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Jones CD, Kidwell-Chandler A, Cederberg KL, Sikes EM, Motl RW. Do fatigue and depression have a bivariate association with device-measured physical activity behavior in persons with multiple sclerosis? Disabil Rehabil 2024; 46:2522-2527. [PMID: 37350026 DOI: 10.1080/09638288.2023.2225876] [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: 08/13/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study examined the bivariate association between fatigue and depression symptoms and physical activity behavior in persons with multiple sclerosis (MS). METHODS The sample of adults with MS completed the Fatigue Severity Scale (FSS) and the Hospital Anxiety and Depression Scale (HADS) and wore a waist mounted accelerometer during waking hours for 7 days. We categorized participants as having elevated fatigue and depression based on cut-points for the FSS (i.e., 4+ as indicative of severe fatigue) and the HADS (i.e., 8+ as indicative of elevated depressive symptoms). We used a two-way multivariate analysis of variance (MANOVA) to examine the contribution of fatigue and depression to volume and pattern of sedentary, light (LPA) and moderate-to-vigorous physical activity (MVPA). RESULTS Results indicated no bivariate association between fatigue and depression and measures of physical activity behavior. The MANOVA indicated there was a significant association between fatigue and MVPA (F = 2.30, p = 0.032) and steps/day (F = 13.6, p < 0.001), independent of depression symptoms. There was no association between depression symptoms and physical activity behavior. CONCLUSIONS This study demonstrated an interrelation between fatigue symptoms and MVPA and steps/day in MS, independent of depression symptoms, and this should be considered in the future design and delivery of physical activity interventions in MS.IMPLICATIONS FOR REHABILIATIONFatigue and depression are prevalent and burdensome symptoms of multiple sclerosis (MS).These symptoms can collectively worsen psychological and functional outcomes in MS.Fatigue symptoms may impact ambulatory physical activity to a greater degree than depression symptom status in persons with MS.Fatigue is an important consideration when designing behavior change interventions targeted at promoting physical activity in persons with MS.
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Affiliation(s)
- C Danielle Jones
- Department of Physical Therapy, University of AL at Birmingham, Birmingham, AL, USA
| | | | - Katie L Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - E Morghen Sikes
- Division of Occupational Therapy, Shenandoah University, Winchesterm, VA, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of IL Chicago, Chicago, IL, USA
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Galperin I, Buzaglo D, Gazit E, Shimoni N, Tamir R, Regev K, Karni A, Hausdorff JM. Gait and heart rate: do they measure trait or state physical fatigue in people with multiple sclerosis? J Neurol 2024:10.1007/s00415-024-12339-8. [PMID: 38693308 DOI: 10.1007/s00415-024-12339-8] [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: 11/10/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Trait and state physical fatigue (trait-PF and state-PF) negatively impact many people with multiple sclerosis (pwMS) but are challenging symptoms to measure. In this observational study, we explored the role of specific gait and autonomic nervous system (ANS) measures (i.e., heart rate, HR, r-r interval, R-R, HR variability, HRV) in trait-PF and state-PF. METHODS Forty-eight pwMS [42 ± 1.9 years, 65% female, EDSS 2 (IQR: 0-5.5)] completed the Timed Up and Go test (simple and with dual task, TUG-DT) and the 6-min walk test (6MWT). ANS measures were measured via a POLAR H10 strap. Gait was measured using inertial-measurement units (OPALs, APDM Inc). Trait-PF was evaluated via the Modified Fatigue Impact Scale (MFIS) motor component. State-PF was evaluated via a Visual Analog Scale (VAS) scale before and after the completion of the 6MWT. Multiple linear regression models identified trait-PF and state-PF predictors. RESULTS Both HR and gait metrics were associated with trait-PF and state-PF. HRV at rest was associated only with state-PF. In models based on the first 3 min of the 6MWT, double support (%) and cadence explained 47% of the trait-PF variance; % change in R-R explained 43% of the state-PF variance. Models based on resting R-R and TUG-DT explained 39% of the state-PF. DISCUSSION These findings demonstrate that specific gait measures better capture trait-PF, while ANS metrics better capture state-PF. To capture both physical fatigue aspects, the first 3 min of the 6MWT are sufficient. Alternatively, TUG-DT and ANS rest metrics can be used for state-PF prediction in pwMS when the 6MWT is not feasible.
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Affiliation(s)
- Irina Galperin
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of General Medicine, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David Buzaglo
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nathaniel Shimoni
- Owlytics Healthcare Ltd., Ramat-Gan, Israel
- Department of Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Raz Tamir
- Owlytics Healthcare Ltd., Ramat-Gan, Israel
| | - Keren Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Neurology and Neurosurgery, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Karni
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Neurology and Neurosurgery, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Department of Physical Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA.
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Tanaka Y, Ikeda K, Kaneko Y, Ishiguro N, Takeuchi T. Why does malaise/fatigue occur? Underlying mechanisms and potential relevance to treatments in rheumatoid arthritis. Expert Rev Clin Immunol 2024; 20:485-499. [PMID: 38224064 DOI: 10.1080/1744666x.2024.2306220] [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: 08/13/2023] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Fatigue and malaise are commonly associated with a wide range of medical conditions, including rheumatoid arthritis (RA). Evidence suggests that fatigue and malaise can be overwhelming for patients, yet these symptoms remain inadequately-managed, largely due to an incomplete elucidation of the underlying causes. AREAS COVERED In this assessment of the published literature relating to the pathogenesis of fatigue or malaise in chronic conditions, four key mechanistic themes were identified. Each theme (inflammation, hypothalamic-pituitary-adrenal axis, dysautonomia, and monoamines) is discussed, as well as the complex network of interconnections between themes which suggests a key role for inflammatory cytokines in the development and persistence of fatigue. EXPERT OPINION Fatigue is multifaceted, poorly defined, and imperfectly comprehended. Moreover, the cause and severity of fatigue may change over time, as a consequence of the natural disease course or pharmacologic treatment. This detailed synthesis of available evidence permits us to identify avenues for current treatment optimization and future research, to improve the management of fatigue and malaise in RA. Within the development pipeline, several new anti-inflammatory therapies are currently under investigation, and we anticipate that the next five years will herald much-needed progress to reduce the debilitating nature of fatigue in patients with RA.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kei Ikeda
- Department of Rheumatology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Jones RR, Turkoz I, Ait-Tihyaty M, DiBernardo A, Houtchens MK, Havrdová EK. Efficacy and Safety of Ponesimod Compared with Teriflunomide in Female Patients with Relapsing Multiple Sclerosis: Findings from the Pivotal OPTIMUM Study. J Womens Health (Larchmt) 2024; 33:480-490. [PMID: 38301149 DOI: 10.1089/jwh.2023.0037] [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] [Indexed: 02/03/2024] Open
Abstract
Background: Multiple sclerosis (MS) is threefold more prevalent in women than men. However, sex-specific efficacy analysis for MS disease-modifying therapies is not typically performed. Methods: Post hoc analyses of data from female patients enrolled in the phase 3, double-blind OPTIMUM study of relapsing MS were carried out. Eligible adults were randomized to ponesimod 20 mg or teriflunomide 14 mg once daily for up to 108 weeks. The primary endpoint was annualized relapse rate (ARR); secondary endpoints included change in symptom domain of Fatigue Symptom and Impact Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS) at week 108, number of combined unique active lesions (CUALs) per year on magnetic resonance imaging, and time to 12- and 24-week confirmed disability accumulation (CDA). Results: A total of 735 female patients (581 of childbearing potential) were randomized to ponesimod (n = 363, 49.4%) or teriflunomide (n = 372, 50.6%). Relative risk reduction in the ARR for ponesimod versus teriflunomide was 33.1% (mean, 0.192 vs. 0.286, respectively; p < 0.002). Mean difference in FSIQ-RMS for ponesimod versus teriflunomide was -4.34 (0.12 vs. 4.46; p = 0.002); rate ratio in CUALs per year, 0.601 (1.45 vs. 2.41; p < 0.0001), and hazard ratio for time to 12- and 24-week CDA risk estimates, 0.83 (10.7% vs. 12.9%; p = 0.38) and 0.91 (8.8% vs. 9.7%; p = 0.69), respectively. Incidence of treatment-emergent adverse events was similar between treatment groups (89.0% and 90.1%). Conclusions: Analyses demonstrate the efficacy and safety of ponesimod, versus active comparator, for women with relapsing MS, supporting data-informed decision-making for women with MS. Clinical Trial Registration Number: NCT02425644.
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Affiliation(s)
- Robyn R Jones
- Office of Chief Medical Officer, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Ibrahim Turkoz
- Department of Statistics and Decision Sciences, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Maria Ait-Tihyaty
- Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Allitia DiBernardo
- Global Medical Affairs, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Maria K Houtchens
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eva Kubala Havrdová
- Department of Neurology, First Medical Faculty, Charles University, Prague, Czech Republic
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Ayache SS, Chalah MA. Neuroimaging and neuromodulation of invisible symptoms in multiple sclerosis. Front Hum Neurosci 2024; 18:1376095. [PMID: 38454906 PMCID: PMC10917909 DOI: 10.3389/fnhum.2024.1376095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Samar S. Ayache
- Department of Neurology, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Institut de la Colonne Vertébrale et des NeuroSciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Creteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Creteil, France
| | - Moussa A. Chalah
- Department of Neurology, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Institut de la Colonne Vertébrale et des NeuroSciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
- Pôle Hospitalo-Universitaire Psychiatrie Paris 15, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
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AlAmri AS, AlShamrani FJ, AlMohish NM, Zafar AS, Alnaaim SA, Alazman HA, Al-Ghanimi IA, AlNahdi AA, AlDawsari FA, AlMatrafi SB, Alzahrani GR, Alnamlah MS, Alkhalifa RA. Frequency and characteristics of chronic fatigue syndrome in multiple sclerosis patients at a university hospital in Eastern Saudi Arabia. J Family Community Med 2024; 31:63-70. [PMID: 38406222 PMCID: PMC10883436 DOI: 10.4103/jfcm.jfcm_73_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease that affects various parts of the central nervous system. Fatigue, a common symptom, transient, prolonged, or chronic experienced by individuals with MS, can significantly impact daily functioning. It can be associated with underlying pathological processes or can have an idiopathic cause, such as chronic fatigue syndrome (CFS). The study aimed to assess the presence and etiology of fatigue in MS patients and its relationship with CFS. MATERIALS AND METHODS This cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Data were collected using a questionnaire from a sample of 225 MS patients receiving care at our university hospital. The questionnaire included the Centers for Disease Control and Prevention (CDC) criteria for diagnosing CFS and the Expanded Disability Status Scale to evaluate fatigue in MS patients. RESULTS Of the total of 225 MS patients who participated in this study, 87.1% were diagnosed with relapsing-remitting MS, 6.7% with primary progressive MS, 3.6% with clinically isolated syndrome, and 2.7% with secondary progressive MS. About 53% had experienced fatigue that persisted for over 6 months. Analysis of CFS diagnosis revealed that 7.3% of patients met both CDC criteria and self-reported answers while 17.5% reported having CFS despite not meeting the CDC criteria. These findings highlight a significant lack of agreement between patient-reported diagnoses and established criteria, indicating poor agreement (P = 0.028). CONCLUSION The study found an association between CFS and MS, and a significant impact on daily functioning. The study revealed lack of agreement between patient-reported diagnoses and established criteria for CFS. This emphasizes the need for a standardized approach to diagnosis and evaluation of fatigue in MS patients.
