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O'Keeffe F, Cogley C, McManus C, Davenport L, O'Connor S, Tubridy N, Gaughan M, McGuigan C, Bramham J. Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study. Mult Scler Relat Disord 2024; 88:105719. [PMID: 38909526 DOI: 10.1016/j.msard.2024.105719] [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: 02/03/2023] [Revised: 05/18/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND People with MS (pwMS) commonly experience a range of hidden symptoms, including cognitive impairment, anxiety and depression, fatigue, pain, and sensory difficulties. These "invisible" symptoms can significantly impact wellbeing, relationships, employment and life goals. We developed a novel bespoke online group neuropsychological intervention combining psychoeducation and cognitive rehabilitation with an Acceptance and Commitment Therapy (ACT)-informed approach for pwMS in an acute tertiary hospital. This 'Neuropsychological Intervention for Managing Invisible Symptoms' in MS (NIMIS-MS) consisted of 6 sessions, each with a psychoeducation and ACT component. The content included psychoeducation around managing cognitive difficulties, fatigue, pain, sleep and other unpleasant sensations in MS with the general approach of understanding, monitoring, and recognising patterns and potential triggers. Specific cognitive rehabilitation and fatigue management strategies were introduced. The ACT-informed component focussed on three core ACT areas of the 'Triflex' of psychological flexibility (Harris, 2019): Being Present, Opening Up, and Doing What Matters. METHODS 118 pwMS attended the NIMIS-MS group intervention which was delivered 14 times in six-week blocks over an 18-month period. To evaluate the effectiveness and acceptability, participants completed measures of depression and anxiety (HADS), functional impairment (WSAS), Values- Progress (VQ) and Values- Obstruction (VQ), and Acceptance of MS (MSAS) pre and post NIMIs-MS group intervention. Qualitative feedback was obtained during focus groups after the final session and via online feedback questionnaires RESULTS: Pre-post analysis showed that symptoms of depression and anxiety were significantly lower and acceptance of MS was significantly higher following completion of the NIMIS-MS group. Qualitative feedback showed that participants reported that they felt more equipped to manage the "invisible" symptoms of MS following completion of the group, and benefited from using ACT-based strategies and techniques. Participants highly valued the peer support that evolved during the NIMIS-MS groups. The online format was considered more accessible than in-person groups, due to less concerns of travel time, cost, fatigue, and comfort and infection. CONCLUSION Evaluation suggests that our novel NIMIS-MS groups is an acceptable, beneficial and feasible approach for providing neuropsychological interventions to individuals with MS.
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Affiliation(s)
- Fiadhnait O'Keeffe
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland; University College Cork, Ireland.
| | - Clodagh Cogley
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
| | | | | | | | - Niall Tubridy
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
| | | | | | - Jessica Bramham
- University College Dublin, Ireland; St. Vincent's University Hospital, Ireland
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Fernández-Canosa S, Brocalero-Camacho A, Martínez-Medina A, Díez-Rodríguez E, Arias P, Oliviero A, Soto-León V. Fatigue insights from walking tests in spinal cord injury and multiple sclerosis individuals. Sci Rep 2024; 14:4761. [PMID: 38413793 PMCID: PMC10899186 DOI: 10.1038/s41598-024-55238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
In the last decade, fatigue in clinical populations has been re-conceptualized, including dimensions such as perceived fatigue (trait and state fatigue) and fatigability. The aim of this study was to evaluate different expressions of fatigue in Spinal Cord Injury (SCI) and Multiple Sclerosis (MS) participants compared to able-bodied controls, during activities of daily living, especially during gait. A total of 67 participants were included in this study (23 with SCI, 23 with MS, and 21 able-bodied controls). All participants performed two functional tests (6-Minute Walk Test and 10-Meter Walk Test) and they completed the Fatigue Severity Scale (FSS). The rate of trait fatigue was different between groups, with MS participants showing the highest rate. Moreover, scores on functional tests and state fatigue were different between groups after the tests. Our results indicate that trait fatigue and state fatigue in individuals with SCI and MS are different with respect to able-bodied population. Both SCI and MS groups experienced more trait fatigue than control group in daily life. In addition, walking tasks produced similar levels of state fatigue between healthy people and patients with MS/SCI. However, these tests induced longer-lasting levels of state fatigue in the patients.
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Affiliation(s)
| | | | | | - Eva Díez-Rodríguez
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain
| | - Pablo Arias
- Department of Physiotherapy, Medicine and Biomedical Sciences and INEF Galicia, NEUROcom (Neuroscience and Motor Control Group) and Biomedical Institute of A Coruña (INIBIC), Universidade da Coruña, 15179, A Coruña, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
- Advanced Rehabilitation Unit, Hospital Los Madroños, 28690, Brunete, Spain.
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
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Weerasinghe-Mudiyanselage PDE, Kim JS, Shin T, Moon C. Understanding the spectrum of non-motor symptoms in multiple sclerosis: insights from animal models. Neural Regen Res 2024; 19:84-91. [PMID: 37488849 PMCID: PMC10479859 DOI: 10.4103/1673-5374.375307] [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: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 07/26/2023] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system and is generally considered to be a non-traumatic, physically debilitating neurological disorder. In addition to experiencing motor disability, patients with multiple sclerosis also experience a variety of non-motor symptoms, including cognitive deficits, anxiety, depression, sensory impairments, and pain. However, the pathogenesis and treatment of such non-motor symptoms in multiple sclerosis are still under research. Preclinical studies for multiple sclerosis benefit from the use of disease-appropriate animal models, including experimental autoimmune encephalomyelitis. Prior to understanding the pathophysiology and developing treatments for non-motor symptoms, it is critical to characterize the animal model in terms of its ability to replicate certain non-motor features of multiple sclerosis. As such, no single animal model can mimic the entire spectrum of symptoms. This review focuses on the non-motor symptoms that have been investigated in animal models of multiple sclerosis as well as possible underlying mechanisms. Further, we highlighted gaps in the literature to explain the non-motor aspects of multiple sclerosis in experimental animal models, which will serve as the basis for future studies.
