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Hildebrandt H, Eling P. Comments on energy conservation treatments for MS-related fatigue and a new proposal. J Neurol Sci 2024; 461:123040. [PMID: 38735103 DOI: 10.1016/j.jns.2024.123040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
Psychological treatments of MS-related fatigue mostly depend on energy conservation programs. We argue that the evidence for energy conservation training is weak - in contrast to some reviews on this topic. The reasons for our concerns are the use of informed passive control groups allowing negative placebo effects, the lack of predefined primary outcome parameter, statistically rather than clinically significant effects, and the use of insensitive fatigue questionnaires. We propose to base psychological interventions not on a view of fatigue as a constant loss of mental energy but as a subjective representation ("feeling") of an inflammatory state, which draws away attentional capacity. This conceptualization allows to develop a three-step treatment approach: Getting short-term control on fatigue, extinction to reduce fatigue-related avoidance behavior, and a systematic increase of activities by pacing. Our proposal depends on the techniques, that can interrupt ongoing feelings of fatigue and can serve as a basis for extinction. We propose that Progressive Muscle Relaxation might be such a technique. The advantage of our model is that it shares similarities with well-established treatments for phobias and chronic pain and we discuss the shared set of assumptions. Hopefully, this will help to improve the treatment of fatigue in future.
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Affiliation(s)
- Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany; Institute of Psychology, University of Oldenburg, Oldenburg, Germany.
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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Pilloni G, Best P, Kister I, Charvet L. Heart Rate Variability (HRV) serves as an objective correlate of distress and symptom burden in multiple sclerosis. Int J Clin Health Psychol 2024; 24:100454. [PMID: 38525015 PMCID: PMC10958478 DOI: 10.1016/j.ijchp.2024.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Background Autonomic nervous system (ANS) dysfunction is frequently seen in people living with multiple sclerosis (MS). Heart rate variability (HRV) is an easy and objective index for evaluating ANS functioning, and it has been previously used to explore the association between ANS and the experience of symptom burden in other chronic diseases. Given ANS functioning can be influenced by physical and psychological factors, this study investigated whether emotional distress and/or the presence of ANS dysfunction is associated with symptom severity in people living with MS. Methods Participants with MS and healthy controls (HC) with no history of cardiac conditions were recruited to self-collect HR data sampled from a chest strap HR monitor (PolarH10). Short-term HR signal was collected for five minutes, and time and frequency HRV analyses were performed and compared between groups. HRV values were then compared to self-reported distress (Kessler Psychological Distress Scale) and MS participants' self-reported measures of symptom burden (SymptoMScreen). Results A total of n = 23 adults with MS (51 ± 12 years, 65 % female, median Patient Determined Disease Steps [PDDS]: 3.0) and n = 23 HCs (43 ± 18 years, 40 % female) completed the study procedures. All participants were able to complete the chest strap placement and HR data capture independently. Participants with MS, compared to the HC participants, had a significantly lower parasympathetic activation as shown by lower values of the root mean square of successive differences between normal heartbeats (RMSSD: 21.86 ± 9.84 vs. 43.13 ± 20.98 ms, p = 0.002) and of high-frequency (HF) power band (HF-HRV: 32.69 ± 12.01 vs. 42.39 ± 7.96 nu, p = 0.016), indicating an overall lower HRV in the MS group. Among individuals with MS, HF-HRV was significantly correlated with the severity of self-reported MS symptoms (r = -0.548, p = 0.010). Participants with MS also reported higher levels of distress compared to HC participants (18.32 ± 6.05 vs. 15.00 ± 4.61, p = 0.050), and HRV correlated with the severity of distress in MS participants (r = -0.569, p = 0.007). A significant mediation effect was also observed, with emotional distress fully mediating the association between HRV and symptom burden. Conclusions These findings suggest the potential for ANS dysfunction, as measured by HRV (i.e., lower value of HF power), to be utilized as an objective marker of symptom burden in people living with MS. Moreover, it is apparent that the relationship between HRV and symptom burden is mediated by emotional distress.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, New York University Grossman School of Medicine, 222 E 41st Street, 10th floor, New York, NY 10017, United States