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Affiliation(s)
- Abdullah S. AlAmri
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Foziah J. AlShamrani
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor M. AlMohish
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Azra S. Zafar
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saud A. Alnaaim
- Department of Clinical Neurosciences, College of Medicine, King Faisal University, Al-Hofuf, Saudi Arabia
| | - Hatem A. Alazman
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibrahim A. Al-Ghanimi
- Department of Radiology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A. AlNahdi
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahad A. AlDawsari
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahad B. AlMatrafi
- Department of Neurology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghaida R. Alzahrani
- Department of Neurology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muna S. Alnamlah
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rawan A. Alkhalifa
- Department of Neurology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Jagadish A, Shankaranarayana AM, Natarajan M, Solomon JM. Transcranial direct current stimulation for fatigue in neurological conditions: A systematic scoping review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2054. [PMID: 37838979 DOI: 10.1002/pri.2054] [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: 03/08/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND PURPOSE Fatigue following neurological conditions negatively impacts daily activities, reducing overall quality of life. Transcranial direct current stimulation (tDCS) for fatigue management is still underexplored. This scoping review explores its use in managing fatigue among various neurological conditions. METHODS A thorough literature search was carried out using PubMed, Scopus, CINAHL, Web of Science, Embase, ProQuest, and the Cochrane Library. Google Scholar and clinicaltrials.gov were manually searched for gray literature and ongoing trials, respectively. Regardless of the study design, all studies utilizing tDCS for the management of fatigue in various neurological conditions were considered. Two reviewers independently screened all the studies, following which the data were retrieved. RESULTS Studies employing tDCS for fatigue management across neurological conditions is as follows: Multiple sclerosis (MS) (n = 28, 66%), stroke (n = 5, 12%), Parkinson's disease (PD) (n = 4, 10%), post-polio syndrome (PPS) (n = 2, 5%), traumatic brain injury (TBI) (n = 2, 5%), and amyotrophic lateral sclerosis (n = 1, 2%). All the studies used anodal stimulation, with the common stimulation site being the left dorsolateral prefrontal cortex for MS, stroke, and PD. A stimulation intensity of 1.0-4.0 mA with a duration ranging from 15 to 30 min in 1 to 24 sessions were commonly reported. The Fatigue Severity Scale (n = 21) and Modified Fatigue Impact Scale (n = 17) were frequently implemented outcome measures. Regardless of the study design, 36/42 (85.7%) studies reported an improvement in fatigue scores in the tDCS group. The common adverse events noted were tingling (n = 8, 35%), headache (n = 6, 26%), and itching (n = 6, 26%). DISCUSSION Application of tDCS for fatigue was explored in individuals with stroke, PD, PPS, and TBI after MS. Even though a wide range of treatment parameters and outcome measures were adopted to assess and target fatigue, tDCS proves to have a promising role in alleviating this symptom.
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Affiliation(s)
- Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Strauss S, Herr T, Nafz C, Seusing N, Grothe M. The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection. Brain Sci 2023; 14:28. [PMID: 38248243 PMCID: PMC10813082 DOI: 10.3390/brainsci14010028] [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: 11/15/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The cortical silent period (CSP), assessed with transcranial magnetic stimulation (TMS), provides insights into motor cortex excitability. Alterations in the CSP have been observed in multiple sclerosis (MS), although a comparison of the sometimes contradictory results is difficult due to methodological differences. The aim of this study is to provide a more profound neurophysiological understanding of fatigue's pathophysiology and its relationship to the CSP. Twenty-three patients with MS, along with a matched control group, underwent comprehensive CSP measurements at four intensities (125, 150, 175, and 200% resting motor threshold), while their fatigue levels were assessed using the Fatigue Scale for Motor and Cognitive Functions (FSMC) and its motor and cognitive subscore. MS patients exhibited a significantly increased CSP duration compared to controls (p = 0.02), but CSP duration was not associated with the total FSMC, or the motor or cognitive subscore. Our data suggest a systematic difference in MS patients compared to healthy controls in the CSP but no association with fatigue when measured with the FSMC. Based on these results, and considering the heterogeneous literature in the field, our study highlights the need for a more standardized approach to neurophysiological data collection and validation. This standardization is crucial for exploring the link between TMS and clinical impairments in diseases like MS.
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Affiliation(s)
| | | | | | | | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, 17475 Greifswald, Germany; (S.S.); (N.S.)
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Snow NJ, Landine J, Chaves AR, Ploughman M. Age and asymmetry of corticospinal excitability, but not cardiorespiratory fitness, predict cognitive impairments in multiple sclerosis. IBRO Neurosci Rep 2023; 15:131-142. [PMID: 37577407 PMCID: PMC10412844 DOI: 10.1016/j.ibneur.2023.07.002] [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: 11/11/2022] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 08/15/2023] Open
Abstract
Background Cognitive impairment is a disabling and underestimated consequence of multiple sclerosis (MS), with multiple determinants that are poorly understood. Objectives We explored predictors of MS-related processing speed impairment (PSI) and age-related mild cognitive impairment (MCI) and hypothesized that cardiorespiratory fitness and corticospinal excitability would predict these impairments. Methods We screened 73 adults with MS (53 females; median [range]: Age 48 [21-70] years, EDSS 2.0 [0.0-6.5]) for PSI and MCI using the Symbol Digit Modalities Test and Montréal Cognitive Assessment, respectively. We identified six persons with PSI (No PSI, n = 67) and 13 with MCI (No MCI, n = 60). We obtained clinical data from medical records and self-reports; used transcranial magnetic stimulation to test corticospinal excitability; and assessed cardiorespiratory fitness using a graded maximal exercise test. We used receiver operator characteristic (ROC) curves to discern predictors of PSI and MCI. Results Interhemispheric asymmetry of corticospinal excitability was specific for PSI, while age was both sensitive and specific for MCI. MS-related PSI was also associated with statin prescriptions, while age-related MCI was related to progressive MS and GABA agonist prescriptions. Cardiorespiratory fitness was associated with neither PSI nor MCI. Discussion Corticospinal excitability is a potential marker of neurodegeneration in MS-related PSI, independent of age-related effects on global cognitive function. Age is a key predictor of mild global cognitive impairment. Cardiorespiratory fitness did not predict cognitive impairments in this clinic-based sample of persons with MS.
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Affiliation(s)
- Nicholas J. Snow
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Josef Landine
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Arthur R. Chaves
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
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Hechenberger S, Helmlinger B, Penner IK, Pirpamer L, Fruhwirth V, Heschl B, Ropele S, Wurth S, Damulina A, Eppinger S, Demjaha R, Khalil M, Pinter D, Enzinger C. Psychological factors and brain magnetic resonance imaging metrics associated with fatigue in persons with multiple sclerosis. J Neurol Sci 2023; 454:120833. [PMID: 37866195 DOI: 10.1016/j.jns.2023.120833] [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: 05/02/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Besides demographics and clinical factors, psychological variables and brain-tissue changes have been associated with fatigue in persons with multiple sclerosis (pwMS). Identifying predictors of fatigue could help to improve therapeutic approaches for pwMS. Therefore, we investigated predictors of fatigue using a multifactorial approach. METHODS 136 pwMS and 49 normal controls (NC) underwent clinical, neuropsychological, and magnetic resonance imaging examinations. We assessed fatigue using the "Fatigue Scale for Motor and Cognitive Functions", yielding a total, motor, and cognitive fatigue score. We further analyzed global and subcortical brain volumes, white matter lesions and microstructural changes (examining fractional anisotropy; FA) along the cortico striatal thalamo cortical (CSTC) loop. Potential demographic, clinical, psychological, and magnetic resonance imaging predictors of total, motor, and cognitive fatigue were explored using multifactorial linear regression models. RESULTS 53% of pwMS and 20% of NC demonstrated fatigue. Besides demographics and clinical data, total fatigue in pwMS was predicted by higher levels of depression and reduced microstructural tissue integrity in the CSTC loop (adjusted R2 = 0.52, p < 0.001). More specifically, motor fatigue was predicted by lower education, female sex, higher physical disability, higher levels of depression, and self-efficacy (adjusted R2 = 0.54, p < 0.001). Cognitive fatigue was also predicted by higher levels of depression and lower self-efficacy, but in addition by FA reductions in the CSTC loop (adjusted R2 = 0.45, p < 0.001). CONCLUSIONS Our results indicate that depression and self-efficacy strongly predict fatigue in MS. Incremental variance in total and cognitive fatigue was explained by microstructural changes along the CSTC loop, beyond demographics, clinical, and psychological variables.
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Affiliation(s)
- Stefanie Hechenberger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Birgit Helmlinger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Iris-Katharina Penner
- Department of Neurology. Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lukas Pirpamer
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Viktoria Fruhwirth
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Bettina Heschl
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Stefan Ropele
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Sebastian Wurth
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Anna Damulina
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Sebastian Eppinger
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Division of Neuroradiology & Interventional Radiology, Department of Radiology, Graz, Austria
| | - Rina Demjaha
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Neurology Biomarker Research Unit, Graz, Austria
| | - Michael Khalil
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Neurology Biomarker Research Unit, Graz, Austria
| | - Daniela Pinter
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria.
| | - Christian Enzinger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
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11
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Hillyer A, Sharma M, Kuurstra A, Rosehart H, Menon R, Morrow SA. Association between limbic system lesions and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 79:105021. [PMID: 37801955 DOI: 10.1016/j.msard.2023.105021] [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: 04/21/2023] [Revised: 08/21/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Persons with Multiple Sclerosis (PwMS) have a higher rate of anxiety and depression than the general population. Depression has been associated with clinical relapses; temporal lesions were shown to predict depression severity. Anxiety is considerably understudied. The role of MS lesions in the limbic system is also understudied, partly due to difficulties identifying limbic lesions on standard 1.5 and 3 Tesla MRI. METHODS This is a retrospective study of 23 PwMS who underwent 7T MRI on the same day as completing the Hospital Anxiety and Depression Scale (HADS). MRI was performed on a Siemens 7T MRI Plus and an 8-channel transmit coil with 32 receiver channels operating in pTx mode. MP2RAGE and DIR-SPACE sequences were analyzed to determine the number of lesions within the limbic system. RESULTS The median number of lesions in the limbic system was 2.0 (range 0-7). When comparing the presence or absence of lesions in the limbic system, there was a significant relationship with anxiety (X2 (1, N = 23)=4.44, p = 0.035), but not for depression. CONCLUSION Although only a small sample size, this study provides preliminary evidence that lesions in the limbic system are associated with the presence of anxiety in PwMS. This relationship warrants further investigation.