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Affiliation(s)
- Poornima D. E. Weerasinghe-Mudiyanselage
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
| | - Joong-Sun Kim
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
| | - Taekyun Shin
- Department of Veterinary Anatomy, College of Veterinary Medicine and Veterinary Medical Research Institute, Jeju National University, Jeju, Republic of Korea
| | - Changjong Moon
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
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Zimek D, Miklusova M, Mares J. Overview of the Current Pathophysiology of Fatigue in Multiple Sclerosis, Its Diagnosis and Treatment Options - Review Article. Neuropsychiatr Dis Treat 2023; 19:2485-2497. [PMID: 38029042 PMCID: PMC10674653 DOI: 10.2147/ndt.s429862] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Fatigue is a common, debilitating and often underestimated symptom in patients with multiple sclerosis (MS). The exact pathophysiological mechanism of fatigue in MS is still unknown. However, there are many theories involving different immunological, metabolic and inflammatory mechanisms of fatigue. Owing to the subjective nature of this symptom, its diagnosis is still very limited and is still based only on diagnostic questionnaires. Although several therapeutic agents have been used in the past to try to influence fatigue in MS patients, no single effective approach for the treatment of fatigue has yet been found. This review article aims to provide the reader with information on the current theories on the origin and mechanism of fatigue in MS, as well as diagnostic procedures and, finally, current therapeutic strategies for the management of fatigue in MS patients.
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Affiliation(s)
- Dalibor Zimek
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
| | - Martina Miklusova
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Mares
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
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Yoon JH, Park NH, Kang YE, Ahn YC, Lee EJ, Son CG. The demographic features of fatigue in the general population worldwide: a systematic review and meta-analysis. Front Public Health 2023; 11:1192121. [PMID: 37575103 PMCID: PMC10416797 DOI: 10.3389/fpubh.2023.1192121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background Fatigue is one of the most common subjective symptoms that impairs daily life and predict health-related events. This study aimed to estimate the prevalence of fatigue in the global population. Methods PubMed and the Cochrane Library were used to search for relevant articles from inception to December 31, 2021. Studies with prevalence data of fatigue in the general population were selected and reviewed by three authors independently and cross-checked. Regarding subgroups, adults (≥18 years), minors (<18 years), and specific occupation population (participants in each study being limited to a specific occupational group), and fatigue types and severity, meta-analysis was conducted to produce point estimates and 95% confidence intervals (95% CI). Results From the initial 3,432 studies, 91 studies accounting for 115 prevalence data points (623,624 participants) were finally selected. The prevalence of general fatigue (fatigue lasting < 6 months, or fatigue of unspecified duration) was 20.4% (95% CI, 16.7-25.0) in adults, 11.7% (95% CI, 5.2-26.6) in minors, and 42.3% (95% CI, 33.0-54.2) in specific occupations. Chronic fatigue (fatigue lasting more than 6 months) affected 10.1% (95% CI, 8.2-12.5) of adults, 1.5% (95% CI, 0.5-4.7) of minors, and 5.5% (95% CI, 1.4-21.6) of subjects in specific occupations. There was an overall female-predominant prevalence for all subgroup analyses, with a total odds ratio of 1.4 (95% CI, 1.3-1.6). Regarding the severity and presence of medical causes, the total prevalence of moderate fatigue [14.6% (95% CI, 9.8-21.8)] was 2.4-fold that of severe fatigue [6.1% (95% CI, 3.4-11.0)], while unexplained fatigue (fatigue experienced by individuals without any underlying medical condition that can explain the fatigue) was ~2.7-fold that of explained fatigue (fatigue experienced by individuals with a medical condition that can explain the fatigue); as proportion of 40.0% of physical, 8.6% of mental, and 28.4% of mixed cause. Conclusions This study has produced the first comprehensive picture of global fatigue prevalence in the general population, which will provide vital reference data contributing to fatigue-related research, including the prevention of diseases. Systematic review registration Identifier: CRD42021270498.
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Affiliation(s)
- Ji-Hae Yoon
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Na-Hyun Park
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Ye-Eun Kang
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, Daejeon, Republic of Korea
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Chang-Gue Son
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
- Institute of Bioscience and Integrative Medicine, Daejeon University, Daejeon, Republic of Korea
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Almulla AF, Abdul Jaleel AKK, Abo Algon AA, Tunvirachaisakul C, Hassoun HK, Al-Hakeim HK, Maes M. Mood Symptoms and Chronic Fatigue Syndrome Due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron. Brain Sci 2023; 13:1073. [PMID: 37509005 PMCID: PMC10377656 DOI: 10.3390/brainsci13071073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune and neuroinflammatory disease of the central nervous system characterized by peripheral activation of immune-inflammatory pathways which culminate in neurotoxicity causing demyelination of central neurons. Nonetheless, the pathophysiology of relapsing-remitting MS (RRMS)-related chronic fatigue, depression, anxiety, cognitive impairments, and autonomic disturbances is not well understood. OBJECTIVES The current study aims to delineate whether the remitted phase of RRMS is accompanied by activated immune-inflammatory pathways and if the latter, coupled with erythron variables, explain the chronic fatigue and mood symptoms due to RRMS. MATERIAL AND METHODS We recruited 63 MS patients, 55 in the remitted phase of RRMS and 8 with secondary progressive MS, and 30 healthy controls and assessed erythron variables, and used a bio-plex assay to measure 27 serum cytokines. RESULTS A significant proportion of the MS patients (46%) displayed activation of the immune-inflammatory response (IRS) and compensatory immune response (CIRS) systems, and T helper (Th)1 and Th17 cytokine profiles. Remitted RRMS patients showed increased chronic fatigue, depression, anxiety, physiosomatic, autonomic, and insomnia scores, which could partly be explained by M1 macrophage, Th1, Th-17, growth factor, and CIRS activation, as well as aberrations in the erythron including lowered hematocrit and hemoglobin levels. CONCLUSIONS Around 50% of remitted RRMS patients show activation of immune-inflammatory pathways in association with mood and chronic-fatigue-like symptoms. IRS and CIRS activation as well as the aberrations in the erythron are new drug targets to treat chronic fatigue and affective symptoms due to MS.
