. RESULTS Eight cross-sectional studies containing 381 patients and 220 healthy controls were included in this meta-analysis. In relation to global cognitive function, patients with MG performed significantly worse than healthy individuals (SMD = -0.4, 95% CI = -0.63 to -0.16, p < 0.001, I2 = 10%). Specifically, the impaired cognitive domains included language, visuospatial function, information processing, verbal immediate and delayed recall memory, visual immediate recall memory, and response fluency, while attention, executive function, and visual delayed recall memory were unimpaired. The patients with early-onset (SMD= -0.527, 95% CI = -0.855 to -0.199, p = 0.002) and generalized MG (SMD= -0.577, 95% CI = -1.047 to -0.107, p = 0.016) had poorer global cognitive performance than the healthy population. CONCLUSIONS Patients with MG may have cognitive disorders, including those associated with the domains of language, visuospatial function, information processing, verbal immediate and delayed recall memory, visual immediate recall memory and response fluency. Furthermore, the age of onset and disease severity may be associated with cognitive disorders in patients with MG.
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Affiliation(s)
- Xiaoling Zhou
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shugang Cao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jinyi Hou
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Acupuncture and Moxibustion, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, China
| | - Tiantian Gui
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Zhu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Berrih-Aknin S, Palace J, Meisel A, Claeys KG, Muppidi S, Saccà F, Amini F, Larkin M, Quinn C, Beauchamp J, Philips G, De Ruyck F, Ramirez J, Paci S. Patient-reported impact of myasthenia gravis in the real world: findings from a digital observational survey-based study (MyRealWorld MG). BMJ Open 2023; 13:e068104. [PMID: 37169499 DOI: 10.1136/bmjopen-2022-068104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES This study aims to explore the impact of myasthenia gravis (MG) - in terms of treatments, side effects, comorbidities, psychological health and work or study- in the real world from a patient perspective. DESIGN AND PARTICIPANTS This is a prospective, observational, digital, longitudinal study. Adults diagnosed with MG residing in the USA, Japan, Germany, the UK, Italy, Spain or Canada were eligible to participate in the study. There were no other exclusion criteria. Participants used a bespoke smartphone application to confirm eligibility, provide consent and enter data about their MG into a profile, a tracker to record MG-related events and a series of patient-reported outcome instruments. 1693 participants completed at least 1 survey and were included in this analysis. RESULTS Results are presented as a percentage of respondents to each survey question. The study population was largely female (69% of 1586 respondents), with an average age of 49.9 years (SD 14.8). In the previous 12 months, 83.7% of 1412 respondents confirmed that they had received one or more routine treatments for MG, and 67.1% of 255 respondents confirmed that they had experienced a side effect in the previous month. Commonly experienced comorbidities reported by 966 respondents were thyroid problems, hypertension and anxiety, experienced by 37.5%, 31.4% and 28.0% of respondents, respectively.According to 889 respondents to the Hospital Anxiety and Depression Scale survey, 52.7% and 43.2% had a score indicative of at least mild anxiety and mild depression, respectively. Of 257 respondents, 33.0% reported experiencing a work or study impact in the past month. CONCLUSIONS This analysis of baseline characteristics of the MyRealWorld MG study population indicates that, despite current treatments, patients experience notable burden. Further scheduled analyses will develop a longitudinal picture of MG burden. TRIAL REGISTRATION NUMBER NCT04176211.
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Affiliation(s)
- Sonia Berrih-Aknin
- INSERM, Institute of Myology, Center of Research in Myology, Sorbonne Université, Paris, France
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Andreas Meisel
- Department of Neurology, Neuroscience Clinical Research Center, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Kristl G Claeys
- Department of Neurology, KU Leuven University Hospitals, Leuven, Belgium
- Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Srikanth Muppidi
- Department of Neurology and Neurosciences, Stanford University, Stanford, California, USA
| | - Francesco Saccà
- Department of DNSRO, University of Naples Federico II, Napoli, Italy
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Brates D, Harel D, Molfenter SM. Perception of Swallowing-Related Fatigue Among Older Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2801-2814. [PMID: 35921661 DOI: 10.1044/2022_jslhr-22-00151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Although fatigue is recognized as clinically relevant to swallowing performance, its prevalence and significance in dysphagic and nondysphagic adults have not been sufficiently examined. In this study, an online survey was used to examine swallowing- and eating-related fatigue (SERF) symptoms, the relationship between perceived SERF and other dysphagia-related health outcomes, and whether perceived SERF predicts risk for dysphagia or malnutrition. METHOD An online survey of older adults (aged 60 years or older) was conducted. A novel 12-item scale was developed to capture perceived SERF. Previously validated scales were used to measure dysphagia risk, sarcopenia, general fatigue, malnutrition risk, and quality of life. Logistic regression was used to examine whether SERF predicted risk for dysphagia and/or malnutrition. RESULTS Complete responses were collected from 417 community-dwelling adults (M age = 70.6 years, SD = 4.9; 263 women); 75% (n = 312) reported at least some degree of SERF. SERF was significantly correlated with dysphagia risk, sarcopenia, general fatigue, malnutrition risk, and quality of life. SERF was a significant predictor of dysphagia risk while controlling for age, gender, and other health outcomes (odds ratio [OR] = 1.2, 95% confidence interval [CI; 1.16, 1.27], p < .001). For every unit increase in SERF score, the odds of being at risk for dysphagia were associated with an increase of 22%. Significant predictors for malnutrition risk included SERF (OR = 0.94, 95% CI [0.91, 0.98]), general fatigue (OR = 0.95, 95% CI [0.92, 0.99]), and quality of life (OR = 1.04, 95% CI [1.0, 1.1]). CONCLUSIONS Fatigue during swallowing and mealtimes is experienced by community-dwelling older adults and predicted dysphagia risk and malnutrition risk. Further research is needed to refine and validate a patient-reported outcome measure for SERF and examine the effects of fatigue on swallowing function and physiology under imaging. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20405835.
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Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, New York University, NY
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ELSAIS A, KERTY E, RUSSELL K, TOSKA K. Does Cardiovascular Autonomic Dysfunction Contribute to Fatigue in Myasthenia Gravis? Physiol Res 2022; 71:79-91. [DOI: 10.33549/physiolres.934660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease characterized by fatigable muscle weakness. Despite full spontaneous or pharmacological remission some MG patients still complain of physical and mental fatigue. Fatigue has been related to autonomic dysregulation. The aim of this study was to assess autonomic responses in a group of MG patients in complete remission but complaining of persistent fatigue. Seventeen well-regulated but persistently fatigued MG patients and 17 individually matched controls underwent echocardiography assessing systolic and diastolic heart function. Beat to beat cardiovascular responses at rest and to 30o head-up tilt, tilt-back, and 2-min static handgrip contraction were recorded. Fatigued MG patients had a statistically significant higher resting HR than their matched controls (p=0.03). The difference in resting heart rate between MG patients not using acetylcholine esterase inhibitors (AChEi) and their matched controls was even more pronounced (p=0.007). The autonomic cardiovascular adjustments to head-up tilt, tilt-back and handgrip contraction were not statistically significant different between patients and controls. We found a higher resting heart rate in all well-regulated but fatigued MG patients compared with controls. The difference was more pronounced between patients not taking AChEi compared to their matched controls. This finding may reflect a disturbed resting sympathovagal balance and this might be a contributing factor to the fatigue symptoms.