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Affiliation(s)
| | - Manas Sharma
- Western University Schulich School of Medicine & Dentistry, Canada
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12
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Grigorescu C, Chalah MA, Ayache SS, Palm U. [Alexithymia in Multiple Sclerosis - Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:404-413. [PMID: 35948023 DOI: 10.1055/a-1882-6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alexithymia is a multidimensional construct of personality implicating difficulties in identifying and describing another's feelings, and externally oriented thinking. It is broadly reported in psychiatric patients but has gained little attention regarding its occurrence and pathophysiology in multiple sclerosis (MS). This narrative review aims to address prevalence, etiology, neurobiological, and clinical findings of alexithymia. The prevalence of alexithymia in MS ranges from 10 to 53%. There seems to be an association with anxiety, depression, fatigue, and some aspects of social cognition, while the relationship with clinical and classical cognitive variables was rarely evaluated. Only a few studies referred to its pathophysiology assuming an aberrant interhemispheric transfer or regional cerebral abnormalities. The prevalence of alexithymia in MS and the potential negative impact on quality of life and interpersonal communication could severely impact clinical MS management and a screnning for these factors should be mandatory. Thus, further evaluation is needed concerning its relationship with clinical, emotional, and cognitive confounders. Large-scale studies employing neuroimaging techniques are needed for a better understanding of the neural underpinnings of this MS feature.
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Affiliation(s)
- Christina Grigorescu
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
- Medical Park Chiemseeblick, Bernau a. Chiemsee
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13
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Luostarinen M, Remes AM, Urpilainen P, Takala S, Venojärvi M. Correlation of fatigue with disability and accelerometer-measured daily physical activity in patients with relapsing-remitting MS. Mult Scler Relat Disord 2023; 78:104908. [PMID: 37517311 DOI: 10.1016/j.msard.2023.104908] [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: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Fatigue is one of the most common symptoms in patients with multiple sclerosis (MS). Furthermore, measuring its effects on patients in daily life is challenging. This study aimed to discover the association between relapsing-remitting MS (RRMS) patients' disability, fatigue, and accelerometer-measured physical activity. METHODS A total of 41 patients with RRMS with an Expanded Disability Status Scale (EDSS) level of 0-5.5 and 20 healthy controls completed the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) questionnaires. The EDSS was evaluated for all patients with RRMS, and all participants performed the MS Functional Composite (MSFC) test and six-min walk test and wore an accelerometer for seven days. RESULTS Patients with an EDSS level of 0-2.5 were found to have higher fatigue levels (p < 0.001) than healthy controls but lower levels than patients with an EDSS level of 3-5.5 (p < 0.001). A significant correlation was found to exist between fatigue and disability level measured by the EDSS (EDSS/FSS, r=0.750/p=0.001; EDSS/MFIS, r=0.661/p=0.001) and with the MSFC test in the patient group (MSFC/FSS, r = -0.350 p=0.025; MSFC/MFIS, r = -0.423/p=0.007). Total daily activity correlated with fatigue as measured by the FSS (MVPS/FSS r = -0.357/p=0.028, step count/FSS r = -0.463/p=0.003), but no correlation was found between the EDSS or the MSFC. CONCLUSION A lower disability rate, better physical condition, and higher daily-living activity were found to predict lower fatigue levels.
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Affiliation(s)
- Marko Luostarinen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland; MRC, Oulu University Hospital and University of Oulu, Oulu, Finland; Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Pirjo Urpilainen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Saara Takala
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
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14
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Ahvenjärvi H, Niiranen M, Simula S, Hämäläinen P, Surcel HM, Remes AM, Ryytty M, Krüger J. Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS. Mult Scler Relat Disord 2023; 77:104861. [PMID: 37442075 DOI: 10.1016/j.msard.2023.104861] [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: 01/05/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual. OBJECTIVES We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types. METHODS Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS. RESULTS All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL. CONCLUSIONS Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.
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Affiliation(s)
- Henrik Ahvenjärvi
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland
| | - Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sakari Simula
- Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland
| | - Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland
| | - Mervi Ryytty
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
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15
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Ciancio A, Moretti MC, Natale A, Rodolico A, Signorelli MS, Petralia A, Altamura M, Bellomo A, Zanghì A, D'Amico E, Avolio C, Concerto C. Personality Traits and Fatigue in Multiple Sclerosis: A Narrative Review. J Clin Med 2023; 12:4518. [PMID: 37445551 DOI: 10.3390/jcm12134518] [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: 05/31/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease. Fatigue is a prevalent and debilitating symptom that significantly impacts the quality of life of these patients. A relationship between personality traits and fatigue in MS has been hypothesized but not clearly defined. (2) Methods: A literature search was carried out from databases up to April 2023 for studies correlating personality traits and fatigue in patients suffering from MS. (3) Results: A total of ten articles was included; most of the studies depict a neuroticism-fatigue correlation; however, they were not consistent in terms of the fatigue, personality, and covariate assessments. (4) Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the link between personality traits and fatigue in MS. Several models of personality and different fatigue assessments have been found. Despite this, a common pathway shows that the neuroticism trait or similar personality patterns has a role in fatigue diagnosis. This may be a useful target to improve the quality of life and enhance the modification of the disease treatment results. Further homogeneous and longitudinal studies are needed.
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Affiliation(s)
- Alessia Ciancio
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Maria Claudia Moretti
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Antonino Petralia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Aurora Zanghì
- Department of Medical and Surgical Specialities, University of Foggia, 71122 Foggia, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Specialities, University of Foggia, 71122 Foggia, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Specialities, University of Foggia, 71122 Foggia, Italy
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
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16
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López-Muñoz P, Torres-Costoso AI, Fernández-Rodríguez R, Guzmán-Pavón MJ, de Arenas-Arroyo SN, Basco-López JÁ, Reina-Gutiérrez S. Effect of Vitamin D Supplementation on Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2861. [PMID: 37447189 DOI: 10.3390/nu15132861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Vitamin D supplementation has been considered a possible treatment to reduce the risk of disease activity and progression in people with multiple sclerosis (MS). However, its effect on disease symptoms remains unclear. The aim of this meta-analysis was to conduct a systematic review to assess the effect of vitamin D on fatigue in this population. The systematic review was conducted using the MEDLINE, Cochrane Library, Embase and Web of Science databases from inception to May 2023. Randomized controlled trials (RCTs) reporting pre-post changes in fatigue after vitamin D supplementation were included. Pooled effect sizes and 95% confidence intervals (95% CIs) were calculated by applying a random effects model with Stata/SE (Version 16.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of five studies with 345 individuals (271 females; age range: 25.4-41.1 years) were included. A significant reduction in fatigue was perceived when vitamin D supplementation was compared with a control group: -0.18 (95% CI: -0.36 to -0.01; I2 = 0%). Thus, our findings show that the therapeutic use of vitamin D on fatigue in people with MS could be considered. Nevertheless, due to the lack of agreement on the dose to be applied, it is recommended to use it under medical prescription.
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Affiliation(s)
- Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Research Group in Pediatric and Neurologic Physiotherapy, ImproveLab, University of Castilla La Mancha, 45071 Toledo, Spain
| | - Ana Isabel Torres-Costoso
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain
| | | | | | | | - Julián Ángel Basco-López
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Research Group in Pediatric and Neurologic Physiotherapy, ImproveLab, University of Castilla La Mancha, 45071 Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain
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17
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Piacentini C, Argento O, Nocentini U. Cognitive impairment in multiple sclerosis: "classic" knowledge and recent acquisitions. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:585-596. [PMID: 37379870 PMCID: PMC10658666 DOI: 10.1055/s-0043-1763485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/11/2022] [Indexed: 06/30/2023]
Abstract
Multiple sclerosis (MS) is a central nervous system (CNS) disease characterized by inflammation, axonal demyelination, and neurodegeneration, which can have a strong impact on all aspects of the life of the patient. Multiple sclerosis causes motor, sensory, cerebellar, and autonomic dysfunctions, as well as cognitive and psychoemotional impairment. The most frequently compromised cognitive domains are complex attention/information processing, memory, executive and visuospatial functions. Recently, alterations have also been evidenced in complex cognitive functions, such as social cognition, moral judgment, and decision-making. Cognitive impairment is characterized by high variability and can affect work skills, social interactions, coping strategies and more generally the quality of life of patients and their families. With the use of sensitive and easy-to-administer test batteries, an increasingly accurate and early diagnosis is feasible: this allows to determine the effectiveness of possible preventive measures, to predict the future progression of the disease and to improve the quality of life of patients. There is currently limited evidence regarding the efficacy, on cognitive impairment, of disease-modifying therapies. The most promising approach, which has received strong empirical support, is cognitive rehabilitation.
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Affiliation(s)
- Chiara Piacentini
- Institute of Hospitalization and Care of a Scientific Character “Santa Lucia”
Foundation, Behavioral Neuropsychology, Rome, Italy.
| | - Ornella Argento
- Institute of Hospitalization and Care of a Scientific Character “Santa Lucia”
Foundation, Behavioral Neuropsychology, Rome, Italy.
| | - Ugo Nocentini
- Institute of Hospitalization and Care of a Scientific Character “Santa Lucia”
Foundation, Behavioral Neuropsychology, Rome, Italy.
- University of Rome “Tor Vergata”, Department of Clinical Sciences and
Translational Medicine, Rome, Italy.
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18
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Linnhoff S, Haghikia A, Zaehle T. Effects of repetitive twice-weekly transcranial direct current stimulations on fatigue and fatigability in people with multiple sclerosis. Sci Rep 2023; 13:5878. [PMID: 37041183 PMCID: PMC10090173 DOI: 10.1038/s41598-023-32779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
Fatigue is associated with a dramatically decreased quality of life in people with multiple sclerosis (pwMS). It refers to a constant subjective feeling of exhaustion and performance decline, known as fatigability. However, inconsistency and heterogeneity in defining and assessing fatigue have led to limited advances in understanding and treating MS-associated fatigue. Transcranial direct current stimulation (tDCS) has emerged as a promising, non-pharmaceutical treatment strategy for subjective fatigue. However, whether repetitive tDCS also have long-term effects on time-on-task performance has not yet been investigated. This pseudorandomized, single-blinded, and sham-controlled study investigated tDCS effects on behavioral and electrophysiological parameters. 18 pwMS received eight twice-weekly 30 min stimulations over the left dorsolateral prefrontal cortex. Fatigability was operationalized as time-on-task-related changes in reaction time variability and P300 amplitude. Additionally, subjective trait and state fatigue ratings were assessed. The results revealed an overall decrease in subjective trait fatigue ratings that lasted at least four weeks after the stimulations. However, the ratings declined after both anodal and sham tDCS. No effects were found on subjective state fatigue and objective fatigability parameters. Linear Mixed Models and Bayesian Regression models likewise favored the absence of a tDCS effect on fatigability parameters. The results confirm the complex relationship between MS-associated fatigue and fatigability. Reliable and clinically relevant parameters need to be established to extend the potential of tDCS for treating fatigability. Furthermore, our results indicate that consecutive stimulations rather than twice-weekly stimulations should be the preferred stimulation scheme in future studies.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), 39106, Magdeburg, Germany.