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Affiliation(s)
- Abbas F Almulla
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
| | | | | | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Hussein K Al-Hakeim
- Department of Chemistry, College of Science, University of Kufa, Kufa 54002, Iraq
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- University of Electronic Science and Technology of China, Chengdu 611731, China
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Alsharif ZI, Mansuri FA, Alamri YA, Alkalbi NA, Almutairi MM, Abu Alkhair AF. The Role of Exercise on Fatigue Among Patients With Multiple Sclerosis in the King Fahad Hospital, Madinah, Saudi Arabia: An Analytical Cross-Sectional Study. Cureus 2023; 15:e42061. [PMID: 37601996 PMCID: PMC10433400 DOI: 10.7759/cureus.42061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic autoimmune disease caused by multiple factors. It can lead to many physical and mental symptoms. Fatigue is one of the most commonly mentioned complaints among MS patients that can affect their quality of life. Physical activity has many benefits for the physical and mental health of patients with MS. Aim To assess the role of exercise on fatigue among patients with multiple sclerosis and identify the relationship between depression, sleep quality, sociodemographic variables, and fatigue. Methods This is an analytical cross-sectional study based on a sample size of 235 patients recruited from the MS clinic at King Fahad Hospital (KFH) in Madinah. The outcome of the study was fatigue among MS patients. Data were collected through telephone calls from February to May 2022 using a structured questionnaire and scales, such as the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire (PHQ2), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed through SPSS version 20 (IBM Corp., Armonk, NY, USA). The correlation coefficient (r), Chi-square tests, and simple and multiple logistic regression were used as found appropriate. Results Out of the total samples, 37.4% were male and 62.6% were female. The median age of patients was 36 years. The prevalence of fatigue was 37% among patients, with a reported median fatigue score of 26. It was found that 63% of the patients were physically inactive; 32.2% were overweight, 14.2% were obese; 63.8% of patients had poor sleep quality. The fatigue score was negatively correlated with the GLTEQ score, but the results were not significant (r=-0.066; P-value (level of significance)=0.335). Nonetheless, a moderately significant correlation was observed between the MFIS and PSQI and MFIS and PHQ2 (r=0.505, P=<0.001 and r=0.520, P=<0.001, respectively). The Chi-square test showed a significant association between fatigue and progressive types of MS, the primary progressive MS (PPMS), secondary progressive MS (SPMS), and relapsing-remitting MS (RRMS) (odds ratio (OR)=4.4; 95% confidence interval (CI): 2.1-8.9), P=<0.001). Depressed patients were 9.7 times more likely to develop fatigue compared to non-depressed patients (P=<0.001). Those with poor sleep quality were 4.6 times more likely to develop fatigue compared to those with good sleep quality (P=<0.001). Fifty-six percent of fatigue among MS patients were predicted by low income, progressive types, unemployment, obesity, depression, and poor sleep quality. Conclusion Fatigue is a major complaint among MS patients. Most of the patients were found to be physically inactive, depressed, and have poor sleep quality. This study found an association between physical inactivity and fatigue, but the results were not significant. There was a significant association between sociodemographic factors like low income and unemployment, poor sleep quality, obesity, progressive types of MS, depression, and fatigue. Encouraging exercise practice and implementing a regular exercise program are needed, along with weight management plans. Further studies and psychological support meetings are required, with the importance of a holistic approach to patient care.
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Affiliation(s)
- Zahrah I Alsharif
- Department of Preventive Medicine, Saudi Board of Preventive Medicine, Ministry of Health, Madinah, SAU
| | - Farah A Mansuri
- Department of Family and Community Medicine, Taibah University, Madinah, SAU
| | - Yasser A Alamri
- Department of Neurology, King Salman Bin Abdulaziz Medical City, Madinah, SAU
| | - Nouf A Alkalbi
- Department of Preventive Medicine, Saudi Board of Preventive Medicine, Ministry of Health, Madinah, SAU
| | - Maha M Almutairi
- Department of Preventive Medicine, Saudi Board of Preventive Medicine, Ministry of Health, Madinah, SAU
| | - Ahmed F Abu Alkhair
- Department of Preventive Medicine, Saudi Board of Preventive Medicine, Ministry of Health, Madinah, SAU
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Aljarallah S, Alkhawajah N, Aldosari O, Alhuqbani M, Alqifari F, Alkhuwaitir B, Aldawood A, Alshenawy O, BaHammam AS. Restless leg syndrome in multiple sclerosis: a case-control study. Front Neurol 2023; 14:1194212. [PMID: 37404942 PMCID: PMC10315471 DOI: 10.3389/fneur.2023.1194212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives This study assessed the prevalence of restless leg syndrome (RLS) among patients with multiple sclerosis (pwMS) and the association between RLS and MS disease duration, sleep disturbance, and daytime fatigue. Methods In this cross-sectional study, we interviewed 123 patients via phone calls using preset questionnaires containing the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria, Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS) diagnostic criteria validated in both Arabic and English. The prevalence of RLS in MS was compared to a group of healthy controls. Results The prevalence of RLS in pwMS, defined by meeting all four requirements included in the IRLSSG diagnostic criteria, was 30.3% compared to 8.3% in the control group. About 27.3% had mild RLS, 36.4% presented with moderate, and the remaining had severe or very severe symptoms. Patients with MS who experience RLS had a 2.8 times higher risk of fatigue compared to pwMS without RLS. pwMS with RLS had worse sleep quality, with a mean difference of 0.64 in the global PSQI score. Sleep disturbance and latency had the most significant impact on sleep quality. Conclusion The prevalence of RLS among MS patients was significantly higher compared to the control group. We recommend educating neurologists and general physicians to increase their awareness of the increasing prevalence of RLS and its association with fatigue and sleep disturbance in patients with MS.
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Affiliation(s)
- Salman Aljarallah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nuha Alkhawajah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Omar Aldosari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Faisal Alqifari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Omar Alshenawy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
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Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
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Salter A. Severity and worsening of fatigue among individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231167079. [PMID: 37101754 PMCID: PMC10123908 DOI: 10.1177/20552173231167079] [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: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/28/2023] Open
Abstract
Background Fatigue is associated with reduced quality of life and social participation, and poor employment outcomes. However, most studies examining fatigue are limited by small sample sizes or short follow-up periods. Objective To characterize the natural history of fatigue. Methods The North American Research Committee on Multiple Sclerosis Registry participants with ≥7 years of longitudinal data between 2004 and 2019 and a relapsing disease course were included. A subset of participants enrolled within 5 years of diagnosis was identified. The Fatigue Performance Scale assessed fatigue and ≥1-point increase in Fatigue Performance Scale sustained at the next survey defined fatigue worsening. Results Of 3057 participants with longitudinal data, 944 were within 5 years of multiple sclerosis diagnosis. Most participants (52%) reported fatigue worsening during follow-up. Median time to fatigue worsening ranged from 3.5 to 5 years at lower levels of index fatigue. Fatigue worsening was associated with lower annual income, increasing disability, lower initial fatigue level, taking injectable disease-modifying therapies and increasing depression levels in the relapsing multiple sclerosis participants. Conclusion Most multiple sclerosis participants early in their disease suffer from fatigue and at least half reported fatigue worsening over time. Understanding factors associated with fatigue may help to identify populations most at risk of fatigue worsening will be informative for the overall management of patients with multiple sclerosis.
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Affiliation(s)
- Amber Salter
- Amber Salter,
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA.