| | - Pamela Best
- Department of Neurology, New York University Grossman School of Medicine, 222 E 41st Street, 10th floor, New York, NY 10017, United States
| | - Ilya Kister
- Department of Neurology, New York University Grossman School of Medicine, 222 E 41st Street, 10th floor, New York, NY 10017, United States
| | - Leigh Charvet
- Department of Neurology, New York University Grossman School of Medicine, 222 E 41st Street, 10th floor, New York, NY 10017, United States
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Cheng S, Li W, Hui D, Ma J, Zhang T, Teng C, Dang W, Xiong K, Hu W, Cong L. Acute combined effects of concurrent physical activities on autonomic nervous activation during cognitive tasks. Front Physiol 2024; 15:1340061. [PMID: 38440348 PMCID: PMC10909997 DOI: 10.3389/fphys.2024.1340061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Backgrounds: The validity of heart rate variability (HRV) has been substantiated in mental workload assessments. However, cognitive tasks often coincide with physical exertion in practical mental work, but their synergic effects on HRV remains insufficiently established. The study aims were to investigate the combined effects of cognitive and physical load on autonomic nerve functions. Methods: Thirty-five healthy male subjects (aged 23.5 ± 3.3 years) were eligible and enrolled in the study. The subjects engaged in n-back cognitive tasks (1-back, 2-back, and 3-back) under three distinct physical conditions, involving isotonic contraction of the left upper limb with loads of 0 kg, 3 kg, and 5 kg. Electrocardiogram signals and cognitive task performance were recorded throughout the tasks, and post-task assessment of subjective experiences were conducted using the NASA-TLX scale. Results: The execution of n-back tasks resulted in enhanced perceptions of task-load feelings and increased reaction times among subjects, accompanied by a decline in the accuracy rate (p < 0.05). These effects were synchronously intensified by the imposition of physical load. Comparative analysis with a no-physical-load scenario revealed significant alterations in the HRV of the subjects during the cognitive task under moderate and high physical conditions. The main features were a decreased power of the high frequency component (p < 0.05) and an increased low frequency component (p < 0.05), signifying an elevation in sympathetic activity. This physiological response manifested similarly at both moderate and high physical levels. In addition, a discernible linear correlation was observed between HRV and task-load feelings, as well as task performance under the influence of physical load (p < 0.05). Conclusion: HRV can serve as a viable indicator for assessing mental workload in the context of physical activities, making it suitable for real-world mental work scenarios.
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Affiliation(s)
- Shan Cheng
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Wenbin Li
- Department of Aerospace Hygiene, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Duoduo Hui
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jin Ma
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Taihui Zhang
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Chaolin Teng
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Weitao Dang
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Kaiwen Xiong
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Wendong Hu
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
| | - Lin Cong
- Department of Aerospace Medical Equipment, School of Aerospace Medicine, Air Force Medical University, Xi’an, Shaanxi, China
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Moebus M, Gashi S, Hilty M, Oldrati P, Holz C. Meaningful digital biomarkers derived from wearable sensors to predict daily fatigue in multiple sclerosis patients and healthy controls. iScience 2024; 27:108965. [PMID: 38362266 PMCID: PMC10867654 DOI: 10.1016/j.isci.2024.108965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Fatigue is the most common symptom among multiple sclerosis (MS) patients and severely affects the quality of life. We investigate how perceived fatigue can be predicted using biomarkers collected from an arm-worn wearable sensor for MS patients (n = 51) and a healthy control group (n = 23) at an unprecedented time resolution of more than five times per day. On average, during our two-week study, participants reported their level of fatigue 51 times totaling more than 3,700 data points. Using interpretable generalized additive models, we find that increased physical activity, heart rate, sympathetic activity, and parasympathetic activity while awake and asleep relate to perceived fatigue throughout the day-partly affected by dysfunction of the ANS. We believe our analysis opens up new research opportunities for fine-grained modeling of perceived fatigue based on passively collected physiological signals using wearables-for MS patients and healthy controls alike.