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19
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NUTRISEP: Assessment of the nutritional status of patients with multiple sclerosis and link to fatigue. Rev Neurol (Paris) 2023; 179:282-288. [PMID: 36792421 DOI: 10.1016/j.neurol.2022.10.004] [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: 08/05/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Fatigue is a common complaint in patients with multiple sclerosis (PwMS) and reduces quality of life. Several hypotheses for the pathogenesis of fatigue in MS are proposed ranging from neurological lesions to malnutrition, but none has been conclusively validated through clinical research. OBJECTIVES The goal of this study was to examine the correlation between fatigue and nutritional status and dietary habits in PwMS. METHODS This was a cross-sectional, multicenter study conducted at 10 French MS centers and enrolling PwMS with an Expanded Disability Status Scale (EDSS) score between 0 and 7. Plasma level of albumin, magnesium, calcium, iron, vitamin D and B12 evaluated nutritional status. A semi-structured eating behavior questionnaire has been developed to evaluate dietary habits. Evaluation of fatigue used specific questionnaire (EMIF-SEP). Quality of sleep was evaluated by visual analogue scale (VAS), depression with Beck Depression Inventory (BDI-II); dysphagia by DYsphagia in MUltiple Sclerosis questionnaire (DYMUS) and taste disorders by gustometry. Association between nutritional deficiencies and different data such as socio-demographic data, disease characteristics, swallowing and taste disorders, food intake, depression and sleep quality was investigated. RESULTS A total of 352 patients mean age: 48.1±10.1 years, mean duration of MS: 15.3±9.1 years and median EDSS: 4 were analyzed. Bivariate and multivariate analyses showed a statistically significant correlation between fatigue and depression and use of sleeping pills, while none of the variables related to dietary habits or nutritional status correlated significantly with fatigue. CONCLUSIONS Dietary habits and nutritional status have little impact on fatigue and general population nutrition recommendations remain the rule for PwMS. In cases of fatigue, specific attention should be paid to depression and use of sleeping pills.
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20
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Comi G, Leocani L, Ferini-Strambi L, Radaelli M, Costa GD, Lanzillo R, Lus G, Bianchi V, Traccis S, Capone F, Grimaldi LME, Salemi G. Impact of treatment with dimethyl fumarate on sleep quality in patients with relapsing-remitting multiple sclerosis: A multicentre Italian wearable tracker study. Mult Scler J Exp Transl Clin 2023; 9:20552173221144229. [PMID: 36776745 PMCID: PMC9912562 DOI: 10.1177/20552173221144229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/23/2022] [Indexed: 02/11/2023] Open
Abstract
Background Sleep disorders are common in patients with multiple sclerosis and have a bidirectional interplay with fatigue and depression. Objective To evaluate the effect of treatment with oral dimethyl fumarate on the quality of sleep in relapsing-remitting multiple sclerosis. Methods This was a multicentre observational study with 223 relapsing-remitting multiple sclerosis subjects starting treatment with dimethyl fumarate (n=177) or beta interferon (n=46). All patients underwent subjective (Pittsburgh Sleep Quality Index) and objective (wearable tracker) measurements of quality of sleep. Fatigue, depression, and quality of life were also investigated and physical activity was monitored. Results Patients treated with dimethyl fumarate had significant improvement in the quality of sleep as measured with the Pittsburgh Sleep Quality Index (p<0.001). At all-time points, no significant changes in Pittsburgh Sleep Quality Index score were observed in the interferon group. Total and deep sleep measured by wearable tracker decreased at week 12 with both treatments, then remained stable for the total study duration. Depression significantly improved in patients treated with dimethyl fumarate. No significant changes were observed in mobility, fatigue and quality of life. Conclusion In patients with relapsing-remitting multiple sclerosis, the treatment with dimethyl fumarate was associated with improvements in patient-reported quality of sleep. Further randomised clinical trials are needed to confirm the benefits of long-term treatment with dimethyl fumarate.
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Affiliation(s)
- Giancarlo Comi
- Giancarlo Comi, Centro Sclerosi Multipla
Ospedale di Gallarate, ASST Valle Olona, Italy.
| | - Letizia Leocani
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, San
Raffaele Scientific Institute, Sleep Disorders Center, Università Vita
Salute San Raffaele, Milan, Italy
| | - Marta Radaelli
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Gloria D Costa
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Roberta Lanzillo
- Neurosciences, Reproductive and
Odontostomatological Sciences Department, Federico II, University of Naples,
Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of
Neurology, University of Campania ‘L. Vanvitelli’ Napoli, Italy
| | | | | | | | - Luigi ME Grimaldi
- Centro Sclerosi Multipla Fondazione Istituto
‘G. Giglio’, Cefalù (PA), Italy
| | - Giuseppe Salemi
- UOC Neurologia e Neurofisiopatologia
Policlinico ‘Paolo Giaccone’, Palermo, Italy
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DENİZ YZ, TECELLİOĞLU M, ÖZCAN C. Multiple Sclerosis Patients’ COVID-19 Catching Ratios and Disease Profiles. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2023. [DOI: 10.17517/ksutfd.1191897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: For a long time ımmunomodulatory / immunosuppressive drugs are used to slow the progression of multiple sclerosis (MS). These treatments are known to suppress the immune system and create susceptibility to infections. In our study, it was aimed to evaluate whether MS patients who received immunomodulatory / immunosuppressive treatments in the current coronavirus disease 2019 (COVID-19) pandemic, negatively affect them in terms of disease severity, frequency and psychological outcomes.
Methods: Participants consist of MS patients who acquired COVID-19 (group 1) aged 18-65, using disease modifying treatments (DMT) with follow-up in neurology outpatient clinic, and the other two groups consist of similar age and gender. One of the other two groups is MS patients who have not had COVID-19 (group 2), the other group consisted of patients who had COVID-19 and did not have MS (group 3). MS profile, coronavirus anxiety scale (CAS) and Beck depression inventory (BDI) scales between groups 1 and 2; COVID-19 profile between groups 1 and 3 compared.
Results: As a result of comparing the MS disease profile of the 1st and 2nd groups and in terms of the COVID-19 disease profile of the 1st and 3rd groups, there was no statistically significant difference in these paired comparison groups (p> 0.05).
Conclusion: İt was concluded that DMT use does not increase the severity of COVID-19 and acquiring COVID-19 did not affect the psychiatric outcomes in MS patients, since no statistically significant difference was observed in 2 MS group and 2 COVID-19 group comparison
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Linnhoff S, Koehler L, Haghikia A, Zaehle T. The therapeutic potential of non-invasive brain stimulation for the treatment of Long-COVID-related cognitive fatigue. Front Immunol 2023; 13:935614. [PMID: 36700201 PMCID: PMC9869163 DOI: 10.3389/fimmu.2022.935614] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Following an acute COVID-19 infection, a large number of patients experience persisting symptoms for more than four weeks, a condition now classified as Long-COVID syndrome. Interestingly, the likelihood and severity of Long-COVID symptoms do not appear to be related to the severity of the acute COVID-19 infection. Fatigue is amongst the most common and debilitating symptoms of Long-COVID. Other symptomes include dyspnoea, chest pain, olfactory disturbances, and brain fog. Fatigue is also frequently reported in many other neurological diseases, affecting a broad range of everyday activities. However, despite its clinical significance, limited progress has been made in understanding its causes and developing effective treatment options. Non-invasive brain stimulation (NIBS) methods offer the unique opportunity to modulate fatigue-related maladaptive neuronal activity. Recent data show promising results of NIBS applications over frontoparietal regions to reduce fatigue symptoms. In this current paper, we review recent data on Long-COVID and Long-COVID-related fatigue (LCOF), with a special focus on cognitive fatigue. We further present widely used NIBS methods, such as transcranial direct current stimulation, transcranial alternating current stimulation, and transcutaneous vagus nerve stimulation and propose their use as possible therapeutic strategies to alleviate individual pathomechanisms of LCOF. Since NIBS methods are safe and well-tolerated, they have the potential to enhance the quality of life in a broad group of patients.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Lilli Koehler
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany,*Correspondence: Tino Zaehle,
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23
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Linnhoff S, Haghikia A, Zaehle T. Fatigability-related oscillatory brain activity changes in people with MS. Mult Scler Relat Disord 2023; 69:104457. [PMID: 36512955 DOI: 10.1016/j.msard.2022.104457] [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: 10/04/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue, a multidimensional and challenging symptom associated with various underlying conditions, can manifest as a subjective feeling and a performance fatigability. The latter is often defined as an objectively measurable performance decline with time on task. Both syndromes are highly prevalent in people with multiple sclerosis (pwMS) and are often resistant to medical therapy. In the absence of valid and reliable objective parameters, the current cognitive fatigue diagnosis remains purely subjective. Assessing brain wave activity changes has repeatedly been a viable strategy for monitoring cognitive fatigue in healthy subjects. In this study, we aimed to investigate oscillatory brain activity changes and their associations with subjective fatigue in pwMS. METHODS We enrolled 21 pwMS and 21 healthy controls (HC) in this study. Subjects performed a sustained attention task divided into six blocks over the course of 30 minutes, and underwent resting state EEGs before and after the task. During the task, subjects were repeatedly asked to rate their subjective levels of mental fitness, mental exhaustion, and mind wandering. Using Linear Mixed Models, we explored fatigability-related changes by focusing on the time course of changes in reaction time variability, subjective ratings of fatigability, as well as frontomedial theta, and occipital alpha power. We further investigated initial and fatigability-induced differences between pwMS and HC at rest. Finally, Pearson correlations were used to examine the relationship between subjective fatigue and objective fatigability parameters. RESULTS Our results revealed a systematically stronger fatigability development in pwMS that was objectively measurable. PwMS reported lower mental fitness levels and demonstrated greater variability in reaction times with time on task. Occipital alpha power significantly increased during the task. Especially for upper alpha power, this increase was significantly more prominent in pwMS compared to HC. However, the time-on-task-induced changes in our study were not associated with the subjective fatigue ratings. CONCLUSIONS The results of this study expand the understanding of the neural mechanisms underlining cognitive fatigability and may complement the fatigue diagnosis and therapy monitoring with quantitative objective methods.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany.