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The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis). IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2022. [DOI: 10.5812/ijpbs-127590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Context: Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged and often occurs between the ages of 20 and 40. In addition to loss of motor, sensory, and cognitive function, patients with MS also experience related symptoms such as depression, anxiety, stress, fatigue, and pain. Objectives: The aim of this study was to systematically and meta-analyze the effectiveness of cognitive-behavioral, mindfulness and acceptance and commitment (CMAC) therapies to improving the psychological symptoms of patients with multiple sclerosis in Iran. Methods: The study was conducted using preferred reporting items for systematic reviews and meta-analysis. This study examined articles published from the beginning until November 20, 2021 in Persian and English on cognitive and behavioral interventions performed in Iran, in order to influence psychological symptoms for people with multiple sclerosis. Articles relevant to research were screened in external (Google Scholar, PubMed, Scopus, Science Direct, Web of Science) and internal databases (Sid, Magiran, Ganj, Irandoc, Civilica). The quality of the included RCTs was assessed using the Cochrane guideline risk of bias tool. The results were expressed in terms of mean difference (MD) and the corresponding 95% confidence interval. Data analyses were performed by RevMan5.4. Results: In the first stage of the search, 792 articles were obtained. After reviewing the titles of the articles, 701 articles were discarded due to irrelevance and duplication and 91 articles remained. Finally, 21 studies were selected by reviewing the abstracts and considering the inclusion criteria. Compared with the control group, the standardized mean difference (SMD) estimate depression was 1.60 (2.27, 0.93), for anxiety 0.49 (0.80, 0.19), for stress 0.97 (1.70, 0.23) and for fatigue 0.19 (2.75, 1.25) had a positive effect; But no significant effect on pain reduction equal to 0.49 (2.21, 1.23) was not found. Conclusions: The meta-analysis in the posttest showed that the effects of CMAC were considerable on reducing depression, anxiety, stress, and fatigue, but the effects were not notable for pain mitigation. Future high quality studies with follow-up evaluations are needed to support the effects of CMAC on reducing symptoms in people with multiple sclerosis and to evaluate the interventional features that enhance and maintain the effects.
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12
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Royer N, Coates K, Aboodarda SJ, Camdessanché JP, Millet GY. How is neuromuscular fatigability affected by perceived fatigue and disability in people with multiple sclerosis? Front Neurol 2022; 13:983643. [DOI: 10.3389/fneur.2022.983643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Whereas fatigue is recognized to be the main complaint of patients with multiple sclerosis (PwMS), its etiology, and particularly the role of resistance to fatigability and its interplay with disability level, remains unclear. The purposes of this review were to (i) clarify the relationship between fatigue/disability and neuromuscular performance in PwMS and (ii) review the corticospinal and muscular mechanisms of voluntary muscle contraction that are altered by multiple sclerosis, and how they may be influenced by disability level or fatigue. Neuromuscular function at rest and during exercise are more susceptible to impairement, due to deficits in voluntary activation, when the disability is greater. Fatigue level is related to resistance to fatigability but not to neuromuscular function at rest. Neurophysiological parameters related to signal transmission such as central motor conduction time, motor evoked potentials amplitude and latency are affected by disability and fatigue levels but their relative role in the impaired production of torque remain unclear. Nonetheless, cortical reorganization represents the most likely explanation for the heightened fatigability during exercise for highly fatigued and/or disabled PwMS. Further research is needed to decipher how the fatigue and disability could influence fatigability for an ecological task, especially at the corticospinal level.
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13
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Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illn 2022; 18:441-457. [PMID: 34515530 PMCID: PMC9397391 DOI: 10.1177/17423953211039783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
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Affiliation(s)
- Sungha Kim
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Ying Xu
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Kelly Dore
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Rebecca Gewurtz
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Nadine Larivière
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Lori Letts
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
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14
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Sobczak AM, Bohaterewicz B, Ceglarek A, Zyrkowska A, Fafrowicz M, Slowik A, Wnuk M, Marona M, Nowak K, Zur-Wyrozumska K, Marek T. Brain Under Fatigue – Can Perceived Fatigability in Multiple Sclerosis Be Seen on the Level of Functional Brain Network Architecture? Front Hum Neurosci 2022; 16:852981. [PMID: 35620154 PMCID: PMC9128356 DOI: 10.3389/fnhum.2022.852981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fatigue is one of the most common symptoms of multiple sclerosis (MS), significantly affecting the functioning of the patients. However, the neural underpinnings of physical and mental fatigue in MS are still vague. The aim of our study was to investigate the functional architecture of resting-state networks associated with fatigue in patients with MS. Methods The sum of 107 high-functioning patients underwent a resting-state scanning session and filled out the 9-item Fatigue Severity Scale (FSS). Based on the FSS score, we identified patients with different levels of fatigue using the cluster analysis. The low-fatigue group consisted of n = 53 subjects, while the high-fatigue group n = 48. The neuroimaging data were analyzed in terms of functional connectivity (FC) between various resting-state networks as well as amplitude of low-frequency fluctuation (ALFF) and fractional amplitude of low-frequency fluctuations (fALFF). Results Two-sample t-test revealed between-group differences in FC of posterior salience network (SN). No differences occurred in default mode network (DMN) and sensorimotor network (SMN). Moreover, differences in fALFF were shown in the right middle frontal gyrus and right superior frontal gyrus, however, no ALFF differences took place. Conclusion Current study revealed significant functional network (FN) architecture between-group differences associated with fatigue. Present results suggest the higher level of fatigue is related to deficits in awareness as well as higher interoceptive awareness and nociception.
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Affiliation(s)
- Anna Maria Sobczak
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- *Correspondence: Anna Maria Sobczak,
| | - Bartosz Bohaterewicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Anna Ceglarek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Aleksandra Zyrkowska
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Magdalena Fafrowicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Collegium Medicum, Kraków, Poland
- Department of Neurology, University Hospital in Krakow, Kraków, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Collegium Medicum, Kraków, Poland
- Department of Neurology, University Hospital in Krakow, Kraków, Poland
| | - Monika Marona
- Department of Neurology, Jagiellonian University Collegium Medicum, Kraków, Poland
- Department of Neurology, University Hospital in Krakow, Kraków, Poland
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Collegium Medicum, Kraków, Poland
- Department of Neurology, University Hospital in Krakow, Kraków, Poland
| | - Kamila Zur-Wyrozumska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
- Department of Neurology, 5th Military Hospital, Kraków, Poland
| | - Tadeusz Marek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
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15
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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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16
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AlSaeed S, Alkhawajah NM, Ayyash M, Aljarallah S, Alarieh R, Abu-Shaheen A. Assessment of factors associated with depression and anxiety among pwMS in Saudi Arabia. BMC Neurol 2022; 22:120. [PMID: 35337277 PMCID: PMC8948449 DOI: 10.1186/s12883-022-02632-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory chronic disease that is characterized by an increased prevalence of adverse mental health outcomes in patients with MS (pwMS). The main aim of this study is to investigate the factors of depression and anxiety in pwMS in the Kingdom of Saudi Arabia (KSA). Materials and methods This is a cross-sectional study conducted in KSA during the period from March to June 2020. Participants were recruited from the Neuroimmunology clinics in King Fahad Medical City (KFMC) and King Saud University medical city (KSUMC)in Riyadh City, KSA. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. Fatigue Severity Scale (FSS) was used to measure fatigue in pwMS. A simple random sampling technique was utilized to select participants and the data were analyzed using SPSS v.24.0. Results A total of 529 participants participated in this study with a response rate of 53.1%. The prevalences of anxiety and depression were 35.3% and 19.7%, respectively. The findings also revealed that depression was more likely to be significantly affected by being male, low education, unemployment, physical inactivity, and fatigue but the anxiety was significantly affected by region, unemployment, short duration since last MS relapse, physical inactivity, and fatigue. Conclusion Anxiety and depression are not uncommon in pwMS. Given their impact on the lives of affected patients, early detection and management of these symptoms and their associated factors are crucial.
