Association of Fatigue Severity With Maladaptive Coping in Multiple Sclerosis: A Data-Driven Psychodynamic Perspective

Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis

Introduction

Functional neurological symptoms (FNS) in multiple sclerosis (MS) have shown to be underinvestigated even though neurological diseases such as MS represent a risk factor for developing FNS. Comorbidity of FNS and MS can produce high personal and social costs since FNS patients have high healthcare utilization costs and a quality of life at least as impaired as in patients with disorders with underlying structural pathology. This study aims to assess comorbid FNS in patients with MS (pwMS) and investigate whether FNS in pwMS are associated with poorer health-related quality of life and work ability.

Methods

Newly admitted patients (234) with MS were studied during their stay at Kliniken Schmieder, a neurological rehabilitation clinic in Konstanz, Germany. The degree to which the overall clinical picture was explained by MS pathology was rated by neurologists and allied health practitioners on a five-point Likert scale. Additionally, neurologists rated each symptom reported by the patients. Health-related quality of life was assessed using a self-report questionnaire and work ability was assessed using the mean number of hours worked per day and information regarding disability pension as reported by patients.

Results

In 55.1% of cases, the clinical picture was completely explained by structural pathology due to MS. 17.1% of pwMS presented an overall clinical picture half or less of which could be explained by underlying structural pathology. PwMS with a higher comorbid FNS burden had a lower health-related quality of life and reported fewer working hours per day than pwMS with symptoms explained by structural pathology. Furthermore, pwMS with a full disability pension had a higher comorbid FNS burden than pwMS with no or partial disability pension.

Discussion

These results show that FNS should be addressed diagnostically and therapeutically since such symptoms are an important comorbidity in MS that is related to poorer health-related quality of life and lower work ability.

Prominent Fatigue but No Motor Fatigability in Non-Hospitalized Patients With Post-COVID-Syndrome

Objectives

Fatigue is a frequent and often disabling symptom in patients with post-COVID syndrome. To better understand and evaluate the symptom of motor fatigue in the context of the post-COVID syndrome, we conducted treadmill walking tests to detect the phenomenon of motor fatigability or to evaluate whether evidence of organic lesions of the motor system could be found, similar to patients with multiple sclerosis.

Method

Twenty-nine non-hospitalized patients with post-COVID syndrome completed the Fatigue Scale for Motor and Cognitive Function (FSMC) questionnaire to determine the trait component of subjective fatigue before they were tested on a treadmill walking at a moderate speed for up to 60 min or until exhaustion. During the walking test oxygen uptake, ventilation and acceleration data of both feet were collected. To determine motor performance fatigability, the Fatigue Index Kliniken Schmieder (FKS) was calculated using the attractor method.

Results

The average walking duration was 42.7 ± 18.6 min with 15 subjects stopping the walking test prematurely. The FSMC score revealed a severe cognitive (37.6 ± 8.2) and motor (37.1 ± 7.8) fatigue averaged over all subjects but only two subjects showed an FKS above the normal range (>4), representing performance fatigability. There was no significant correlation between subjective fatigue (FSMC) and FKS as well as walking time. Absolute values of oxygen uptake and ventilation were in the normal range reported in literature (r = 0.9, p < 0.05), although eight subjects did not produce a steady-state behavior.

Conclusion

Almost all patients with post-COVID syndrome and subjectively severe motor fatigue, did not show motor fatigability nor severe metabolic anomalies. This is argued against organic, permanent damage to the motor system, as is often seen in MS. Many of the patients were - to our and their own surprise - motorically more exertable than expected.

High prevalence of fatigue in patients with Takayasu arteritis: a case–control study in a Brazilian centre

Objectives

Several studies have shown not only a high prevalence of fatigue but also a reduction in health-related quality of life (HRQoL) in patients with rheumatic diseases. Owing to insufficient research in this area, we aimed to assess the prevalence of fatigue and its contribution to impairment of HRQoL in patients with Takayasu arteritis (TAK).

Methods

This single-centre case–control study included 53 TAK patients who were matched by age, BMI and sex with 100 healthy individuals. Aside from the patients’ general data, the following information was collected: disease activity, level of activities of daily living (HAQ), physical activity levels and chronic fatigue.

Results

The TAK patients and healthy individuals were comparable in terms of current age, BMI and sex distribution. The median disease duration of TAK was 13.0 (7.0–20.0) years, and 11 (20.8%) patients had active disease. Compared with healthy individuals, patients with TAK had a higher prevalence of fatigue and lower HAQ score, physical activity level and intensity, and physical and psychosocial domains of the modified fatigue impact scale (P < 0.01). Moreover, TAK patients had increased fatigue rates compared with the healthy individuals (fatigue severity scale: odds ratio = 2.6; 95% CI = 1.2, 5.4; modified fatigue impact scale: odds ratio = 2.6; 95% CI = 1.2, 5.5). Fatigue was positively correlated with worsening HAQ, CRP levels, daily prednisone dose and disease activity, and negatively correlated with disease duration.

Conclusion

TAK patients have a higher prevalence of fatigue, which affects different aspects of the disease, including physical function. Thus, fatigue-focused treatments should also be considered in clinical practice.

Trial registration

The Brazilian Clinical Trials Registry (ReBEC), https://ensaiosclinicos.gov.br/, RBR-9n4z2hh.

Cognitive Fatigability, not Fatigue predicts employment status in patients with MS three months after rehabilitation

BACKGROUND

Fatigue is potentially the most important factor causing unemployment in people with Multiple Sclerosis (PwMS). Widely accepted is a discrimination between fatigue as subjective sensation and fatigability as objective measure of change in performance. The aim of this study was to identify, whether cognitive fatigue or cognitive fatigability is a better predictor for employment status three months after discharge from a neurological rehabilitation center.

METHODS

64 PwMS (mean age 48.9, 43 females, mean time since diagnosis 14.7 years, median Expanded Disability Status Scale (EDSS) 3.8), complaining of fatigue and reporting difficulties with their working capacity, participated in a cognitive loading task during inpatient rehabilitation. Reaction time performance was measured using a standardized alertness test (TAP-M). Tonic alertness was measured at 8 a.m., 11 a.m. and 2 p.m. Patients worked on a standardized test battery during the morning and after lunch to induce fatigability. All of them completed the Fatigue Scale for Motor and Cognition (FSMC), a standardized questionnaire to rate the trait component of cognitive and motor fatigue. Their employment status was rated within a standardized interview by phone three months after discharge from the clinic.

RESULTS

Mean cognitive fatigue according to the FSMC was 38.9 ± 7.4 and mean motor fatigue 41.0 ± 5.6, indicating severe cognitive and motor fatigue. 15 (88%) of 17 patients working fulltime had severe fatigue according to the FSMC. The cognitive subscale of the FSMC ("FSMC cognition") did not correlate (r_s = -.084, p = .512) and the motor subscale of the FSMC ("FSMC motor") correlated rather weakly but not significantly (r_s= -.220, p = .080) with the employment status. In contrast, there was a significant and medium correlation between alertness at 8 a.m. (alertness₁) and employment status (r_s = -.304, p = .014). Ordered logistic regression revealed that only alertness₁ and the alertness difference between afternoon and noon (alertness difference₃₂) predicted significantly the employment status. The FSMC motor and cognition subscales had no predictive value for employment.

CONCLUSION

Cognitive fatigability (tonic alertness at 8 a.m. or increase of reaction time during the afternoon) is more adequate to predict employment status in PwMS three months after discharge from the clinic than the subjective sensation of fatigue as determined by the FSMC.