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24
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Van Patten R, Iverson GL. Examining associations between concussion history, subjectively experienced memory problems, and general health factors in older men. Clin Neuropsychol 2023; 37:119-140. [PMID: 34668844 DOI: 10.1080/13854046.2021.1991481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Examine associations between subjective memory complaints (SMCs), concussion history, and cognitive, psychological, and physical health in older men from the general population. METHOD Participants were 504 men aged 50-79 who were recruited using an online labor market. Participants completed a survey assessing demographics, medication history, concussion history, recent memory problems, and additional aspects of recent cognitive, mental, and physical health. RESULTS Men with a lifetime history of ≥3 concussions also reported a lifetime history of being prescribed medication for anxiety (46.8%), depression (43.5%), chronic pain (79.0%), and high blood pressure (66.1%). When asked about symptoms experienced over the past year and the past week, they endorsed higher rates of cognitive and mental health problems, migraines, and difficulties with sleep and fatigue. The multivariable logistic regression model for predicting mild or greater memory problems was significant, χ2(8) = 168.97, p < .001. In unadjusted analyses, significant predictors, in order of magnitude (strongest to weakest), were fatigue (odds ratio [OR] = 3.21), back or neck pain (OR = 2.28), migraines (OR = 2.11), anxiety (OR = 2.07), depression (OR = 2.04), difficulty sleeping (OR = 1.98), and concussion history (OR = 1.49). In the multivariable model, only back or neck pain (OR = 1.51, p = .004) and fatigue (OR = 1.99, p = .004) were significant predictors. CONCLUSIONS A personal history of multiple concussions was associated with perceived memory problems, but to a lesser degree than fatigue, back or neck pain, and migraines.
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Affiliation(s)
- Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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25
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Sedighi B, Abedini Parizi M, Haghdoost AA, Jangipour Afshar P, Shoraka HR, Jafari S. How does multiple sclerosis affect sexual satisfaction in patients' spouses? Front Psychol 2023; 14:1110884. [PMID: 37082576 PMCID: PMC10111138 DOI: 10.3389/fpsyg.2023.1110884] [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: 11/29/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023] Open
Abstract
Background Sexual dysfunction (SD) is a common complaint among multiple sclerosis (MS) patients with a significant impact on the quality of life (QoL) of afflicted couples. The purpose of this study was to determine sexual satisfaction (SS) in the spouses of MS patients and its impact on the QoL. Methods A total of 214 spouses of MS patients were enrolled in this cross-sectional study. They completed the Larson Sexual Satisfaction Questionnaire and SF-8 Health Survey. Results The mean ± SD age of the spouses was 39.8 ± 9.7 years, and the duration of MS was 5 years or less in most of their partners. The mean ± SD score of QoL was 71.0 ± 20.3 (out of 100), and the mean SS score was 89.2 ± 18.6 (out of 125), showing moderate satisfaction. The highest score was among male spouses younger than 40 years old. The SS scores were also lower among female spouses. In the final model, it was found that SD, psychiatric symptoms, cognitive impairment, and the level of disability of patients were independent explanatory factors for the SS of their spouses. Conclusion The findings supported the role of SS in the QoL of spouses of MS patients. Therefore, the attention of physicians to this hidden aspect of the life of MS patients is crucial.
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Affiliation(s)
- Behnaz Sedighi
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- Epidemiology, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Parya Jangipour Afshar
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Reza Shoraka
- Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Simin Jafari
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- *Correspondence: Simin Jafari
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26
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Linnhoff S, Haghikia A, Zaehle T. Cognitive fatigue-related sensory gating deficits in people with multiple sclerosis. Neurobiol Dis 2023; 176:105950. [PMID: 36493977 DOI: 10.1016/j.nbd.2022.105950] [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: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive fatigue is highly prevalent in people with multiple sclerosis (pwMS) and significantly limits their quality of life. Fatigue can be subdivided into a subjective feeling of constant (trait) or current (state) exhaustion, as well as an objective performance decline, also known as fatigability. However, the current fatigue diagnosis in pwMS is purely subjective, leaving fatigability mostly unattended. Sensorimotor and sensory gating deficits have recently been described as possible objective markers for fatigability in healthy subjects. Thus, this study aimed to investigate the potential of prepulse inhibition (PPI) ratios and the P50 sensory gating suppression as surrogate markers for cognitive fatigue in pwMS. METHODS PPI and P50 sensory gating ratios were assessed before and after a 30-min fatigability-inducing AX- continuous performance task. Subjective trait fatigue was operationalized via self-report questionnaires, subjective state fatigue via visual analog scales (VAS), and fatigability via the change in both gating ratios. The data were analyzed using Linear Mixed Models and Pearson correlations. RESULTS We included 18 pwMS and 20 healthy controls (HC) in the final analyses. The task-induced fatigability was more pronounced in pwMS. While the initial PPI and P50 ratios were similar in both groups, P50 sensory gating was significantly disrupted after fatigability induction in pwMS. PPI, on the other hand, decreased in both groups. Moreover, initial P50 sensory gating ratios were negatively associated with subjective trait fatigue in pwMS, indicating that higher trait fatigue is associated with disrupted sensory gating. Finally, fatigability-related changes in P50 sensory gating were associated with the changes in VAS ratings, but only in HC. CONCLUSIONS This study demonstrated that P50 sensory gating is a promising objective fatigue and fatigability parameter. Importantly, P50 sensory gating correlated with subjective trait and state fatigue ratings. Our results extend the subjective fatigue diagnosis and broaden the understanding of pathophysiological neuronal mechanisms in MS-related fatigue. This is the first study to present fatigue-related disruption of sensory gating in pwMS.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany.
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Muñoz-Paredes I, Herrero AJ, Román-Nieto N, Peña-Gomez AM, Seco-Calvo J. Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis. Healthcare (Basel) 2022; 11:healthcare11010084. [PMID: 36611546 PMCID: PMC9818739 DOI: 10.3390/healthcare11010084] [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: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to a great deterioration in the quality of life. OBJECTIVE We aimed to assess the effectiveness of two individual programs, one based on transcranial direct current stimulation (tDCS) and another based on the effect of physical exercise on fatigue and quality of life in patients with MS. METHODS A total of 12 patients with relapsing-remitting and progressive secondary MS participated. Fatigue and quality of life were assessed before and after intervention. The exercise program and tDCS were carried out over a 4-week period, with a washout period of 5 months. RESULTS The results show significant improvements in the different quality of life subscales after the application of tDCS, activities of daily living (r = 0.625; p = 0.037) (g = 0.465), psychological well-being (r = 0.856; p = 0.004) (g = 0.727) and coping (r = 0.904; p = 0.18) (g = 0.376), and in those after the application of exercise, activities of daily living (r = 0.853; p = 0.003) (g = 0.570) and psychological well-being (r = 0.693; p = 0.041) (g = 0.417). After the application of both therapies, more than 50% of the subjects did not have a positive fatigue score on the MFIS scale. CONCLUSION The major findings suggest that the application of both therapies produces a beneficial effect with significant improvements in the quality of life of this sample.
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Affiliation(s)
- Inés Muñoz-Paredes
- Faculty of Health Sciences, University of León, 24071 León, Spain
- Correspondence: (I.M.-P.); (J.S.-C.)
| | - Azael J. Herrero
- Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
- Research Center on Physical Disability, ASPAYM Castilla y León, 47008 Valladolid, Spain
| | | | - Alba M. Peña-Gomez
- Multiple Sclerosis Association of Palencia, 34004 Palencia, Spain
- Physiotherapy Department, Hospital of Cabueñes, University of Oviedo, 33394 Gijón, Spain
| | - Jesús Seco-Calvo
- Faculty of Physiotherapy and Nursing, University of Leon, 24071 León, Spain
- Physiology Department, University of the Basque Country, 48940 Leioa, Spain
- Correspondence: (I.M.-P.); (J.S.-C.)
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28
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Argento O, Piacentini C, Bossa M, Nocentini U. Emotional Recognition and Its Relation to Cognition, Mood and Fatigue in Relapsing-Remitting and Secondary Progressive Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16408. [PMID: 36554293 PMCID: PMC9778255 DOI: 10.3390/ijerph192416408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Emotional recognition (ER), the ability to read into others' minds and recognize others' emotional states, is important in social environment adaptation. Recently it has been found that ER difficulties affect patients with multiple sclerosis (pMS) and relate to different gray matter atrophy patterns from secondary progressive (SP-pMS) and relapsing-remitting (RR-pMS). The aim of this study was to compare the performances of the two MS phenotypes on the Reading the Mind in the Eyes test (RMEt) and other cognitive, mood and fatigue measures. We also examined associations between performance on the RMEt and cognitive, mood and fatigue variables. (2) Methods: A total of 43 pMS (27RR-pMS/16SP-pMS) underwent a clinical assessment, the RMEt, the cognitive battery, and completed mood and fatigue questionnaires. Both groups' performances on the RMEt were then correlated with all these measures. (3) Results: the RMEt scores of RR-pMS were significantly correlated with the impairment degree in some cognitive scores. SP-pMS scores correlated mainly with fatigue, anxiety, anger and depression. (4) Conclusions: ER performances relate to cognitive aspects in RR-pMS, whereas mainly to mood outcomes in the SP-pMS group. We can hypothesize that deficits in ER are a further sign of disease progression. Our data support the different roles of cognitive and emotional deficits related to different disease courses and lesional correlates.