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Affiliation(s)
| | | | - Mohsen Ayyash
- School of Mathematical Sciences, Universiti Sains Malaysia, USM, 11800, Penang, Malaysia
| | | | - Rola Alarieh
- Department of Nuerology, King Fahad Medical City, Riyadh, Saudi Arabia
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17
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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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18
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Oliver-Hall H, Ratschen E, Tench CR, Brooks H, Constantinescu CS, Edwards L. Pet Ownership and Multiple Sclerosis during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312683. [PMID: 34886405 PMCID: PMC8656830 DOI: 10.3390/ijerph182312683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Background: Multiple sclerosis (MS) is associated with lower quality of life, reduced social participation, and decreased self-efficacy. The COVID-19 pandemic has had documented effects on the health and wellbeing of people with and without MS. Previous research has demonstrated the positive impact pets can have for people living with long-term conditions. Objectives: To explore the rates of pet ownership and pet attachment in people living with MS and pet ownership associations with quality of life, satisfaction with social roles, and self-efficacy scores; and to explore the effects of the COVID-19 outbreak on people’s perceived relationships with their pets. Materials and Methods: A postal questionnaire was distributed to members of a local MS Register and a control group of people without MS. The questionnaire assessed quality of life, satisfaction with social roles, self-efficacy, the perceived roles of pets, and pet-related concerns experienced during the COVID-19 pandemic. Results: No apparent difference in attachment to pets was found between the patient and control groups. Pet ownership and level of attachment were not associated with differences in quality of life or self-efficacy scores in people living with MS. Using multiple regression analysis, pet ownership was associated with a decrease in satisfaction with participation in social roles, but with the estimated effect being small compared to having a diagnosis of MS or being unemployed. Most participants reported that pets had positive roles during the pandemic, and the most reported pet-related concern was access to veterinary treatment. Conclusion: Pet owners both with and without MS reported subjective benefits to their wellbeing from pet ownership during COVID-19, although analysis suggested that pet ownership was associated with a reduction in satisfaction with social roles. The study had several limitations and suggestions are made for future work.
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Affiliation(s)
- Holly Oliver-Hall
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK;
| | - Elena Ratschen
- Department of Health Sciences, University of York, York YO10 5DD, UK;
| | - Christopher R. Tench
- Mental Health & Clinical Neurosciences, Clinical Neurology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK; (C.R.T.); (C.S.C.)
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Cris S. Constantinescu
- Mental Health & Clinical Neurosciences, Clinical Neurology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK; (C.R.T.); (C.S.C.)
- Department of Neurology, Cooper University Hospital, Camden, NJ 08103, USA
| | - Laura Edwards
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK;
- Division of Rehabilitation Medicine, Florence Nightingale Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road, Derby DE1 2QY, UK
- Correspondence:
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19
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Sanborn V, Lace J, Gunstad J, Galioto R. Considerations regarding noncredible performance in the neuropsychological assessment of patients with multiple sclerosis: A case series. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 30:458-467. [PMID: 34514920 DOI: 10.1080/23279095.2021.1971229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Determining the validity of data during clinical neuropsychological assessment is crucial for proper interpretation, and extensive literature has emphasized myriad methods of doing so in diverse samples. However, little research has considered noncredible presentation in persons with multiple sclerosis (pwMS). PwMS often experience one or more factors known to impact validity of data, including major neurocognitive impairment, psychological distress/psychogenic interference, and secondary gain. This case series aimed to illustrate the potential relationships between these factors and performance validity testing in pwMS. Six cases from an IRB-approved database containing pwMS referred for neuropsychological assessment at a large, academic medical center involving at least one of the above-stated factors were identified. Backgrounds, neuropsychological test data, and clinical considerations for each were reviewed. Interestingly, no pwMS diagnosed with major neurocognitive impairment was found to have noncredible performance, nor was any patient with noncredible performance in the absence of notable psychological distress. Given the variability of noncredible performance and multiplicity of factors affecting performance validity in pwMS, clinicians are strongly encouraged to consider psychometrically appropriate methods for evaluating validity of cognitive data in pwMS. Additional research aiming to elucidate base rates of, mechanisms begetting, and methods for assessing noncredible performance in pwMS is imperative.
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Affiliation(s)
| | - John Lace
- Cleveland Clinic, Neurological Institute, Section of Neuropsychology, Cleveland, OH, USA
| | - John Gunstad
- Psychological Sciences, Kent State University, Kent, OH, USA.,Brain Health Research Institute, Kent State University, Kent, OH, USA
| | - Rachel Galioto
- Cleveland Clinic, Neurological Institute, Section of Neuropsychology, Cleveland, OH, USA.,Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland, OH, USA
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20
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Fleming KM, Herring MP, Coote SB, Tindall D. Participant experiences of eight weeks of supervised or home-based Pilates among people with multiple sclerosis: a qualitative analysis. Disabil Rehabil 2021; 44:5549-5556. [PMID: 34151667 DOI: 10.1080/09638288.2021.1939446] [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: 10/21/2022]
Abstract
PURPOSE An exploratory qualitative study investigating participants' experiences of a feasibility study of supervised and home-based Pilates. METHODS All 10 females who participated in an eight-week supervised (n = 4) or home-based Pilates (n = 6) program were invited and agreed to be interviewed. Data were collected via semi-structured interviews and researcher observations of participant experiences. Data were analysed using codebook thematic analysis framework. RESULTS Two domain summaries emerged: (1) the suitability of home-based Pilates in particular for this population. Participants indicated that supervised and home-based Pilates was a safe, intensity-appropriate, and implementable exercise method to improve mental health outcomes among persons with multiple sclerosis (PwMS), and (2) the benefits experienced by PwMS while participating in Pilates. Home-based Pilates reduced both exercise participation and accessibility barriers commonly experienced by PwMS. Furthermore, PwMS reported improvements in mental health outcomes following Pilates, in both exercise environments. CONCLUSIONS PwMS reported experiencing improved mood following regular Pilates training and indicated that home-based in particular reduced barriers regularly experienced by this population. Results support Pilates as a feasible exercise modality providing potential mood improvements among PwMS. Future appropriately powered home-based randomised controlled trials to further explore the effects of Pilates training on mental health among PwMS with minimal-to-mild mobility disability are warranted.Implications for RehabilitationParticipants in this study described the mental health benefits experienced from engaging in Pilates, a non-traditional exercise modality.Home-based Pilates overcame participatory and accessibility barriers to exercise among people with multiple sclerosis (MS).Participants valued that Pilates was low intensity and did not exacerbate fatigue.Home-based Pilates is a feasible exercise method for people with MS with minimal-to-mild mobility disability.