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Affiliation(s)
- A ELSAIS
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - E KERTY
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - K RUSSELL
- Department of Cardiology, Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - K TOSKA
- Faculty of Medicine, Section for Physiology, University of Oslo, Oslo, Norway,
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Causes of symptom dissatisfaction in patients with generalized myasthenia gravis. J Neurol 2021; 269:3086-3093. [PMID: 34806129 DOI: 10.1007/s00415-021-10902-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient-centered assessments have attracted increasing attention in the last decade in clinics and research. The purpose of this study was to examine the association between patients' satisfaction with symptoms and several disease-specific and generic outcome measures in 100 patients with generalized myasthenia gravis (gMG). METHODS In this cross-sectional study, patients with gMG followed at the Copenhagen Neuromuscular Center from October 2019 to June 2020 participated in one test. The patients completed commonly used MG-specific outcome measures and generic questionnaires for depression (Major Depression Inventory), comorbidities (Charlson Comorbidity Index), fatigue (Multidimensional Fatigue Inventory), overall health state (EQ-5D-3L), and satisfaction with MG treatment. The analyses were anchored in the Patient Acceptable Symptom State (PASS). RESULTS N = 190 patients were screened for the study, and 100 patients were included. One-third of the patients reported dissatisfaction (negative PASS status) with the current symptom state. Increasing MG symptoms, fatigue, depression, low MG-related quality of life, and shorter disease duration were associated with negative PASS status. Age, sex, BMI, MG treatment, and comorbidity did not influence PASS status. CONCLUSIONS This study shows that dissatisfaction with the current symptom level is high in patients with gMG and that dissatisfaction is associated with disease severity, disease length, depression, fatigue, and lower MG-related quality of life. The results emphasize the importance of a patient-centered approach to MG treatment to optimize patient satisfaction. The PASS question was useful in this study to investigate the causes of symptom dissatisfaction in gMG.
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Ruiter AM, Verschuuren JJGM, Tannemaat MR. Prevalence and associated factors of fatigue in autoimmune myasthenia gravis. Neuromuscul Disord 2021; 31:612-621. [PMID: 34034925 DOI: 10.1016/j.nmd.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Fatigue is usually defined as a subjective perception of lacking energy, mentally or physically, with a difficulty sustaining voluntary activities. It is a common symptom of many diseases and most likely has a multifactorial cause. In myasthenia gravis (MG), fatigue has a high prevalence and is correlated with female sex and disease severity. However, no large scale studies have been performed. Therefore, we aimed to evaluate fatigue in the Dutch participants (n = 420) of the Dutch-Belgian Myasthenia Patient Registry using an online survey. Additional information was obtained on mood, sleep, coping, quality of life, disease severity, physical activities and medication. Severe fatigue was present in 62% with a mean score of 37.1 ± 13.2 points. Fatigue severity and prevalence increased significantly with disease severity. A positive correlation was found for female gender, BMI, disease severity and depressive symptoms. A negative correlation was found for strenuous physical activities and older age. The strong association with disease severity suggests that fatigue should be recognized as an element of the symptomatology of MG. The observed association between strenuous activity and fatigue and differences in coping style between fatigued and non-fatigued patients warrant future clinical trials on exercise and cognitive behavioral therapy.
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Affiliation(s)
- Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, the Netherlands.
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Fatigue, self-efficacy and psychiatric symptoms influence the quality of life in patients with myasthenia gravis in Tianjin, China. J Clin Neurosci 2020; 79:84-89. [DOI: 10.1016/j.jocn.2020.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
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Ruiter AM, Verschuuren JJ, Tannemaat MR. Fatigue in patients with myasthenia gravis. A systematic review of the literature. Neuromuscul Disord 2020; 30:631-639. [DOI: 10.1016/j.nmd.2020.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
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Quality of Life of Myasthenia Gravis Patients in Regard to Epidemiological and Clinical Characteristics of the Disease. Neurologist 2019; 24:115-120. [DOI: 10.1097/nrl.0000000000000238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Boscoe AN, Xin H, L'Italien GJ, Harris LA, Cutter GR. Impact of Refractory Myasthenia Gravis on Health-Related Quality of Life. J Clin Neuromuscul Dis 2019; 20:173-181. [PMID: 31135620 PMCID: PMC6571178 DOI: 10.1097/cnd.0000000000000257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Myasthenia gravis (MG) may be refractory to traditional therapies. Quality of life (QOL) and disease burden in patients with refractory and nonrefractory MG were compared using Myasthenia Gravis Foundation of America MG Patient Registry data. METHODS Adults aged 18 years or older with MG diagnosed ≥2 years before enrollment were included. Participants with refractory MG had received ≥2 previous and 1 current MG treatment and had MG Activities of Daily Living Scale total score ≥6 at enrollment; other participants had nonrefractory MG. MG QOL 15-item scale (MG-QOL15) scores were compared. RESULTS In total, 56 participants with refractory and 717 participants with nonrefractory MG enrolled. Participants with refractory MG had significantly higher mean (SD) MG-QOL15 total scores [31.4 (11.1) vs. 20.8 (15.0), P < 0.0001] and were more likely to have had exacerbations, emergency department visits, and recent hospitalizations. CONCLUSIONS Participants with refractory MG experience worse QOL and greater clinical burden than those with nonrefractory disease.
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Affiliation(s)
- Audra N. Boscoe
- Alexion Pharmaceuticals, New Haven, CT. Dr. Boscoe is now with Agios Pharmaceuticals, Cambridge, MA. Dr. L'Italien is now with Biohaven Pharmaceuticals, New Haven, CT
| | - Haichang Xin
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL; and
| | - Gilbert J. L'Italien
- Alexion Pharmaceuticals, New Haven, CT. Dr. Boscoe is now with Agios Pharmaceuticals, Cambridge, MA. Dr. L'Italien is now with Biohaven Pharmaceuticals, New Haven, CT
| | - Linda A. Harris
- Alexion Pharmaceuticals, New Haven, CT. Dr. Boscoe is now with Agios Pharmaceuticals, Cambridge, MA. Dr. L'Italien is now with Biohaven Pharmaceuticals, New Haven, CT
| | - Gary R. Cutter
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Abstract
Purpose To evaluate the effect of eculizumab on perceived fatigue in patients with anti-acetylcholine receptor antibody-positive, refractory, generalized myasthenia gravis (MG) using the Quality of Life in Neurological Disorders (Neuro-QOL) Fatigue subscale, and to evaluate correlations between improvements in Neuro-QOL Fatigue and other clinical endpoints. Methods Neuro-QOL Fatigue, MG Activities of Daily Living (MG-ADL), Quantitative MG (QMG), and the 15-item MG Quality of Life (MG-QOL15) scales were administered during the phase 3, randomized, placebo-controlled REGAIN study (eculizumab, n = 62; placebo, n = 63) and subsequent open-label extension (OLE). Data were analyzed using repeated-measures models. Correlations between changes in Neuro-QOL Fatigue and in MG-ADL, QMG, and MG-QOL15 scores were determined at REGAIN week 26. Results At REGAIN week 26, eculizumab-treated patients showed significantly greater improvements in Neuro-QOL Fatigue scores than placebo-treated patients (consistent with improvements in MG-ADL, QMG, and MG-QOL15 scores previously reported in REGAIN). Improvements with eculizumab were sustained through OLE week 52. Correlations between Neuro-QOL Fatigue and MG-QOL15, MG-ADL, and QMG scores were strong for eculizumab-treated patients at REGAIN week 26, and strong, moderate, and weak, respectively, for placebo-treated patients. Conclusions Compared with placebo, eculizumab was associated with improvements in perceived fatigue that strongly correlated with improvements in MG-specific outcome measures. Trial ID Registration: NCT01997229, NCT02301624. Electronic supplementary material The online version of this article (10.1007/s11136-019-02148-2) contains supplementary material, which is available to authorized users.