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Affiliation(s)
- Ornella Argento
- Behavioral Neuropsychology Laboratory, I.R.C.C.S. “Santa Lucia” Foundation, 00179 Rome, Italy
| | - Chiara Piacentini
- Behavioral Neuropsychology Laboratory, I.R.C.C.S. “Santa Lucia” Foundation, 00179 Rome, Italy
| | - Michela Bossa
- Behavioral Neuropsychology Laboratory, I.R.C.C.S. “Santa Lucia” Foundation, 00179 Rome, Italy
| | - Ugo Nocentini
- Behavioral Neuropsychology Laboratory, I.R.C.C.S. “Santa Lucia” Foundation, 00179 Rome, Italy
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Cüce İ, Altun Y. Validity and reliability characteristics of the Silhouettes Fatigue Scale in measuring multiple sclerosis-related fatigue in Turkish-speaking adults. Acta Neurol Scand 2022; 146:671-679. [PMID: 36121165 DOI: 10.1111/ane.13708] [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: 05/28/2022] [Revised: 08/11/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the reliability and validity as well as the clinical utility of the Silhouettes Fatigue Scale (SFS), a single-item visual scale to assess fatigue, in adult patients with multiple sclerosis (MS). METHODS The study included 61 MS patients and 73 matched healthy controls. Demographic data and disease-related variables of all participants were recorded. Then, the SFS, Visual Analogue Scale (VAS)-fatigue, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Beck Depression Inventory (BDI) were applied. SFS, VAS-fatigue, and FSS were repeated after one week. Reliability was evaluated with the intra-class correlation coefficient (ICC) and Bland-Altman analysis. Validity was tested by comparison of healthy controls and patients with MS and correlations with other scales. Accuracy and clinical utility were also evaluated. RESULTS SFS scores were 4.49 ± 3.11 (mean ± SD) in MS patients and 1.40 ± 1.44 in healthy controls (p < .001). The ICC for SFS was 0.946. The mean difference between test-retest measurements of SFS was -0.04651 (-95% CI, -0.4815-0.38848), and there was no systemic bias. SFS scores were not correlated with the expanded disability status scale, whereas they were poorly correlated with BDI. Correlations ranging from poor to good were calculated between the SFS and other fatigue-related scales. The optimum cut-off score of the SFS scale was four, with a sensitivity of 0.72 and a specificity of 0.84. CONCLUSION This study demonstrated that the SFS is a reliable, responsive, and valid scale with acceptable sensitivity and specificity to assess and quantify clinically significant fatigue in MS patients. These findings as well as the brief and understandable nature of the SFS were encouraging that this scale has good clinical utility.
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Affiliation(s)
- İsa Cüce
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yaşar Altun
- Department of Neurology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
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30
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Cederberg KLJ, Schuetz ML, Mathison B, Motl RW. Restless legs syndrome severity associated with reduced physical function in adults with multiple sclerosis. Gait Posture 2022; 97:56-61. [PMID: 35882097 DOI: 10.1016/j.gaitpost.2022.06.012] [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] [Received: 12/02/2020] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a sleep disorder that occurs in approximately 26 % of adults with multiple sclerosis (MS) and may be associated with reduced physical function. RESEARCH QUESTION The present study examined the relationship between RLS symptomology (i.e., overall severity, frequency, and occurrence) and physical function outcomes in adults with MS who had RLS. METHODS Participants (N = 22) with MS who had RLS came into the laboratory for a single session wherein a rater performed a brief neurological examination for scoring the Expanded Disability Status Scale (EDSS) and completed a demographics questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Restless Legs Syndrome Scale-6 (RLS-6) followed by the Short Physical Performance Battery (SPPB) and the Six-minute Walk Test (6 MW). RESULTS Bivariate Spearman's rho correlation analyses indicated total IRLS had a strong, negative association with total distance traveled during the 6 MW (ρ = -0.50) and a moderate association with SPPB scores (ρ = -0.43), but not EDSS scores (ρ = 0.28). RLS severity during the day while active had strong, negative associations with total distance traveled during the 6 MW (ρ = -0.61) and SPPB scores (ρ = -0.52), but not EDSS scores (ρ = 0.13). SIGNIFICANCE We observed associations between worse overall RLS severity and RLS severity during the day while active with reduced performance during the 6 MW and lower SPPB scores. The management of RLS may offer an opportunity for mitigating reductions in physical function in adults with MS who have RLS.
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Affiliation(s)
- Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA.
| | - Morgan L Schuetz
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA
| | - Brianna Mathison
- Department of Physical Therapy, University of Alabama at Birmingham, 1720 Second Avenue South, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition University of Illinois Chicago.
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31
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Cederberg KLJ, Jeng B, Sasaki JE, Motl RW. Physical Activity and Sedentary Behavior Timing in Fatigued and Nonfatigued Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2022; 103:1758-1765. [PMID: 35063422 PMCID: PMC9294061 DOI: 10.1016/j.apmr.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine device-measured physical activity levels and sedentary behavior participation during different times of the day (ie, morning, midday, and evening) in adults with multiple sclerosis (MS) who differed in fatigue status. DESIGN Cross-sectional survey. SETTING Remote survey study managed by a university-based research laboratory. PARTICIPANTS A population-based sample of 1000 participants with MS were sent recruitment materials by the North American Research Committee on Multiple Sclerosis and 218 participants completed all relevant outcomes (N=218). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants (N=218) completed the Fatigue Severity Scale (FSS) as a measure of fatigue severity and were divided into subgroups of fatigued (FSS score ≥4) and nonfatigued (FSS score <4). Participants wore an ActiGraph GT3X+ on the nondominant hip for 7 days to measure physical activity (ie, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], steps) and sedentary behavior. RESULTS Fatigued participants engaged in less MVPA (F[1216]=18.5, P<.001), fewer steps (F[1216]=27.8, P<.001), and more sedentary time (F[1216]=8.2, P=.005) than nonfatigued participants. Regardless of group, the highest levels of LPA (F[1.7355.7]=72.9, P<.001) and MVPA (F[1.8395.3]=23.0,P<.001) occurred in the morning and middle of the day, with the lowest levels in the evening. Regardless of group, the highest levels of sedentary behavior occurred in the evening, with similar levels in the morning and evening (F[1.6354.5]=84.3,P<.001). Regardless of group, participants had more steps in the middle of the day, followed by morning and then evening (F[1.8383.9]=84.7,P<.001). CONCLUSIONS Our results suggest that physical activity timing should be considered in future development and delivery of behavior interventions that focus on increasing physical activity and reducing sedentary behavior among adults with MS who have fatigue.
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Affiliation(s)
- Katie L J Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeffer E Sasaki
- Department of Sport Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Toscano VG, Coelho FM, do Prado GF, Tufik S, de Oliveira EML. Sleep disorders in multiple sclerosis: a case-control study using the São Paulo Epidemiologic sleep study (Episono) database. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:822-830. [PMID: 36252591 PMCID: PMC9703895 DOI: 10.1055/s-0042-1755233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sleep disorders such as obstructive sleep apnea and restless legs syndrome are prevalent in the general population and patients with chronic diseases such as multiple sclerosis (MS). OBJECTIVES This study compared the prevalence of sleep disorders complaints, fatigue, depression, and chronotype of adult patients with multiple sclerosis (PwMS) to a representative sample of São Paulo city residents. METHODS A comparative study was made between PwMS and volunteers from the São Paulo Epidemiologic Sleep Study (Episono) study. We compared the scores of sleep questionnaires using the multivariate analysis of variance (MANOVA) test to evaluate the effects and analysis of variance (ANOVA) as a follow-up test. Covariates were age, sex, and physical activity. The Pearson correlation test was performed to measure the correlation between Expanded Disability Status Scale (EDSS) and the scores of the sleep questionnaires. Finally, we applied propensity score matching to reduce bias in estimating differences between the two groups. Analyses were performed using Stata 14 (StataCorp, College Station, TX, USA) and IBM SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA). RESULTS The Episono group had worse sleep quality, and more excessive daytime sleepiness than PwMS. Obstructive sleep apnea and restless legs syndrome were more frequent in the Episono group. There was no difference in chronotype between the two groups, with morning and intermediate preference. There was no correlation between EDSS and sleep complaints. Fatigue was intensively present among PwMS. CONCLUSIONS Disease Modifying Drug (DMD)-treated PwMS had a lower frequency of sleep complaints, no difference in chronotype, and a higher prevalence of fatigue than a sample of São Paulo city residents. The immunomodulatory drugs commonly used to treat MS may have contributed to these findings.
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Affiliation(s)
- Vanessa Granato Toscano
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Fernando Morgadinho Coelho
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil,Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
| | | | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
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Prolonged visual evoked potential latency predicts longitudinal worsening of fatigue in people with multiple sclerosis. Mult Scler Relat Disord 2022; 67:104073. [DOI: 10.1016/j.msard.2022.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/25/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
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Effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis: a pilot study. Lasers Med Sci 2022; 37:3107-3113. [PMID: 35499744 DOI: 10.1007/s10103-022-03567-3] [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: 07/20/2021] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammation and destruction of the myelin sheath. Fatigue is one of the main symptoms of this disease, with a negative impact on quality of life and few treatment options. Photobiomodulation is used for several inflammatory conditions and may be beneficial for the treatment of fatigue in individuals with multiple sclerosis. Conduct a pilot study to analyze the effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis. The participants were recruited from the UNINOVE Integrated Health Clinic and randomly allocated to two groups: group 1, administration of photobiomodulation (808 nm, 36 J for 360 s) under the tongue and group 2, administration of photobiomodulation over the radial artery. Fatigue was measured using the Modified Fatigue Impact Scale (MFIS). No significant differences were found regarding the total MFIS score or subscale scores (p < 0.05, two-way ANOVA). Photobiomodulation with the parameters employed in the present study had no effect on fatigue in individuals with multiple sclerosis. ClinicalTrials.gov Identifier: NCT03360487.
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Yeni K, Tulek Z, Terzi M. Effect of self-acupressure on fatigue in patients with multiple sclerosis. Complement Ther Clin Pract 2022; 47:101572. [DOI: 10.1016/j.ctcp.2022.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
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Ayache SS, Serratrice N, Abi Lahoud GN, Chalah MA. Fatigue in Multiple Sclerosis: A Review of the Exploratory and Therapeutic Potential of Non-Invasive Brain Stimulation. Front Neurol 2022; 13:813965. [PMID: 35572947 PMCID: PMC9101483 DOI: 10.3389/fneur.2022.813965] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Fatigue is the most commonly reported symptom in patients with multiple sclerosis (MS). It is a worrisome, frequent, and debilitating manifestation that could occur at any time during the course of MS and in all its subtypes. It could engender professional, familial, and socioeconomic consequences and could severely compromise the patients' quality of life. Clinically, the symptom exhibits motor, cognitive, and psychosocial facets. It is also important to differentiate between perceived or subjective self-reported fatigue and fatigability which is an objective measure of decrement in the performance of cognitive or motor tasks. The pathophysiology of MS fatigue is complex, and its management remains a challenge, despite the existing body of literature on this matter. Hence, unraveling its neural mechanisms and developing treatment options that target the latter might constitute a promising field to explore. A PubMed/Medline/Scopus search was conducted to perform this review which aims (a) to reappraise the available electrophysiological studies that explored fatigue in patients with MS with a particular focus on corticospinal excitability measures obtained using transcranial magnetic stimulation and (b) to assess the potential utility of employing neuromodulation (i.e., non-invasive brain stimulation techniques) in this context. A special focus will be put on the role of transcranial direct current stimulation and transcranial magnetic stimulation. We have provided some suggestions that will help overcome the current limitations in upcoming research.