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Affiliation(s)
- Karl M Fleming
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Matthew P Herring
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Susan B Coote
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,School of Allied Health, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Daniel Tindall
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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21
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Pandit L, Mustafa S. Epidemiology and clinical features of demyelinating disorders in India. ACTA ACUST UNITED AC 2021. [DOI: 10.1111/ncn3.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lekha Pandit
- Center for Advanced Neurological Research KS Hegde Medical Academy Nitte University Mangalore India
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22
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Madroñero-Miguel B, Cuesta-García C. [Effects of rehabilitation on fatigue, disability and quality of life in people with multiple sclerosis: A systematic review]. Rehabilitacion (Madr) 2021; 55:38-48. [PMID: 32441265 DOI: 10.1016/j.rh.2020.01.007] [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: 08/16/2019] [Revised: 12/31/2019] [Accepted: 01/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the effectiveness of rehabilitation, highlighting the role of Occupational Therapy, in people with multiple sclerosis, in terms of disability, fatigue and quality of life. MATERIALS AND METHODS A literature search was carried out in the BVS, Cochrane, OT-Seeker, PubMed and PEDro databases. INCLUSION CRITERIA Controlled clinical trials published between January 2011 and April 2019 in Spanish or English with a score of ≥5 on the PEDro scale whose purpose was rehabilitation through the use of assistive technology, skills training, vestibular rehabilitation, behaviour modification, therapeutic education or specific Occupational Therapy interventions. RESULTS A total of 16 studies (1,279 subjects) were included. Rehabilitation improved patients' fatigue and disability and slightly enhanced their quality of life. CONCLUSIONS Rehabilitation can provide benefits to the performance of people with multiple sclerosis by reducing their perceived fatigue and disability. LIMITATIONS The heterogeneity of the sample, the type and duration of the interventions and variability of the instruments for measuring results.
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Affiliation(s)
- B Madroñero-Miguel
- Departamento de Terapia Ocupacional y Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, España.
| | - C Cuesta-García
- Departamento de Terapia Ocupacional y Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, España; Grupo de Investigación Occupational Thinks, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Madrid, España
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Rzepka M, Toś M, Boroń M, Gibas K, Krzystanek E. Relationship between Fatigue and Physical Activity in a Polish Cohort of Multiple Sclerosis Patients. ACTA ACUST UNITED AC 2020; 56:medicina56120726. [PMID: 33371510 PMCID: PMC7767485 DOI: 10.3390/medicina56120726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
Background and objectives: Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). It can be defined as a subjective lack of physical and mental energy. The aim of this study was to evaluate the frequency and severity of fatigue in patients with MS and its relationship with overall physical activity and disease-related disability. Materials and Methods: The study included 100 patients with a clinical relapsing-remitting form of MS. Patients with severe depression were excluded. Neurological impairment was rated using the Expanded Disability Status Scale (EDSS). Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS), with FSS scores greater than 36 indicating patients with fatigue. Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ) and categorized on three levels: low, moderate, and high, using standard metabolic equivalents (MET). Results: The average FSS and MFIS scores were (mean ± SD) 31.3 ± 15.2 and 30.1 ± 17.0, respectively. The mean EDSS score was 2.5 ± 1.5. 42%. Patients were classified as fatigued based on FSS. Fatigued patients had higher mean EDSS scores than non-fatigued (3.0 ± 1.6 vs. 2.2 ± 1.4, respectively, p = 0.002). Low, moderate, and high levels of physical activity were reported in 35%, 20%, and 45% of patients, respectively. Higher scores of fatigue in FSS and MFIS were inversely correlated with the intensity of physical activity (r = -0.38, p < 0.001 and r = -0.33, p < 0.001, respectively). Conclusions: In patients with MS, fatigue is a common symptom. Patients with lower physical activity and greater MS-related disability have a higher severity of fatigue, which negatively affects cognitive, psychosocial, and physical functioning.
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Affiliation(s)
- Michalina Rzepka
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (M.T.); (K.G.)
| | - Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (M.T.); (K.G.)
| | - Michał Boroń
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Katarzyna Gibas
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (M.T.); (K.G.)
| | - Ewa Krzystanek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (M.T.); (K.G.)
- Correspondence:
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Kister I, Bacon T, Cutter GR. A longitudinal study of symptom botheration in Multiple Sclerosis. Mult Scler Relat Disord 2020; 46:102585. [PMID: 33296981 DOI: 10.1016/j.msard.2020.102585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is well documented that ambulatory disability in MS worsens over time, but there is a dearth of information on symptom evolution in other domains commonly affected by MS. METHODS SymptoMScreen (SyMS) is a validated tool for assessing symptom severity in 12 domains commonly affected by MS. Patients who attended two specialized MS centers filled out SyMS at each visit. We included in the study patients with neurologist-diagnosed MS who completed two SyMS questionnaires separated at least 12 months. We used the first and final assessment and adjusted for time on study, baseline SyMS score, age, sex, race, MS type, disability strata, and site. Changes over time were also examined using Markov chain estimates of moving from one level of botheration to another for each domain over 1-year periods. RESULTS A total of 1,014 MS patients met the inclusion criteria. Mean composite SyMS score was 1.4 (±1.16) at baseline and increased by 0.084 (±0.73) points during 21.0 (±5.5) months of followup (p<0.0001). The initial mean composite SyMS score correlated strongly with the final mean composite SyMS score (r=0.81). Individual domain SyMS scores at baseline were highest for fatigue: 2.2 (±1.7), and lowest for vision: 1.1 (±1.3) and dexterity: 1.1 (±1.4). Small but significant increases during followup were seen in dexterity, bladder, vision, and pain domains, while significant decreases were seen in anxiety and sensory domains. We observed a high degree of inter-individual variability in symptom severity with the more extreme scores tending to resolve over time. CONCLUSIONS Symptom botheration increases modestly year-to-year, as would be expected in a slowly progressive disease that evolves over decades. Initial symptom burden strongly correlated with final symptom burden, but there was a high degree of individual variability in symptom severity.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY; NJ, USA.