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Xin H, Harris LA, Aban IB, Cutter G. Examining the Impact of Refractory Myasthenia Gravis on Healthcare Resource Utilization in the United States: Analysis of a Myasthenia Gravis Foundation of America Patient Registry Sample. J Clin Neurol 2019; 15:376-385. [PMID: 31286711 PMCID: PMC6620464 DOI: 10.3988/jcn.2019.15.3.376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization. Methods The 825 included participants were aged 18–64 years, enrolled in the Myasthenia Gravis Foundation of America Patient Registry between July 2013 and February 2018, and had been diagnosed with MG ≥2 years previously. Results Participants comprised 76 (9.2%) with refractory MG and 749 (90.8%) with nonrefractory MG. During the 6 months before enrollment, participants with refractory MG were significantly more likely than those with nonrefractory MG to have experienced at least one exacerbation [67.1% vs. 52.0%, respectively, p=0.01; odds ratio (OR)=1.882, 95% confidence interval (CI)=1.141–3.104], visited an emergency room at least once [43.4% vs. 27.1%, p<0.01; OR=2.065, 95% CI=1.276–3.343], been hospitalized overnight at least once (32.9% vs. 20.5%, p=0.01; OR=1.900, 95% CI=1.140–3.165), ever been admitted to an intensive care unit (ICU) (61.8% vs. 33.4%, p<0.01; OR=3.233, 95% CI=1.985–5.266), or ever required a feeding tube (21.1% vs. 9.1%, p<0.01; OR=2.671, 95% CI=1.457–4.896). A total of 75.8% younger females with refractory disease (<51 years, n=33) experienced at least one exacerbation, 69.7% had been admitted to an ICU, and 30.3% had required a feeding tube. For older females with refractory disease (≥51 years, n=33), 60.6%, 54.6%, and 6.1% experienced these outcomes, respectively (between-group differences were not significant). Conclusions Refractory MG is associated with higher disease burden and healthcare utilization than nonrefractory MG.
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Affiliation(s)
- Haichang Xin
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Inmaculada B Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Fatigue in patients with myasthenia gravis. J Neurol 2018; 265:2312-2321. [DOI: 10.1007/s00415-018-8995-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
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Burns TM. Estimating and managing fatigue for our patients: Are we measuring up? Muscle Nerve 2018. [DOI: 10.1002/mus.26125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ted M. Burns
- University of Virginia, Department of NeurologyCharlottesville Virginia USA
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Tascilar NF, Saracli O, Kurcer MA, Ankarali H, Emre U. Is there any relationship between quality of life and polysomnographically detected sleep parameters/disorders in stable myasthenia gravis? Acta Neurol Belg 2018; 118:29-37. [PMID: 28456888 DOI: 10.1007/s13760-017-0787-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
It is known that quality of life in myasthenia gravis is positively correlated with subjective sleep quality, still no data is available regarding the relationship between QOL and polysomnographically detected sleep parameters and disorders. In this study, we tried to highlighten this relationship, by performing polysomnography. Sleep-related complaints were evaluated in face-to-face interviews with 19 clinically stable MG patients and 26 healthy controls. During the interviews questionnaires assessing sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, and Turkish version of the MG-QOL 15-item scale [(MG-QOL15(T)] were administered and then an overnight polysomnography was performed. Sleep disorders, especially obstructive sleep apnea and fatigue were higher, whereas subjective sleep duration was significantly lower, in patients than controls. Excessive daytime sleepiness and poor sleep quality were not different between patients and controls. Other than percentage of sleep stage III, which was negatively correlated with MG-QOL15(T) scores, neither other sleep parameters nor sleep disorders were correlated with MG-QOL15(T) scores. MG composite, subjective sleep duration, fatigue severity and Hamilton depression rating scale scores were found to be positively correlated with MG-QOL15(T) scores. It was shown that decreasing disease severity and enhancing psychological well-being will improve patients' quality of life. We recommend that our findings should be repeated in a large prospective cohort of MG patients.
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Tran C, Bril V, Katzberg HD, Barnett C. Fatigue is a relevant outcome in patients with myasthenia gravis. Muscle Nerve 2018; 58:197-203. [PMID: 29342314 DOI: 10.1002/mus.26069] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patients with myasthenia gravis often experience fatigue, but its effect on quality of life (QoL) is underestimated, and fatigue is rarely measured in clinical trials. METHODS Two hundred fifty-seven myasthenic patients completed the Neuro-QoL-Fatigue and measures of disease severity and QoL. We studied the relationship between fatigue and clinical and demographic variables. Finally, we studied the responsiveness of the Neuro-QoL-Fatigue in 95 patients receiving treatments for myasthenia and estimated the minimal important difference (MID). RESULTS Fatigue correlated with greater disease severity (r = 0.52-0.69, P < 0.0001) and worse QoL (r = 0.65-0.75, P < 0.0001). Patients in remission, with minimal manifestations, and pure ocular symptoms reported minimal fatigue. Regression modeling showed that, in addition to its relationship with disease severity, fatigue was worse in females, patients with generalized disease, and those with anxiety/depression. Fatigue improved after immunomodulation (P < 0.0001), and the MID was 5.3 points. DISCUSSION Fatigue in myasthenia correlates with disease severity, affects QoL, and can improve after treatment. Muscle Nerve 58: 197-203, 2018.
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Affiliation(s)
- Christopher Tran
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University Health Network and University of Toronto, 200 Elizabeth Street, 5EC Room 344, Toronto, Ontario, M5G 2C4, Canada
| | - Hans D Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University Health Network and University of Toronto, 200 Elizabeth Street, 5EC Room 344, Toronto, Ontario, M5G 2C4, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University Health Network and University of Toronto, 200 Elizabeth Street, 5EC Room 344, Toronto, Ontario, M5G 2C4, Canada
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Abstract
The field of psychoneuroimmunology (PNI) aims to uncover the processes and consequences of nervous, immune, and endocrine system relationships. Behavior is a consequence of such interactions and manifests from a complex interweave of factors including immune-to-neural and neural-to-immune communication. Often the signaling molecules involved during a particular episode of neuroimmune activation are not known but behavioral response provides evidence that bioactives such as neurotransmitters and cytokines are perturbed. Immunobehavioral phenotyping is a first-line approach when examining the neuroimmune system and its reaction to immune stimulation or suppression. Behavioral response is significantly more sensitive than direct measurement of a single specific bioactive and can quickly and efficiently rule in or out relevance of a particular immune challenge or therapeutic to neuroimmunity. Classically, immunobehavioral research was focused on sickness symptoms related to bacterial infection but neuroimmune activation is now a recognized complication of diseases and disorders ranging from cancer to diabesity to Alzheimer's. Immunobehaviors include lethargy, loss of appetite, and disinterest in social activity/surrounding environment. In addition, neuroimmune activation can diminish physical activity, precipitate feelings of depression and anxiety, and impair cognitive and executive function. Provided is a detailed overview of behavioral tests frequently used to examine neuroimmune activation in mice with a special emphasis on pre-experimental conditions that can confound or prevent successful immunobehavioral experimentation.