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Affiliation(s)
- Samar S. Ayache
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- *Correspondence: Samar S. Ayache
| | - Nicolas Serratrice
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Georges N. Abi Lahoud
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Moussa A. Chalah
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- Moussa A. Chalah
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: a systematic review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:199-215. [PMID: 35465914 DOI: 10.1016/j.nrleng.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, Spain; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zurich, Switzerland
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, Spain; Departamento de Dirección Médica, Clínica San Vicente, Madrid, Spain
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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AlSaeed S, Aljouee T, Alkhawajah NM, Alarieh R, AlGarni H, Aljarallah S, Ayyash M, Abu-Shaheen A. Fatigue, Depression, and Anxiety Among Ambulating Multiple Sclerosis Patients. Front Immunol 2022; 13:844461. [PMID: 35422797 PMCID: PMC9004709 DOI: 10.3389/fimmu.2022.844461] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory disease associated with adverse effects: including depression, anxiety, fatigue, which may affect physical activity and the quality of life (QoL) among patients with MS (pwMS). Objective This study aims to assess the prevalence of depression, anxiety, and fatigue among pwMS who have no physical disability in Saudi Arabia, and demonstrate any correlation between these factors and physical activity as well as the QoL. Methods A cross-sectional study was conducted in the Neuroimmunology outpatient clinics in King Fahad Medical City (KFMC) and King Saud University Medical City (KSUMC) in Riyadh City, KSA. The Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels. The HADS scores were then categorized into three levels according to the total points: normal (0–7 points), borderline (7–10 points), and anxiety/depression (11 – 21 points). The Arabic version of the Fatigue Severity Scale (FSS) was used to measure fatigue (cut-off point ≥5). The physical activity was measured by the Arabic version of the short form of the International Physical Activity Questionnaire (IPAQ), which measure time spent walking, moderate- and vigorous-intensity physical activity of at least 10 minutes duration. The QoL was also measured by the Arabic version of the EuroQOL five-dimensional (EQ-5D-3L) instrument (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Results A total of 323 pwMS participated in this study, 83 had scores that indicated anxiety (25.7%) and 44 had depression (13.6%). The majority of patients had scores with the normal range of depression and anxiety (70% and 57% respectively). The mean of EuroQol Group visual analogue scale (EQ-VAS) score was 80.43 (SD=19.8). 156 (48.3%) out of 323 pwMS reported fatigue while the remainder had no fatigue (n=167, 51.7%). The results indicate that only 143 patients (44.3%) had participated in vigorous physical activity during the last 70 days, with a median of 3 days per week (IQR= 5–3) and a median of 60 minutes per day 0 (Interquartile range: IQR = 60–30). Only 149 patients (49.2%) had patricpated in moderate physical activities during the previous week with a median of 3 days per week (IQR = 5–3) and a median of 40 minutes per day (IQR = 60–30). 194 patients had participated in walking activities (60.0%) with a median of 5 days per week (IQR = 7–3) and a median of 45 minutes per day (IQR = 60–30). The results revealed that fatigue was positively correlated with depression (r = 0.407, p-value < 0.001) and anxiety (r = 0.289, p-value < 0.001). Conclusion The current study shows depression, anxiety, and fatigue tend to be correlated and clustered together among pwMS in our cohort. However, fatigue is not associated with the intensity of physical activity undertaken. The results of this study are important for the improvement of the clinical management of MS patients.
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Affiliation(s)
- Safanah AlSaeed
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tamadher Aljouee
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Rola Alarieh
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hanan AlGarni
- Physical Therapy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohsen Ayyash
- School of Mathematical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Portaccio E, Bellinvia A, Razzolini L, Pastò L, Goretti B, Niccolai C, Fonderico M, Zaffaroni M, Pippolo L, Moiola L, Falautano M, Celico C, Viterbo R, Patti F, Chisari C, Gallo P, Riccardi A, Borghi M, Bertolotto A, Simone M, Pozzilli C, Bianchi V, Roscio M, Martinelli V, Comi G, Filippi M, Trojano M, Ghezzi A, Amato MP. Long-term Cognitive Outcomes and Socioprofessional Attainment in People With Multiple Sclerosis With Childhood Onset. Neurology 2022; 98:e1626-e1636. [DOI: 10.1212/wnl.0000000000200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and ObjectivesPatients with pediatric-onset multiple sclerosis (MS) can be especially vulnerable to cognitive impairment (CI) due to the onset of MS during a critical period for CNS development and maturation. The objective of this longitudinal study was to assess long-term cognitive functioning and socioprofessional attainment in the Italian pediatric MS cohort, previously assessed at baseline and 2 and 5 years.MethodsThe 48 patients evaluated at the 5-year assessment were screened for inclusion. All participants were assessed with a cognitive test battery exploring 4 different cognitive abilities. Depression, fatigue, and socioprofessional attainment were also assessed. Mean cognitive z scores were calculated for the whole cohort, and their evolution over time was analyzed with an analysis of variance for repeated measurements test. Predictors of cognitive worsening or improvement were assessed with a linear mixed-model analysis.ResultsThirty-three participants were included (mean follow-up 12.8 ± 0.8 years). The global cognitive performance worsened at year 2 and improved at year 5, although the z score remained significantly lower than at baseline (−0.9 ± 1.2 vs −0.3 ± 0.9, p = 0.002). There was no significant variation between years 5 and 12 (−0.7 ± 1.1, p = 0.452). Higher IQ (>90) at baseline (effect 0.3, 95% CI 0.1–0.5, p = 0.017) and lower number of relapses in the 2 years before baseline (effect −0.1, 95% CI −0.1 to 0.1, p = 0.025) predicted better cognitive performances. Eighteen (54.5%) patients failed at least 2 tests compared with healthy controls and were defined as cognitively impaired. The presence of CI predicted worse socioprofessional attainment (β = 4.8, 95% CI 1.4–8.2, p = 0.008).DiscussionThe longitudinal cognitive trajectory in pediatric-onset MS has a heterogeneous course over time, with a decline in the first years followed by a partial recovery over the long term. However, at the last follow-up evaluation, the proportion of impaired patients was more than double compared with baseline, with a negative impact on the individual’s socioprofessional attainment in adulthood. This study underscores how cognitive reserve may partially mitigate the negative effects of brain damage, highlighting the critical importance of intellectual enrichment early during the disease course.
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Adibi I, Sanayei M, Tabibian F, Ramezani N, Pourmohammadi A, Azimzadeh K. Multiple sclerosis-related fatigue lacks a unified definition: A narrative review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:24. [PMID: 35419061 PMCID: PMC8995308 DOI: 10.4103/jrms.jrms_1401_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
Fatigue is the most common symptom in multiple sclerosis (MS). Although MS-related fatigue (MS-F) strongly affects quality of life and social performance of patients, there is currently a lack of knowledge about its pathophysiology, which in turns leads to poor objective diagnosis and management. Recent studies have attempted to explain potential etiologies as well as treatments for MS-F. However, it seems that without a consensus on its nature, these data could not provide a route to a successful approach. In this Article, we review definitions, epidemiology, risk factors and correlated comorbidities, pathophysiology, assessment methods, neuroimaging findings, and pharmacological and nonpharmacological treatments of MS-F. Further studies are warranted to define fatigue in MS patients more accurately, which could result in precise diagnosis and management.
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Affiliation(s)
- Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Sanayei
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Farinaz Tabibian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Pourmohammadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiarash Azimzadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: A systematic review of the literature. Neurologia 2022; 37:199-215. [PMID: 29898858 DOI: 10.1016/j.nrl.2018.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, España; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zúrich, Suiza
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, España; Departamento de Dirección Médica, Clínica San Vicente, Madrid, España
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
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Román CAF, DeLuca J, Yao B, Genova HM, Wylie GR. Signal Detection Theory as a Novel Tool to Understand Cognitive Fatigue in Individuals With Multiple Sclerosis. Front Behav Neurosci 2022; 16:828566. [PMID: 35368296 PMCID: PMC8966482 DOI: 10.3389/fnbeh.2022.828566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple Sclerosis (MS) affects 2.8 million persons worldwide. One of the most persistent, pervasive, and debilitating symptoms of MS is cognitive fatigue. While this has been known for over a century, cognitive fatigue has been difficult to study because patients' subjective (self-reported) cognitive fatigue has consistently failed to correlate with more objective measures, such as reaction time (RT) and accuracy. Here, we investigated whether more nuanced metrics of performance, specifically the metrics of Signal Detection Theory (SDT), would show a relationship to cognitive fatigue even if RT and accuracy did not. We also measured brain activation to see whether SDT metrics were related to activation in brain areas that have been shown to be sensitive to cognitive fatigue. Fifty participants (30 MS, 20 controls) took part in this study and cognitive fatigue was induced using four blocks of a demanding working memory paradigm. Participants reported their fatigue before and after each block, and their performance was used to calculate SDT metrics (Perceptual Certainty and Criterion) and RT and accuracy. The results showed that the SDT metric of Criterion (i.e., response bias) was positively correlated with subjective cognitive fatigue. Moreover, the activation in brain areas previously shown to be related to cognitive fatigue, such as the striatum, was also related to Criterion. These results suggest that the metrics of SDT may represent a novel tool with which to study cognitive fatigue in MS and other neurological populations. These results hold promise for characterizing cognitive fatigue in MS and developing effective interventions in the future.
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Affiliation(s)
- Cristina A. F. Román
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - John DeLuca
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
- Department of Neurology, New Jersey Medical School, Newark, NJ, United States
| | - Bing Yao
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - Helen M. Genova
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
| | - Glenn R. Wylie
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States
- Department of Veterans Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange, NJ, United States
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Covey TJ, Golan D, Doniger GM, Sergott R, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Mebrahtu S, Bergmann C, Wilken J, Gudesblatt M. The relationship between cognitive impairment, cognitive fatigue, and visual evoked potential latency in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103349. [DOI: 10.1016/j.msard.2021.103349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
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Treatment of multiple sclerosis fatigue with the synthetic psychoactive drug modafinil. Exp Neurol 2021; 347:113906. [PMID: 34710403 DOI: 10.1016/j.expneurol.2021.113906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022]
Abstract
Multiple sclerosis (MS) is a complex disorder characterized by a broad spectrum of symptoms that evolve throughout the disease. Symptoms can be categorized as visible and invisible based on external sight recognition. However, although others poorly recognize it, invisible symptoms such as mood dysfunction, neuropathic pain, or fatigue can significantly affect activities of daily living and the quality of life of people with MS (PwMS). PwMS frequently complain of fatigue, which has physical or cognitive manifestations. Fatigue in MS does not improve or resolve with rest, and it is disproportionate with respect to the exerted effort. Fatigue management in MS is challenging, and a few pharmacological approaches have been successfully proposed. Among them, the drug modafinil has attracted attention because of its properties as a synthetic psychoactive drug. In this review, we focus on the evidence available to date, supporting the use of modafinil in MS fatigue. However, despite the availability of some trials evaluating the effects of modafinil on fatigue, their contrasting results failed to support its usefulness in fatigue management in MS.