| | - Tamar Bacon
- NYU Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY; NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL
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Depression mediates the relationship between fatigue and mental health-related quality of life in multiple sclerosis. Mult Scler Relat Disord 2020; 47:102620. [PMID: 33242724 DOI: 10.1016/j.msard.2020.102620] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fatigue is among the most prevalent symptoms for people with multiple sclerosis (pwMS) and is significantly detrimental to mental health-related (mental) quality of life (QoL). We examined the role of depression and physical activity as mediators in the fatigue-QoL relationship in pwMS. METHODS Using baseline cross-sectional data from an international cohort of 2,104 pwMS, characteristics of fatigue and mental QoL, measured by Fatigue Severity Scale and MSQOL-54 respectively, were assessed using linear and log-binomial regression. Structural Equation Models (SEM) were used to explore the mediating roles of depression and physical activity between fatigue and mental QoL. RESULTS The median mental QoL score was 71.9/100. The mean fatigue score was 41.5/63, with 65.6% participants having clinically significant fatigue. In the SEM evaluating depression as a mediator of the fatigue-QoL relationship, mental QoL was 14.72 points lower (95% CI: -16.43 -13.01, p<0.001) in participants with clinically significant fatigue, of which depression accounted for 53.0% (-7.80, 95% CI: -9.03 -6.57, p<0.001). In the SEM evaluating physical activity as a mediator of the fatigue-QoL relationship, mental QoL was 10.89 points lower (95% CI: -12.47, -9.32, p<0.001) in participants with clinically significant fatigue, of which the indirect effect via physical activity accounted for only 4.4% (-0.48, 95% CI: -0.81, -0.14, p=0.005). CONCLUSION Depression accounted for the majority of the fatigue-mental QoL relationship when modelled as a mediator, while physical activity had only a minor role. Our findings may inform the development of treatments for reducing the impacts of fatigue and improving mental QoL in pwMS.
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Tutuncu M, Ertem DH, Soysal A. Prevalence And Impact Of Myofascial Pain Syndrome In Relapsing-Remitting Multiple Sclerosis And The Effects Of Local Anesthetic Injections For Short-Term Treatment. Mult Scler Relat Disord 2020; 46:102528. [PMID: 33022587 DOI: 10.1016/j.msard.2020.102528] [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: 07/01/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have suggested that patients with multiple sclerosis (MS) who have comorbid musculoskeletal disorders have a lower quality of life. However, there is limited data on the relationship between myofascial pain syndromes (MFPS) and MS. The aim of the study to investigate the frequency and impact of MFPS in patients with MS, to evaluate the effect of local anesthetic injections for short-term treatment. METHOD Three hundred ninety-eight patients with MS patients were evaluated during the study period. Patients meeting the inclusion criteria investigated for MFPS. Patients with active myofascial trigger points received local anesthetics blocks monthly and attended at least 4 follow-up appointments. Multiple Sclerosis Quality of Life Instrument 54 (MSQO-54), Beck Depression Scale, The Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale, and Fatigue Impact Scale were administered before and after injections. The primary outcome was a 50 % reduction in pain intensity. RESULTS One hundred thirty-seven patients with relapsing remitting MS (RRMS) met the inclusion criteria. MFPS was present in 70 of 137 (51.9 %) patients. Thirty-one patients participated; however, 25 patients completed the study. From 3-months post injections, a significant decrease in NPRS was found (p<0.001); in addition, the scores of MSQO-54 have significantly increased and the scores of fatigue impact and severity tests were decreased (p<0.001). No serious complications were noted. CONCLUSION The results of this study support that MFPS can be experienced in patients with RRMS. Local anesthetic injections for trigger points may be an effective, tolerable, and inexpensive treatment for this patient group and contribute to significant reductions in pain severity scores and increase the quality of life.
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Affiliation(s)
- Mesude Tutuncu
- University Of Health Sciences İstanbul Bakırköy Prof. Dr. Mazhar Osman Psychıatrıc Traınıng And Research Hospıtal, Department of Neurology, Istanbul, Turkey.
| | - Devrimsel Harika Ertem
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Pain Management, Istanbul, Turkey.
| | - Aysun Soysal
- University Of Health Sciences İstanbul Bakırköy Prof. Dr. Mazhar Osman Psychıatrıc Traınıng And Research Hospıtal, Department of Neurology, Istanbul, Turkey.
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Malekzadeh A, Bader I, van Dieteren J, Heijboer AC, Beckerman H, Twisk JWR, de Groot V, Teunissen CE. Diurnal Cortisol Secretion Is Not Related to Multiple Sclerosis-Related Fatigue. Front Neurol 2020; 10:1363. [PMID: 32063881 PMCID: PMC6999765 DOI: 10.3389/fneur.2019.01363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
Some evidence supports the involvement of the hypothalamic–pituitary–adrenal axis (HPA axis) with multiple sclerosis (MS)-related fatigue. In this study, we determined the relation of HPA-axis function with primary fatigue in MS patients in the longitudinal treating fatigue in a MS cohort. MS patients from the TREeating FAtigue in MS (TREFAMS) research program that consists of three randomized controlled trials to study the effects of aerobic training, energy conservation management, and cognitive behavioral therapy on MS-related fatigue were included. The HPA-axis functioning was determined at baseline, the end of treatment (16 weeks) and after 52 weeks. The cortisol awakening response (CAR) and night-time cortisol levels were analyzed. Fatigue was measured with the fatigue subscale of the Checklist Individual Strength (CIS20r fatigue). There was no relationship between CAR and night-time cortisol parameters with CIS20r fatigue scores. Neither of the treatments influenced CAR and night-time cortisol parameters, with the exception of an effect in the energy conservation management treatment group on the CAR surge increase over 52 weeks (β = −114.8, p = 0.007, 95% CI = −197.6, −31.9). Our data suggest that the diurnal cortisol secretion is not associated with MS-related fatigue. This indicates that MS-related fatigue is not attributed to diurnal cortisol secretion and is likely caused by other disease mechanisms.