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Affiliation(s)
- Max Moebus
- Department of Computer Science, ETH Zürich, Stampfenbachstrasse 48, 8092 Zürich, Switzerland
- Competence Center for Rehabilitation Engineering and Science, ETH Zürich, Gloriastrasse 37/39, 8092 Zürich, Switzerland
| | - Shkurta Gashi
- Department of Computer Science, ETH Zürich, Stampfenbachstrasse 48, 8092 Zürich, Switzerland
- ETH AI Center, ETH Zürich, OAS J17, Binzmühlestrasse 13, 8092 Zürich, Switzerland
| | - Marc Hilty
- Neuroimmunology Department, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland
| | - Pietro Oldrati
- Neuroimmunology Department, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland
| | - PHRT author consortium
- Department of Computer Science, ETH Zürich, Stampfenbachstrasse 48, 8092 Zürich, Switzerland
- ETH AI Center, ETH Zürich, OAS J17, Binzmühlestrasse 13, 8092 Zürich, Switzerland
- Neuroimmunology Department, University Hospital Zürich, Frauenklinikstrasse 26, 8091 Zürich, Switzerland
- Competence Center for Rehabilitation Engineering and Science, ETH Zürich, Gloriastrasse 37/39, 8092 Zürich, Switzerland
| | - Christian Holz
- Department of Computer Science, ETH Zürich, Stampfenbachstrasse 48, 8092 Zürich, Switzerland
- ETH AI Center, ETH Zürich, OAS J17, Binzmühlestrasse 13, 8092 Zürich, Switzerland
- Competence Center for Rehabilitation Engineering and Science, ETH Zürich, Gloriastrasse 37/39, 8092 Zürich, Switzerland
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Sousa de Andrade PH, de Souza Fonseca BH, Rodrigues Osawa C, da Silva AE, de Souza LAPS, Luvizutto GJ. Decreased functional mobility in individuals with mild to moderate expanded disability status from relapsing multiple sclerosis: Analysis of the Glittre-ADL test. Physiother Theory Pract 2024:1-13. [PMID: 38165106 DOI: 10.1080/09593985.2023.2299726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease that significantly limits an individual's activities of daily living (ADLs) and negatively affects their social participation as it progresses. The impact of activities and participation must be continuously assessed, and the Glittre-ADL is a validated test for MS to assess functional capacity in tasks similar to ADLs. OBJECTIVE To evaluate whether the Glittre-ADL test is a valid method for assessing functional mobility in individuals with MS and moderate disability or those who use assistive devices. METHODS This cross-sectional study enrolled 30 individuals in two groups: 1) MS group (n = 15); and 2) healthy control group (n = 15). The MS group underwent three functional mobility tests: 1) Glittre-ADL; 2) Timed 25-Foot Walk (T25FWT); and 3) Timed Up and Go (TUG) while the healthy group underwent only the Glittre-ADL test. RESULTS An association was found between the Glittre-ADL time and T25FWT (r = 0.78, p < .001) and TUG (r = 0.56, p = .030) times. In the MS group, statistically significant differences were found in time (F = 2.88, p = .038) and speed (F = 5.17, p = .024) between laps. A statistically significant difference was observed between the total time in the MS and control groups (Area Under Curve - AUC: 0.982, p < .0001). A total time > 46.0s represents the reduction of functional performance during ADLs in individuals with MS (sensitivity: 93.3%; specificity: 92.2%). CONCLUSION The Glittre-ADL test is a valid tool for assessing functional mobility in individuals with MS and mild to moderate disability (EDSS score ≤ 6.5).