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Kamal SM, Elhusseini NM, Sedik MF, Mohamad MF, Khedr EM, Kotb HI. Effect of transcranial direct current brain stimulation of the motor cortex on chemotherapy induced nausea and vomiting in female patients with breast cancer. PAIN MEDICINE 2021; 23:571-578. [PMID: 34677609 DOI: 10.1093/pm/pnab313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chemotherapy-induced nausea and vomiting (CINV) is a negative impact associated to chemotherapy and its management still challenging. This study aimed to research the additive impact of single-session tDCS (2 mA) over the motor cortex for 20 minutes before chemotherapy to antiemetic on CINV in female patients suffers from breast cancer who obtained highly emetogenic chemotherapy. STUDY LAYOUT Prospective randomized double-blind Sham-controlled study. SETTING Academic medical center. METHOD Sixty breast cancer patients prepared for chemotherapy treatment were selected and allocated randomly into two equal groups: a real and a sham group; tDCS became implemented over the primary motor area (M1) (2 mA) for 20 minutes. Patients' nausea was measured by cumulative index of nausea and visual analog scale for nausea (VAS-N), and vomiting by cumulative index of episodes of vomiting, and Edmonton symptoms Assessment Scale (ESAS) to assess symptoms like pain, malaise, and sense of well-being. Evaluation was done prestimulation and every 24 h for 72 h after end of infusion of chemotherapy. RESULTS Real tDCS group showed reduction of cumulative index of nausea (P < 0.001, F = 50), VAS-N (P < 0.001, F = 52) and for ESAS in malaise score (P < 0.001, F = 37.6) and sense of wellbeing score (P < 0.001, F = 25) than sham group. Six patients (20%) in the real group required rescue antiemtic therapy vs. 14 patients (46.7%) in the Sham group (P < 0.028). CONCLUSION Single session of real M1 tDCS could be suggested as an effective adjuvant maneuver in control of CINV in female patients suffers from breast cancer who obtained highly emetogenic chemotherapy. TRIAL REGISTRATION Clinical Trials.gov trial registry (identifier: NCT03405324).
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Affiliation(s)
- S M Kamal
- Associate professor in Anesthesia, intensive care and pain management department, South Egypt Cancer institute, Assiut University, Assiut, Egypt
| | - N M Elhusseini
- Resident of anesthesiology, intensive care and pain management, South Egypt Cancer institute, Assiut University, Assiut, Egypt
| | - M F Sedik
- Lecturer in medical oncology department, South Egypt Cancer institute, Assiut University, Assiut, Egypt
| | - M F Mohamad
- Associate professor in Anesthesia, intensive care and pain management department, South Egypt Cancer institute, Assiut University, Assiut, Egypt
| | - E M Khedr
- Professor of neurology and psychiatry, faculty of medicine, Assiut University, Assiut, Egypt
| | - H I Kotb
- Professor of anesthesiology, intensive care and pain management, Faculty of medicine, Assiut University, Assiut, Egypt
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Heaney A, McKenna SP, Hagell P. Evaluation of the Unidimensional Fatigue Impact Scale (U-FIS) in Crohn's Disease: The Importance of Local Item Dependency. J Nurs Meas 2021; 30:JNM-D-20-00116. [PMID: 34518414 DOI: 10.1891/jnm-d-20-00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Unidimensional Fatigue Impact Scale (U-FIS) was developed for use in a multiple sclerosis population. The aim was to determine whether the U-FIS is a valid tool for measuring the impact of fatigue in Crohn's disease (CD). METHOD CD patients completed the U-FIS as part of a validation study of the Crohn's Life Impact Questionnaire (CLIQ). Data were analyzed according to Rasch measurement theory (RMT). RESULTS Two hundred sixty-one completed U-FIS questionnaires were available for analysis. After rescoring the items to resolve disordered thresholds, all 22 items showed acceptable RMT fit. However, there was considerable local item dependency (LID). CONCLUSION The U-FIS did not provide unidimensional measurement in a sample of CD patients due to high levels of LID. Combining the three FIS outcomes into a single measure was not justified.
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Affiliation(s)
| | - Stephen P McKenna
- Galen Research Ltd, Manchester, UK; University of Manchester, Manchester, UK
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47
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Kassie SA, Alia J, Hyland L. Biopsychosocial implications of living with multiple sclerosis: a qualitative study using interpretative phenomenological analysis. BMJ Open 2021; 11:e049041. [PMID: 34404710 PMCID: PMC8372815 DOI: 10.1136/bmjopen-2021-049041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is estimated to affect 2.8 million people worldwide, with increasing prevalence in all world regions (Walton et al). While there is no cure for MS, medication and lifestyle modifications can slow disease progression and enhance patients' quality of life. The biopsychosocial model of health recognises important interactions among biological, psychological and social factors in illness, including those relating to illness management, which contribute to the experience of those diagnosed with MS. OBJECTIVE This qualitative, idiographic study aimed to explore the lived experiences of patients in the United Arab Emirates (UAE) diagnosed with S. METHODS Semistructured interviews were conducted with a purposive sample of eight patients with MS ranging in age from 25 to 56 years. All participants were residing in the UAE at the time of data collection. Interpretative phenomenological analysis was used to analyse the data. RESULTS Three superordinate themes were identified from patients' candid accounts of their lives with MS, highlighting issues of illness management, acceptance and gratitude, and adaptive coping. These themes broadly illustrate biological, psychological and social aspects of patients' MS experiences. CONCLUSION The study emphasised the importance of adopting the biopsychosocial model to treat and manage MS. Additionally, it highlights the need for routine assessment and early, multidimensional approach with multidisciplinary team efforts to improve patients' quality of life.
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Affiliation(s)
- Seada A Kassie
- Shared Clinical Services, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
- Psychology, Middlesex University Dubai, Dubai, UAE
| | - Jannat Alia
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Lynda Hyland
- Psychology, Middlesex University Dubai, Dubai, UAE
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48
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Ferorelli P, Antonelli F, Shevchenko A, Mischiati C, Doepp M, Lenzi S, Borromeo I, Feriotto G, Beninati S. Reduction in Fatigue Symptoms Following the Administration of Nutritional Supplements in Patients with Multiple Sclerosis. Med Sci (Basel) 2021; 9:52. [PMID: 34287336 PMCID: PMC8293375 DOI: 10.3390/medsci9030052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Despite recent advances in immune-modulatory drugs, pharmacological therapies have been proven ineffective in severe presentations of multiple sclerosis (MS), including secondary progressive MS. At present, therapeutic interventions' performance is primarily focused on ameliorating symptoms to improve the patient's quality of life (QOL). Among complementary treatments, nutrition has been considered a decisive factor to control symptoms and enhance the wellness of MS patients. Although no special diets are associated with MS, the impact of diet and dietary supplements on the course of progressive forms of the disease has been studied during the last few years. Fatigue is among the most common and disabling symptoms reported by MS patients. Fatigue has been defined in the Multiple Sclerosis Council for Clinical Practice Guidelines (MSCCPG, 1998) as a "subjective lack of physical and/or mental energy that the individual perceives as an interference with habitual and desired activities". This study aimed to compare the psychometric functioning of the "Fatigue Severity Scale" (FSS) and the "Modified Fatigue Impact Scale" (MFIS) in our sample of people with MS. Specifically, during chronic treatment, the change in these two parameters with two vitamin-rich dietary supplements (Citozym® and Ergozym®) was evaluated. The impact of these nutritional supplements revealed differences in antioxidant and anti-inflammatory parameters among the volunteers in the treatment group, with a subsequent improvement in fatigue. In conclusion, the results obtained have confirmed the effectiveness of complementary nutritional therapies, evaluated essentially based on hematological biomarkers, through which it is possible to act on disability to improve the QOL of MS patients.
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Affiliation(s)
| | | | - Anna Shevchenko
- Department of Pharmacology, Kabardine University, 101000 Nalchik, Russia;
| | - Carlo Mischiati
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44100 Ferrara, Italy;
| | - Manfred Doepp
- Department of Psychology and Sports Science, Giessen Justus, Liebig University Gießen, 35398 Gießen, Germany;
| | - Stefano Lenzi
- Department of Health Engineering, Université Européenne de Bruxelles Jean Monnet, Schaerbeek, 1030 Brussels, Belgium;
| | - Ilaria Borromeo
- Department of Physics, University of Tor Vergata, 00100 Rome, Italy;
| | - Giordana Feriotto
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44100 Ferrara, Italy;
| | - Simone Beninati
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00100 Rome, Italy
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49
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Oliver BJ, Walsh K, Messier R, Mehta F, Cabot A, Klawiter E, Pagnotta P, Solomon A, England SE. System-Level Variation in Multiple Sclerosis Care Outcomes: Initial Findings from the Multiple Sclerosis Continuous Quality Improvement Research Collaborative. Popul Health Manag 2021; 25:46-56. [PMID: 34134513 DOI: 10.1089/pop.2021.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Multiple sclerosis (MS) is a "3C" (complex, chronic, costly) condition that is a common and disabling neurological illness affecting approximately 1 million adults in the United States. MS has been studied at the basic science, individual, and population levels, but not at the system level to assess small-area variation effects on MS population health outcomes. System-level effects have been observed in other 3C conditions including cystic fibrosis, rheumatoid arthritis, and inflammatory bowel disease. The authors report here on system-level variation findings from the baseline period during the first year of the Multiple Sclerosis Continuous Quality Improvement (MS-CQI) study. Stepwise binary logistic regression analyses were conducted to investigate system-level (small-area variation) effects on MS relapses (exacerbations), disease-modifying therapy (DMT) utilization, and brain MRI utilization, controlling for demographics (age and sex) and other potential confounders. Significant differences were observed in people with MS (PwMS) between centers for a number of demographic and disease characteristics, including sex, age, and MS subtype. Controlling for these factors, significant system-level effects were observed on outcomes, including DMT utilization, MRI utilization, and relapses. Significant relationships also were observed between outcomes and urgent care utilization, including emergency department visits and hospitalizations. This initial study provides evidence establishing the presence of system-level variation effects on MS outcomes in a multicenter population study - where PwMS get their care can influence their outcomes. Results support continued systems-level research and improvement initiatives to optimize MS population health outcomes in this challenging and costly complex chronic condition.
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Affiliation(s)
- Brant J Oliver
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Karen Walsh
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | - Falguni Mehta
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA
| | - Ann Cabot
- Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Eric Klawiter
- Multiple Sclerosis Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia Pagnotta
- Multiple Sclerosis Center, Department of Neurology, University of Vermont Medical Center and Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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50
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Ayache SS, Chalah MA. Cognitive fatigability in the healthy brain: Neurophysiological substrates and the use of tDCS. Clin Neurophysiol 2021; 132:1714-1715. [PMID: 33958264 DOI: 10.1016/j.clinph.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.
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