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Jordan B, Schweden TLK, Mehl T, Menge U, Zierz S. Cognitive fatigue in patients with myasthenia gravis. Muscle Nerve 2017; 56:449-457. [PMID: 28033668 DOI: 10.1002/mus.25540] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/21/2016] [Accepted: 12/24/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cognitive fatigue has frequently been reported in myasthenia gravis (MG). However, objective assessment of cognitive fatigability has never been evaluated. METHODS Thirty-three MG patients with stable generalized disease and 17 healthy controls underwent a test battery including repeated testing of attention and concentration (d2-R) and Paced Auditory Serial Addition Test. Fatigability was based on calculation of linear trend (LT) reflecting dynamic performance within subsequent constant time intervals. Additionally, fatigue questionnaires were used. RESULTS MG patients showed a negative LT in second d2-R testing, indicating cognitive fatigability. This finding significantly differed from stable cognitive performance in controls (P < 0.05). Results of Paced Auditory Serial Addition Test testing did not differ between groups. Self-assessed fatigue was significantly higher in MG patients compared with controls (P < 0.001), but did not correlate with LT. CONCLUSIONS LT quantifies cognitive fatigability as an objective measurement of performance decline in MG patients. Self-assessed cognitive fatigue is not correlated with objective findings. Muscle Nerve 56: 449-457, 2017.
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Affiliation(s)
- Berit Jordan
- Department of Neurology, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
| | - Tabea L K Schweden
- Institute of Psychology, Martin-Luther-University Halle, Halle/Saale, Germany
| | - Theresa Mehl
- Department of Neurology, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
| | - Uwe Menge
- Institute of Psychology, Martin-Luther-University Halle, Halle/Saale, Germany
| | - Stephan Zierz
- Department of Neurology, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
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Jordan B, Mehl T, Schweden TL, Menge U, Zierz S. Assessment of physical fatigability and fatigue perception in myasthenia gravis. Muscle Nerve 2017; 55:657-663. [DOI: 10.1002/mus.25386] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Berit Jordan
- Department of Neurology; Martin Luther University Halle; Ernst-Grube-Strasse 40 06120 Halle Germany
| | - Theresa Mehl
- Department of Neurology; Martin Luther University Halle; Ernst-Grube-Strasse 40 06120 Halle Germany
| | - Tabea L.K. Schweden
- Institute of Psychology, Martin Luther University Halle; Halle/Saale Germany
| | - Uwe Menge
- Institute of Psychology, Martin Luther University Halle; Halle/Saale Germany
| | - Stephan Zierz
- Department of Neurology; Martin Luther University Halle; Ernst-Grube-Strasse 40 06120 Halle Germany
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Hoffmann S, Ramm J, Grittner U, Kohler S, Siedler J, Meisel A. Fatigue in myasthenia gravis: risk factors and impact on quality of life. Brain Behav 2016; 6:e00538. [PMID: 27781147 PMCID: PMC5064345 DOI: 10.1002/brb3.538] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 06/08/2016] [Accepted: 06/27/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Emerging evidence suggests that fatigue in myasthenia gravis (MG) is a relevant problem that negatively impacts activities of daily living (ADL). The relationship between fatigue and quality of life (QoL) has never been systematically explored in MG patients. The study aimed to assess the prevalence of fatigue and its relation to ADL and QoL as well as to identify factors associated with fatigue in MG. MATERIAL AND METHODS This was a cross-sectional observational study in patients with confirmed diagnosis of MG independent of disease severity. Prevalence of fatigue was assessed using the Chalder Fatigue Scale (CFQ). Impact of fatigue on ADL and QoL was assessed by the MG activities of daily living profile (MG-ADL) and the MG-specific quality-of-life instrument (MG-QoL), respectively. Association of fatigue with sociodemographics, clinical characteristics of MG, and comorbidities including mood and anxiety disorders as well as sleep disorders was investigated using multivariable logistic regression analyses. RESULTS Overall, 200 MG patients were included. The observed rate of fatigue was 56.1%, of those 70.4% fulfilled the criteria of chronic fatigue (CF) with a duration of ≥6 months. Relevant fatigue was strongly associated to ADL and QoL. Factors associated with relevant fatigue were disease severity and depressive state. Furthermore, positive muscle-specific tyrosine kinase (MuSK) antibody status showed a strong association with relevant fatigue. CONCLUSIONS MG patients have a high prevalence of fatigue which negatively impacts ADL and QoL. MG-specific clinical characteristics are related to fatigue and might help to identify MG patients at risk for fatigue.
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Affiliation(s)
- Sarah Hoffmann
- NeuroCure Clinical Research Center Charité - Universitätsmedizin Berlin Berlin Germany; Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
| | - Johanna Ramm
- NeuroCure Clinical Research Center Charité - Universitätsmedizin Berlin Berlin Germany
| | - Ulrike Grittner
- Center for Stroke Research (CSB)Charité - Universitätsmedizin Berlin Berlin Germany; Department for Biostatistics and Clinical Epidemiology Charité - Universitätsmedizin Berlin Berlin Germany
| | - Siegfried Kohler
- NeuroCure Clinical Research Center Charité - Universitätsmedizin Berlin Berlin Germany; Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
| | - Jana Siedler
- NeuroCure Clinical Research Center Charité - Universitätsmedizin Berlin Berlin Germany
| | - Andreas Meisel
- NeuroCure Clinical Research Center Charité - Universitätsmedizin Berlin Berlin Germany; Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
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Major motor-functional determinants associated with poor self-reported health-related quality of life in myasthenia gravis patients. Neurol Sci 2016; 37:717-23. [PMID: 27038315 DOI: 10.1007/s10072-016-2556-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/14/2016] [Indexed: 12/26/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder in which disabling muscle weakness may affect health-related quality of life (HRQoL). The aim of this study was to investigate which common motor-functional deficits and corresponding severity are most determinant of poor HRQoL in these patients. In 41 patients, the dichotomized first item of the Italian Myasthenia Gravis Questionnaire (IMGQ), categorizing patients who report "good" and "poor" HRQoL, was chosen as dependent-outcome variable. All items composing the myasthenia gravis-specific scale (MG-ADL), i.e. talking, chewing, swallowing, breathing, impairment of ability to brush teeth or comb hair, impairment of ability to rise from chair, double vision, and eyelid droop were acquired as independent variables and dichotomized. Stepwise backward LR multivariable logistic regression analysis was performed. In addition, the main characteristics of patients were compared. MG-ADL items "chewing" ≥1, i.e. "fatigue chewing solid food", and "breathing" ≥2, i.e. "shortness of breath at rest" proved to be significant determinants. Higher dose of corticosteroid therapy was significantly (p = 0.027; r s = -0.35), correlated with poor HRQoL. At diagnosis, a decremental response to repetitive nerve stimulation (RNS) from the abductor pollicis brevis was significantly more frequent in patients with poor HRQoL. In conclusion, impaired "chewing" and "breathing" functions indicate the need for careful planning of rehabilitation, re-education and patient management. Moreover, decremental response to RNS at diagnosis may identify patients at risk for poor HRQoL.