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Affiliation(s)
| | | | - Caroline Rodrigues Osawa
- Department of Applied Physical Therapy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Alex Eduardo da Silva
- Department of Medicine, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brazil
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Zawadka-Kunikowska M, Rzepiński Ł, Cieślicka M, Klawe JJ, Tafil-Klawe M. Association between Daytime Sleepiness, Fatigue and Autonomic Responses during Head-Up Tilt Test in Multiple Sclerosis Patients. Brain Sci 2023; 13:1342. [PMID: 37759943 PMCID: PMC10526123 DOI: 10.3390/brainsci13091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to assess dynamic changes in hemodynamic and autonomic function in response to the head-up tilt test (HUTT) in patients with multiple sclerosis (MS) compared to healthy controls (HCs) and evaluate its relationship with the patients' reported daytime sleepiness and fatigue symptoms. A total of 58 MS patients and 30 HCs were included in the analysis. Fatigue and sleepiness were evaluated using the Chalder Fatigue Scale (CFQ) and the Epworth Sleepiness Scale (ESS), respectively. Hemodynamic response, baroreflex sensitivity, heart rate variability, and systolic and diastolic blood pressure (BP) variability (SBPV, DBPV) parameters were calculated at rest, and in response to the HUTT. The MS patients displayed attenuated BP responses coupled with a more pronounced decrease in cardiac index as well as a reduced increase in the low frequency (LFnu) of DBPV (p = 0.021) and the sympathovagal ratio (p = 0.031) in the latter-phase orthostatic challenge compared to HCs. In MS patients, the ESS score showed no correlation with CFQ or clinical disease outcomes, but exhibited a moderate correlation with LFnu of BPVrest. Fatigue and disease variants predicted blood pressure response to HUTT. These findings underscore the importance of subjective daytime sleepiness and fatigue symptoms and their role in blood pressure regulation in MS patients.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Łukasz Rzepiński
- Sanitas–Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland;
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland;
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
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Marques KC, Quaresma JAS, Falcão LFM. Cardiovascular autonomic dysfunction in "Long COVID": pathophysiology, heart rate variability, and inflammatory markers. Front Cardiovasc Med 2023; 10:1256512. [PMID: 37719983 PMCID: PMC10502909 DOI: 10.3389/fcvm.2023.1256512] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Long COVID is characterized by persistent signs and symptoms that continue or develop for more than 4 weeks after acute COVID-19 infection. Patients with Long COVID experience a cardiovascular autonomic imbalance known as dysautonomia. However, the underlying autonomic pathophysiological mechanisms behind this remain unclear. Current hypotheses include neurotropism, cytokine storms, and inflammatory persistence. Certain immunological factors indicate autoimmune dysfunction, which can be used to identify patients at a higher risk of Long COVID. Heart rate variability can indicate autonomic imbalances in individuals suffering from Long COVID, and measurement is a non-invasive and low-cost method for assessing cardiovascular autonomic modulation. Additionally, biochemical inflammatory markers are used for diagnosing and monitoring Long COVID. These inflammatory markers can be used to improve the understanding of the mechanisms driving the inflammatory response and its effects on the sympathetic and parasympathetic pathways of the autonomic nervous system. Autonomic imbalances in patients with Long COVID may result in lower heart rate variability, impaired vagal activity, and substantial sympathovagal imbalance. New research on this subject must be encouraged to enhance the understanding of the long-term risks that cardiovascular autonomic imbalances can cause in individuals with Long COVID.
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Affiliation(s)
| | - Juarez Antônio Simões Quaresma
- Center for Biological Health Sciences, State University of Pará (UEPA), Belém, Brazil
- School of Medicine, São Paulo University (USP), São Paulo, Brazil
- Tropical Medicine Center, Federal University of Pará (UFPA), Belém, Brazil
| | - Luiz Fábio Magno Falcão
- Center for Biological Health Sciences, State University of Pará (UEPA), Belém, Brazil
- School of Medicine, São Paulo University (USP), São Paulo, Brazil
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Koutsouraki E, Theodoros K, Eleni G, Marianna K, Areti N, Ariadni K, Dimitrios M. Autonomic nervous system disorders in multiple sclerosis. J Neurol 2023:10.1007/s00415-023-11725-y. [PMID: 37084150 DOI: 10.1007/s00415-023-11725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.
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Affiliation(s)
- Effrosyni Koutsouraki
- First Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | - Koukoulidou Ariadni
- Nursing School, International University of Greece, Sindos, Thessaloniki, Greece
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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