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Accommodation of workers with chronic neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:505-16. [PMID: 26563806 DOI: 10.1016/b978-0-444-62627-1.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The ability to work is important to those with chronic neurologic disorders (CND) and to the aging workforce. Many signs and symptoms are similar in those with CND and normal aging, but may interfere with the ability to work if not appropriately accommodated. This requires the healthcare provider to recognize the specific features of the CND that interferes with work and how it can be accommodated. Review of the American with Disabilities Act and the subsequent amendment informs the healthcare provider as to what is covered under the law and how the disability can be accommodated. Overall employers want to retain qualified employees and therefore accommodating workers is beneficial to both the employee with CND and the employer.
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Wagle Shukla A, Brown R, Heese K, Jones J, Rodriguez RL, Malaty IM, Okun MS, Kluger BM. High rates of fatigue and sleep disturbances in dystonia. Int J Neurosci 2015; 126:928-35. [PMID: 26289935 DOI: 10.3109/00207454.2015.1085035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nonmotor symptoms in dystonia are increasingly recognized to impair the quality of life. The primary objective of this study was to determine the prevalence of fatigue and sleep disturbances in dystonia and to ascertain their impact on quality of life using standardized questionnaires. METHODS Dystonia patients presenting to a Botulinum toxin clinic were prospectively administered Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Epworth Sleepiness Scale (ESS) and Parkinson's Disease Sleep Scale (PDSS) for assessment of fatigue and sleep disturbances. Health-related Quality of life (HRQOL) was determined using MOS SF-36 scale and depressive symptoms were assessed using the Beck Depression Inventory II. RESULTS Ninety-one patients with dystonia participated (66 women, 25 men, mean age 60 ± 17 years). Nine subjects had generalized dystonia, 18 segmental dystonia and 64 had focal dystonia. Moderate to severe fatigue was present in 43% of the cohort (FSS), excessive daytime somnolence in 27% (ESS) and other sleep disturbances in 26% (PDSS). FSS and MFI scores correlated significantly with HRQOL even when controlled for depression and sleep disturbances. Excessive daytime somnolence and nocturnal sleep disturbances correlated significantly with the HRQOL; however, these effects were not seen for daytime somnolence when controlled for depression. Psychometric testing found adequate reliabilities and convergent validities for both fatigue and sleep scales. CONCLUSION Fatigue and sleep disturbances revealed high prevalence rates in this large, first of its dystonia study. They negatively impacted the quality of life even when controlled for comorbid depression.
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Affiliation(s)
- A Wagle Shukla
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - R Brown
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
| | - K Heese
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
| | - J Jones
- c 3 Department of Clinical Health Psychology , University of Florida , Gainesville , FL , USA
| | - R L Rodriguez
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - I M Malaty
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - M S Okun
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - B M Kluger
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
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Vinge L, Jakobsen J, Pedersen AR, Andersen H. Diurnal and day-to-day variation of isometric muscle strength in myasthenia gravis. Muscle Nerve 2015; 53:67-72. [PMID: 25914163 DOI: 10.1002/mus.24696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION In patients with myasthenia gravis (MG), muscle strength is expected to decrease gradually during the day due to physical activities. METHODS Isometric muscle strength at the shoulder, knee, and ankle was determined in 10 MG patients (MGFA class II-IV) who were receiving usual medical treatment and in 10 control subjects. To determine diurnal and day-to-day variation, muscle strength was measured 4 times during day 1 and once at day 2. RESULTS Knee extension strength decreased during the day in both patients and controls. Neither diurnal nor day-to-day variation of muscle strength was higher in patients compared with controls. CONCLUSIONS Patients with mild to moderate MG did not have increased variation of isometric muscle strength during the day or from day-to-day compared with controls. This suggests that isometric muscle performance can be determined with high reproducibility in similar groups of MG patients without regard to time of day.
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Affiliation(s)
- Lotte Vinge
- Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, Building 10, 8000 Aarhus C, Denmark
| | | | - Asger Roer Pedersen
- Research Unit, Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, Building 10, 8000 Aarhus C, Denmark
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A web-based cognitive behaviour therapy for chronic fatigue in type 1 diabetes (Dia-Fit): study protocol for a randomised controlled trial. Trials 2015; 16:262. [PMID: 26044447 PMCID: PMC4461902 DOI: 10.1186/s13063-015-0764-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background Fatigue is frequently reported by patients with type 1 diabetes mellitus. A recent study showed that 40 % of patients experienced severe fatigue that lasted for more than six months and was accompanied by substantial impairments in daily functioning. Currently, there is no effective treatment available for chronic fatigue in patients with type 1 diabetes. Cognitive behaviour therapy aimed at cognitions and behaviours that perpetuate fatigue is effective in reducing fatigue in other chronic diseases. Recent research showed that these cognitions and behaviours are also potential determinants of fatigue in type 1 diabetes. We designed Dia-Fit, a web-based cognitive behaviour therapy for severe and chronic fatigue in patients with type 1 diabetes. This patient-tailored intervention is aimed at reducing fatigue by changing cognitions and behaviours assumed to maintain fatigue. The efficacy of Dia-Fit will be investigated in this study. Methods/design A randomised controlled trial will be conducted in 120 patients with type 1 diabetes who are chronically and severely fatigued. Patients will be randomised to a treatment or waiting list group. The treatment group will receive Dia-Fit, a blended care therapy consisting of up to eight internet modules and face-to-face sessions with a therapist during a five-month period. The treatment will be tailored to the fatigue-maintaining cognitions and behaviours that are relevant for the patient and are determined at baseline. The waiting list group will receive Dia-Fit after a waiting period of five months. The primary outcome measure is fatigue severity. Secondary outcome measures are functional impairment and glucose control determined by haemoglobin A1c and blood glucose variability. Discussion To our knowledge, this is the first study investigating the efficacy of a cognitive behavioural intervention for chronic fatigue in patients with type 1 diabetes. Trial registration Dutch trial register NTR4312 (10 December 2013).
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Frayne E, Coulson S, Adams R, Croxson GR. Self-regulatory fatigue after neurological and musculoskeletal injury: implications for physiotherapy management. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x14y.0000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Jones SM, Gwathmey KG, Burns TM. Quality of life measures for myasthenia gravis and evaluation of non-motor symptoms. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah M. Jones
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Kelly G. Gwathmey
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Ted M. Burns
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
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Wong SH, Nitz JC, Williams K, Brauer SG. Effects of balance strategy training in myasthenia gravis: a case study series. Muscle Nerve 2013; 49:654-60. [PMID: 23966018 DOI: 10.1002/mus.24054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Studies of exercise in patients with myasthenia gravis (MG) are sparse. Balance strategy training (BST) multimodal exercise has proven efficacy in adults for enhancing balance and functional mobility. This prospective study aims to determine if BST improves functional ability and balance in people with MG. METHODS Seven individuals with MG participated in a 16-session workstation intervention. Repeated measures (pre/post-intervention and 4-week follow-up) consisting of quantitative myasthenia gravis score (QMG), 6-minute walk test (6MWT), timed up and go (TUG) with dual task (TUG(manual) and TUG(cognitive)), and standing stability on foam with eyes closed (foamEC) were assessed. RESULTS Most measurements showed sustained improvement at follow-up. QMG, TUG(cognitive), and foam EC achieved clinically significant improvements (>15%). No adverse effects were reported. CONCLUSIONS BST was effective in improving balance and QMG scores in subjects with MG. A multimodal BST approach is thus suggested to target different aspects of balance and functional mobility.
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Affiliation(s)
- Shi Hui Wong
- Division of Physiotherapy, School of Health & Rehabilitation Sciences, University of Queensland, St. Lucia, Brisbane, Queensland, 4072, Australia
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Elsais A, Wyller VB, Loge JH, Kerty E. Fatigue in myasthenia gravis: is it more than muscular weakness? BMC Neurol 2013; 13:132. [PMID: 24088269 PMCID: PMC3852076 DOI: 10.1186/1471-2377-13-132] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 09/25/2013] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have focused on fatigue in myasthenia gravis (MG), and fatigue in relation to the autonomic system has never been systematically explored in these patients. The study aimed to document the prevalence of MG-related fatigue in ethnic Norwegians and to examine whether MG severity is associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and functional disability. Methods Eighty two of the 97 who fulfilled the study inclusion criteria participated in the study. Controls were 410 age- and sex-matched subjects drawn from a normative sample (n = 2136) representative of the Norwegian population. Bivariate analyses and multivariate linear regression analyses were used to assess associations between questionnaire-reported MG severity, symptoms of autonomic disturbance, fatigue (mental and physical) and functional disability. Results Forty-four per cent (36/82) of patients fulfilled the criteria for fatigue compared with 22% (90/410) of controls (odds ratio 2.0; p = 0.003). Twenty-one per cent of patients (17/82) met the criteria for chronic fatigue versus 12% (48/410) of controls (odds ratio 1.96; p = 0.03). MG patients had higher total fatigue scores than controls (p < 0.001) and a high prevalence of autonomic symptoms, especially poor thermoregulation and sleep disturbance. According to multivariate analyses controlled for MG score, symptoms of autonomic disturbances were independently positively associated with fatigue (p < 0.001), and fatigue was independently negatively associated with functional level (p < 0.001). Conclusion Norwegian ethnic patients with MG have higher levels of fatigue and a higher prevalence of chronic fatigue than controls, even in patients in full remission. MG severity is highly suggestive to be associated with symptoms of autonomic disturbance, which in turn is associated with fatigue and the level of functional disability.
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Affiliation(s)
- Ahmed Elsais
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424 Oslo, Norway.
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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Jagersma E, Jeukens-Visser M, van Paassen BW, Meester-Delver A, Nollet F. Severe fatigue and reduced quality of life in children with hereditary motor and sensory neuropathy 1A. J Child Neurol 2013; 28:429-34. [PMID: 22752492 DOI: 10.1177/0883073812447681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe fatigue and low quality of life are reported by a majority of adult patients with hereditary motor and sensory neuropathy 1A. In children with hereditary motor and sensory neuropathy 1A, the prevalence and impact of fatigue have not been studied yet. In this questionnaire survey, 55 Dutch children (response rate 77%) with genetically confirmed hereditary motor and sensory neuropathy 1A participated (mean age 15 years [standard deviation 2.1]). Prevalence of severe fatigue (based on a cut-off score of the Checklist Individual Strength) was 24%, in contrast to 14% in a Dutch school-based population (P < .05). Almost all quality-of-life scores (measured with the Child Health Questionnaire-Child Form 87) were significantly worse than population norms (P < .05). Fatigue severity was associated significantly (P < .01) with all quality-of-life scores (-0.4 < r < -0.7). In conclusion, severe fatigue and diminished quality of life are more frequent among children with hereditary motor and sensory neuropathy 1A compared to healthy peers. The strong association between fatigue severity and quality of life suggests a negative impact of fatigue on quality of life in these children.
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Affiliation(s)
- Elbrich Jagersma
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 2013; 80:409-16. [PMID: 23339207 DOI: 10.1212/wnl.0b013e31827f07be] [Citation(s) in RCA: 631] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado Denver, Aurora, USA.
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Menotti F, Bazzucchi I, Felici F, Damiani A, Gori MC, Macaluso A. Neuromuscular function after muscle fatigue in Charcot-Marie-Tooth type 1A patients. Muscle Nerve 2012; 46:434-9. [DOI: 10.1002/mus.23366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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York JM, Blevins NA, Baynard T, Freund GG. Mouse testing methods in psychoneuroimmunology: an overview of how to measure sickness, depressive/anxietal, cognitive, and physical activity behaviors. Methods Mol Biol 2012; 934:243-276. [PMID: 22933150 DOI: 10.1007/978-1-62703-071-7_13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The field of psychoneuroimmunology (PNI) aims to uncover the processes and consequences of nervous, immune, and endocrine system relationships. Behavior is a consequence of such interactions and manifests from a complex interweave of factors including immune-to-neural and neural-to-immune communication. Often the signaling molecules involved during a particular episode of neuroimmune activation are not known but behavioral response provides evidence that bioactives such as neurotransmitters and cytokines are perturbed. Immunobehavioral phenotyping is a first-line approach when examining the neuroimmune system and its reaction to immune stimulation or suppression. Behavioral response is significantly more sensitive than direct measurement of a single specific bioactive and can quickly and efficiently rule in or out relevance of a particular immune challenge or therapeutic to neuroimmunity. Classically, immunobehavioral research was focused on sickness symptoms related to bacterial infection but neuroimmune activation is now a recognized complication of diseases and disorders ranging from cancer to diabesity. Immunobehaviors include lethargy, loss of appetite, and disinterest in social activity and the surrounding environment. In addition, neuroimmune activation can precipitate feelings of depression and anxiety while negatively impacting cognitive function and physical activity. Provided is a detailed overview of behavioral tests frequently used to examine neuroimmune activation in mice with a special emphasis on preexperimental conditions that can confound or prevent successful immunobehavioral experimentation.
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Affiliation(s)
- Jason M York
- Department of Animal Sciences, University of Illinois, Urbana, IL, USA
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Boentert M, Young P. Fatigue, exzessive Tagesschläfrigkeit und schlafbezogene Atmungsstörungen bei myotonen Dystrophien. SOMNOLOGIE 2011. [DOI: 10.1007/s11818-011-0509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Psychosocial aspects in myasthenic patients treated by plasmapheresis. J Neurol 2011; 258:1240-6. [DOI: 10.1007/s00415-011-5913-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 11/29/2022]
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de Vries JM, Hagemans MLC, Bussmann JBJ, van der Ploeg AT, van Doorn PA. Fatigue in neuromuscular disorders: focus on Guillain-Barré syndrome and Pompe disease. Cell Mol Life Sci 2010; 67:701-13. [PMID: 20196238 PMCID: PMC2824125 DOI: 10.1007/s00018-009-0184-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/12/2009] [Accepted: 10/13/2009] [Indexed: 12/03/2022]
Abstract
Fatigue accounts for an important part of the burden experienced by patients with neuromuscular disorders. Substantial high prevalence rates of fatigue are reported in a wide range of neuromuscular disorders, such as Guillain-Barré syndrome and Pompe disease. Fatigue can be subdivided into experienced fatigue and physiological fatigue. Physiological fatigue in turn can be of central or peripheral origin. Peripheral fatigue is an important contributor to fatigue in neuromuscular disorders, but in reaction to neuromuscular disease fatigue of central origin can be an important protective mechanism to restrict further damage. In most cases, severity of fatigue seems to be related with disease severity, possibly with the exception of fatigue occurring in a monophasic disorder like Guillain-Barré syndrome. Treatment of fatigue in neuromuscular disease starts with symptomatic treatment of the underlying disease. When symptoms of fatigue persist, non-pharmacological interventions, such as exercise and cognitive behavioral therapy, can be initiated.
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Affiliation(s)
- J M de Vries
- Department of Neurology, Erasmus MC, University Medical Centre, Room Number EE 22-30, Dr. Molenwaterplein 50-60, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
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Symonette CJ, Watson BV, Koopman WJ, Nicolle MW, Doherty TJ. Muscle strength and fatigue in patients with generalized myasthenia gravis. Muscle Nerve 2009; 41:362-9. [DOI: 10.1002/mus.21493] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Resqueti VR, Oliveira GWDS, Dourado Junior ME, Andrade ADD, Casan P, Fregonezi GADF. Confiabilidade do teste da caminhada de seis minutos em pacientes com miastenia gravis generalizada. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo objetivou determinar a confiabilidade do teste da caminhada de seis minutos (TC6M) como um teste de capacidade funcional em pacientes com miastenia gravis generalizada (MG). Foram selecionados 11 pacientes com MG - 5 homens, 6 mulheres - com idade de 55±9 anos, avaliados inicialmente quanto à função fulmonar, que se submeteram a três TC6M em dias diferentes. Durante e/ou após cada teste foram medidas freqüência cardíaca e saturação de oxigênio (por oxímetro portátil), sensação de dispnéia (pela escala de Borg) e distância percorrida. Nos três testes as distâncias percorridas foram 498 m, 517 m e 520 m (respectivamente 99%, 103% e 104% do valor predito). Em média, a freqüência cardíaca, dispnéia e saturação de oxigênio mostraram comportamento constante nos três testes. Foram encontradas alta confiabilidade relativa, com coeficiente de correlação interclasse maior que 0,90 entre os testes (TC6M1-TC6M2, 0,960; TC6M1-TC6M3, 0,945; e TC6M2-TC6M3, 0,970) e confiabilidade absoluta de 4%, 3,5% e 4,8%, com reprodutibilidade de 11%, 9,8% e 13,4%, respectivamente para o primeiro, segundo e terceiro testes. Os limites superiores e inferiores de concordância e o valor médio das médias das diferenças (bias) calculados pelo teste de Bland-Altman mostraram-se clinicamente aceitáveis. Conclui-se que o TC6M se mostrou seguro, confiável e reprodutível, podendo ser aplicado para avaliação e seguimento da tolerância ao exercício em pacientes com MG generalizada.
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Trip J, de Vries J, Drost G, Ginjaar HB, van Engelen BGM, Faber CG. Health status in non-dystrophic myotonias: close relation with pain and fatigue. J Neurol 2009; 256:939-47. [PMID: 19252786 PMCID: PMC2698970 DOI: 10.1007/s00415-009-5049-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 10/29/2008] [Accepted: 01/20/2009] [Indexed: 12/02/2022]
Abstract
To determine self-reported health status in non-dystrophic myotonias (NDM) and its relationship to painful myotonia and fatigue. In a cross-sectional study, 32 NDM patients with chloride and 30 with sodium channelopathies, all off treatment, completed a standardised interview, the fatigue assessment scale (FAS), and the 36-item Short-Form Health Survey (SF-36). Beside formal assessment of pain, assessment of painful or painless myotonia was determined. The domain scores of the SF-36 were compared with Dutch community scores. Apart from the relationship among SF-36 scores and (1) painful myotonia and (2) fatigue, regression analyses in both NDM groups were conducted to determine the strongest determinants of the SF-36 domains general health perception, physical component (PCS) and mental component summary (MCS). All physically oriented SF-36 domains in both NDM groups (P ≤ 0.01) and social functioning in the patients with sodium channelopathies (P = 0.048) were substantially lower relative to the Dutch community scores. The patients with painful myotonia (41.9%) scored substantially (P < 0.05) lower on most SF-36 domains than the patients without painful myotonia (58.1%). Fatigued patients (53.2%) scored substantially lower (P ≤ 0.01) on all SF-36 domains than their non-fatigued counterparts (46.8%). The regression analysis showed that fatigue was the strongest predictor for the general-health perception and painful myotonia for the physical-component summary. None of the patients showed below-norm scores on the domain mental-component summary. The impact of NDM on the physical domains of patients’ health status is substantial, and particularly painful myotonia and fatigue tend to impede their physical functioning.
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Affiliation(s)
- J Trip
- Department of Neurology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Mullins LL, Carpentier MY, Paul RH, Sanders DB. Disease-specific measure of quality of life for myasthenia gravis. Muscle Nerve 2008; 38:947-56. [DOI: 10.1002/mus.21016] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zwarts M, Bleijenberg G, van Engelen B. Clinical neurophysiology of fatigue. Clin Neurophysiol 2008; 119:2-10. [DOI: 10.1016/j.clinph.2007.09.126] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 09/07/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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Kalkman JS, Schillings ML, Zwarts MJ, van Engelen BGM, Bleijenberg G. The development of a model of fatigue in neuromuscular disorders: a longitudinal study. J Psychosom Res 2007; 62:571-9. [PMID: 17467412 DOI: 10.1016/j.jpsychores.2006.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 11/02/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe fatigue is reported by the majority of patients with three relatively common types of neuromuscular disorders. OBJECTIVE This study aimed to identify predictors of fatigue in a longitudinal study and to develop a model of fatigue in patients with three neuromuscular disorders. METHODS One hundred ninety-eight patients [60 facioscapulohumeral muscular dystrophy (FSHD), 70 adult-onset myotonic dystrophy (MD), and 68 hereditary motor and sensory neuropathy type I (HMSN-I) patients] were studied twice during an 18-month period. Fatigue severity was assessed by the Checklist Individual Strength. A multidimensional assessment method was used, including self-report questionnaires, a daily Self-Observation List, and physical activity (actometer). Muscle strength was determined using the Medical Research Council scale. Structural equation modeling was used to develop and test a model of factors contributing to the persistence of experienced fatigue. RESULTS Muscle strength, self-reported physical activity, sleep disturbances, and pain at baseline contributed directly or indirectly to fatigue and impairment at follow-up. Lower muscle strength contributed to lower levels of physical activity, which, in turn, contributed to fatigue severity. The model showed excellent fit for the whole group of neuromuscular disorders. In FSHD, pain also contributed to physical activity. A model with the actometer as measurement for actual physical activity instead of self-report showed an excellent model fit in FSHD and HMSN but an insufficient fit in MD. CONCLUSION The model of perpetuating factors for fatigue in FSHD and HMSN is different from the model in MD. The main difference is in physical (in)activity. These differences have implications for interventions based on these models.
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Affiliation(s)
- Joke S Kalkman
- Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands.
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Galin FS, Chrisman CL, Cook JR, Xu L, Jackson PL, Noerager BD, Weathington NM, Blalock JE. Possible therapeutic vaccines for canine myasthenia gravis: implications for the human disease and associated fatigue. Brain Behav Immun 2007; 21:323-31. [PMID: 17113748 PMCID: PMC1857319 DOI: 10.1016/j.bbi.2006.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 10/03/2006] [Accepted: 10/04/2006] [Indexed: 11/21/2022] Open
Abstract
Myasthenia gravis (MG) is caused by T cell-dependent antibodies reactive with acetylcholine receptors. These autoreactive antibodies cause muscle weakness by interfering with neuromuscular transmission via removal of acetylcholine receptors from the neuromuscular junction as well as changing the architecture of the junction itself. Consequently, muscle fatigue is a debilitating aspect of MG often leading to more general feelings of tiredness not directly due to muscle weakness. We have previously described two peptides that are mimetics of antigen receptors on certain autoreactive T and B cells that are involved in MG. When used as vaccines in the rat model of MG, these peptides prevented and ameliorated disease and muscle fatigue by blunting acetylcholine receptor antibody responses. Such disease protection resulted from vaccine-induced anergizing antibodies against acetylcholine receptor-specific T and B cell antigen receptors. The present study prospectively evaluated the efficacy of these two vaccines in spontaneous acquired MG in pet dogs. When compared to historical controls that were prospectively studied, the vaccines increased the proportion of remitted dogs from 17 to 75%. In comparison to retrospectively studied historical controls that spontaneously remitted from MG, the vaccines accelerated the rate of decline in acetylcholine receptor antibody titers which resulted in a 3-fold decrease in the mean time to remission. These results are suggestive of a new type of targeted therapy that can drive autoimmune responses into long-term remission and possibly afford a means of determining whether correction of a physical cause of muscle weakness also corrects the perception of chronic, generalized fatigue.
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Affiliation(s)
- F Shawn Galin
- Department of Physiology and Biophysics, University of Alabama at Birmingham, 1918 University Blvd., MCLM 896, Birmingham, AL 35294-0005, USA
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Schillings ML, Kalkman JS, Janssen HMHA, van Engelen BGM, Bleijenberg G, Zwarts MJ. Experienced and physiological fatigue in neuromuscular disorders. Clin Neurophysiol 2006; 118:292-300. [PMID: 17166763 DOI: 10.1016/j.clinph.2006.10.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 10/27/2006] [Accepted: 10/31/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fatigue has been described as a typical symptom of neurological diseases. It might be caused both by changes at the peripheral and at the central level. This study measured the level of experienced fatigue and physiological correlates of fatigue in three genetically defined neuromuscular disorders. METHODS Sixty-five facioscapulohumeral dystrophy (FSHD), 79 classical myotonic dystrophy (DM), 73 hereditary motor and sensory neuropathy type I (HMSN) patients and 24 age-matched healthy controls made a 2-min sustained maximal voluntary contraction of the biceps brachii muscle. Experienced fatigue at the current moment was assessed with the abbreviated fatigue questionnaire just before the physiological measurement. Peripheral fatigue was quantified by comparing the amplitudes of an initial and a final stimulated force response during rest. Muscle fibre conduction velocity was determined from a 5-channel surface EMG recording in order to show peripheral changes during the contraction. Central aspects of fatigue were measured using superimposed electrical endplate stimulation. RESULTS Patients showed an increased level of experienced fatigue. Total physiological and peripheral fatigue were smaller in patients compared to controls, and central fatigue was normal. The most interesting result of this study was the presence of a large central activation failure (CAF) in all groups of neuromuscular patients; they showed CAF values of 36-41% already directly at the start of sustained contraction, whereas the control group showed only 12%. CAF slightly correlated with the level of experienced fatigue just before the test. CONCLUSIONS The cause of the large CAF in patients is unclear. Reduced concentration, motivation or effort can lead to lower central activation. In neuromuscular patients especially fear of physical activity or fear to damage the muscle or nerve tissue may contribute. Besides, also physiological feedback mechanisms or changes at the motocortical level may be a cause of reduced central activation. SIGNIFICANCE For the clinician it is important to know that experienced fatigue is part of the clinical spectrum of neuromuscular patients. Besides, the weakness in these patients is aggravated by reduced central activation. Potentially, both problems could be subject of an intervention.
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Affiliation(s)
- M L Schillings
- Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Fregonezi GADF, Regiane-Resqueti V, Pradas J, Vigil L, Casan P. [The relationship between lung function and health-related quality of life in patients with generalized myasthenia gravis]. Arch Bronconeumol 2006; 42:218-24. [PMID: 16740236 DOI: 10.1016/s1579-2129(06)60449-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study lung function abnormalities and health-related quality of life (HRQL) in a group of patients diagnosed with generalized myasthenia gravis, and to analyze the relationship between these 2 sets of variables. PATIENTS AND METHODS In a prospective study of 20 patients diagnosed with generalized myasthenia gravis, the following parameters were measured: spirometry, static lung volumes, breathing pattern, maximal respiratory pressures, and maximum voluntary ventilation. HRQL was assessed using the 36-item short form general health questionnaire (SF-36). RESULTS The mean (SD) age of the patients was 64 (11) years. Patients were classified into 2 groups depending on whether they had IIa (12 patients) or IIb (8 patients) type disease. A small decrease in total lung capacity (86%) and slight reductions in maximal inspiratory pressure (88%) and maximum voluntary ventilation (63% in group IIb) were observed. The HRQL domains most affected were those related to physical activity and self-perceived health status in all groups, although women were more affected. The scores relating to vitality and physical activity were found to be significantly associated with forced vital capacity and lung volumes. Tidal volume was associated with maximal inspiratory and expiratory pressures, inspiratory capacity, and maximum voluntary ventilation. The respiratory rate to tidal volume ratio was inversely associated with the first three of these variables. CONCLUSIONS A very slight restrictive pattern and a reduction in inspiratory muscle strength were observed. The HRQL domains most affected were those related to physical activity and the patients' self-perceived health status. The weakness of the respiratory muscles contributes to the abnormalities observed in lung function and to the deterioration of health-related quality of life.
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Affiliation(s)
- G A de Freitas Fregonezi
- Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona, España
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Kalkman JS, Schillings ML, Zwarts MJ, van Engelen BGM, Bleijenberg G. Influence of Relatives on Fatigue Experienced by Patients with Facioscapulohumeral Dystrophy, Myotonic Dystrophy and HMSN-I. Eur Neurol 2006; 56:24-30. [PMID: 16914927 DOI: 10.1159/000095137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 06/23/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fatigue is a common symptom experienced by patients with various neuromuscular disorders. The purpose of this study was to assess the influence of relatives on fatigue experienced by patients with various neuromuscular disorders. METHODS In total, 106 close relatives of patients with facioscapulohumeral dystrophy (FSHD), adult-onset myotonic dystrophy (MD), and hereditary motor and sensory neuropathy type I (HMSN), completed the Checklist Individual Strength for themselves, and how they thought their relatives filled in this questionnaire. We compared the agreement between the two. The reaction of the relative to the fatigue and to the neuromuscular disorder of the patient was assessed by the Family Response Questionnaire. Marital dissatisfaction was also measured. The influence of the relative's response to the patients' fatigue and the relatives' fatigue on the fatigue of the patient was tested in linear regression models. RESULTS In all 3 patient groups, the responses of the relatives to fatigue and disease were characterized by sympathetic-empathic responses. Low agreement existed between relatives and MD patients (r = 0.26) over the patients' level of fatigue, but higher agreement was found between relatives and FSHD (r = 0.67) and HMSN (r = 0.73) patients. The spouses of MD patients reported less marital satisfaction. The sympathetic-empathic responses of the relatives of FSHD and HMSN patients, and in FSHD also the fatigue experienced by the relative, contributed significantly to higher levels of fatigue experienced by the patients. CONCLUSION The sympathetic-empathic responses of close relatives to the fatigue of the patient were related to the higher levels of fatigue experienced by FSHD and HMSN patients, but not MD patients.
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Affiliation(s)
- Joke S Kalkman
- Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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