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Affiliation(s)
- Arjan Malekzadeh
- Neurochemistry Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Ilona Bader
- Neurochemistry Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Julia van Dieteren
- Neurochemistry Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Annemieke C Heijboer
- Endocrinology Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands
| | - Heleen Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, Netherlands.,MS Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, Netherlands.,MS Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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Bass AD, Van Wijmeersch B, Mayer L, Mäurer M, Boster A, Mandel M, Mitchell C, Sharrock K, Singer B. Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vsMS Survey. Int J MS Care 2019; 22:158-164. [PMID: 32863783 DOI: 10.7224/1537-2073.2018-087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The vsMS survey was conducted to better understand the negative effects of fatigue, cognitive impairment, emotional burden, and decreased physical functioning on the personal, professional, and social lives of individuals with multiple sclerosis (MS). Methods The vsMS survey was an online survey conducted in Australia, Canada, France, Italy, Spain, the United Kingdom, and the United States that assessed the impact of MS on individuals' daily activities, emotional well-being, relationships, and employment. Results The survey included 1075 participants with relapsing-remitting MS. Almost 42% of participants reported that their ability to perform and manage daily activities had worsened during the previous 2 years. More than 50% reported limitations in daily activities due to fatigue, physical weakness, problems with balance/coordination, heat/cold sensitivity, memory problems, numbness/tingling, trouble concentrating, impaired movement/muscle stiffness, and impaired sleeping. Participants also reported a negative effect on emotional and social factors, including self-esteem, general outlook, well-being, maintaining/starting relationships, ability to progress in their career/keep their job, and ability to cope with life roles. Conclusions These data highlight the importance of addressing the impact of MS and the social and emotional disease burdens on daily activities when planning the care of patients with MS.
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Lee CH, Giuliani F. The Role of Inflammation in Depression and Fatigue. Front Immunol 2019; 10:1696. [PMID: 31379879 PMCID: PMC6658985 DOI: 10.3389/fimmu.2019.01696] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Depression and fatigue are conditions responsible for heavy global societal burden, especially in patients already suffering from chronic diseases. These symptoms have been identified by those affected as some of the most disabling symptoms which affect the quality of life and productivity of the individual. While many factors play a role in the development of depression and fatigue, both have been associated with increased inflammatory activation of the immune system affecting both the periphery and the central nervous system (CNS). This is further supported by the well-described association between diseases that involve immune activation and these symptoms in autoimmune disorders, such as multiple sclerosis and immune system activation in response to infections, like sepsis. Treatments for depression also support this immunopsychiatric link. Antidepressants have been shown to decrease inflammation, while higher levels of baseline inflammation predict lower treatment efficacy for most treatments. Those patients with higher initial immune activation may on the other hand be more responsive to treatments targeting immune pathways, which have been found to be effective in treating depression and fatigue in some cases. These results show strong support for the hypothesis that depression and fatigue are associated with an increased activation of the immune system which may serve as a valid target for treatment. Further studies should focus on the pathways involved in these symptoms and the development of treatments that target those pathways will help us to better understand these conditions and devise more targeted treatments.
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Affiliation(s)
- Chieh-Hsin Lee
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Fabrizio Giuliani
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Khazaei M, Karevan A, Taheri M, Ghafouri-Fard S. Comparison of the effects of amantadine and ondansetron in treatment of fatigue in patients with multiple sclerosis. Clin Transl Med 2019; 8:20. [PMID: 31263986 PMCID: PMC6603072 DOI: 10.1186/s40169-019-0239-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis (MS) is a common neurological disorder with a variety of manifestations including fatigue. Fatigue may interfere with daily work and activities. Different pharmacological and non-pharmacological methods have been used for treatment of this symptom in MS patients. In this study, the effect of ondansetron and amantadine in the treatment of fatigue was compared. Methods In this randomized clinical trial, 53 MS patients with fatigability were enrolled (mean age ± standard deviation: 54.00 ± 7.88, Female/male ratio: 45/8). Patients were referred to Imam Clinic and Sina Hospital, Hamadan, Iran. Patients were assessed using the Fatigue Severity Scale (FSS) questionnaire. Patients were randomly assigned to either the amantadine or ondansetron treatment groups and received treatments in a crossover manner. The severity of fatigue was measured using FSS questionnaire in four stages (beginning and end of each regimen). Data were analyzed using SPSS software version 16. Results The mean and standard deviation of patients’ fatigue scores before treatment were 43.07 ± 10.36 and 43.22 ± 9.67 in the amantadine and ondansetron group, respectively. These scores were 37.36 ± 7.87 and 40.00 ± 8.94 after treatment in the amantadine and ondansetron group, respectively. Both drugs significantly decreased the fatigue severity of patients (P < 0.001). There was no statistically significant difference between two regimens in terms of the mean score of fatigue before and after treatment and the frequency of complications. However, when ranking the severity of fatigue (mild, moderate, severe), fatigue reduction after intervention in the amantadine group was significantly higher than ondansetron (P = 0.026). Conclusion Both amantadine and ondansetron reduce fatigue in MS patients, but the efficacy of amantadine in reducing the MS-associated fatigue is greater than that of ondansetron.
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Affiliation(s)
- Mojtaba Khazaei
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ashkan Karevan
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Moumdjian L, Moens B, Maes PJ, Van Nieuwenhoven J, Van Wijmeersch B, Leman M, Feys P. Walking to Music and Metronome at Various Tempi in Persons With Multiple Sclerosis: A Basis for Rehabilitation. Neurorehabil Neural Repair 2019; 33:464-475. [PMID: 31079541 DOI: 10.1177/1545968319847962] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Mobility dysfunctions are prevalent in persons with multiple sclerosis (PwMS), thus novel rehabilitation mechanisms are needed toward functional training. The effect of auditory cueing is well-known in Parkinson's disease, yet the application of different types of auditory stimuli at different tempi has not been investigated yet. Objectives. Investigating if PwMS, compared with healthy controls (HC), can synchronize their gait to music and metronomes at different tempi during walking and the effects of the stimuli on perceived fatigue and gait. Additionally, exploring if cognitive impairment would be a factor on the results. Methods. The experimental session consisted of 2 blocks, music and metronomes. Per block, participants walked 3 minutes per tempi, with instructions to synchronize their steps to the beat. The tempi were 0%, +2%, +4% +6%, +8%, +10% of preferred walking cadence (PWC). Results. A total of 28 PwMS and 29 HC participated. On average, participants were able to synchronize at all tempi to music and metronome. Higher synchronization was obtained for metronomes compared with music. The highest synchronization for music was found between +2% and +8% of PWC yet pwMS perceived less physical and cognitive fatigue walking to music compared with metronomes. Cognitive impaired PwMS (n = 9) were not able to synchronize at tempi higher than +6%. Conclusion. Auditory-motor coupling and synchronization was feasible in HC and PwMS with motor and cognitive impairments. PwMS walked at higher tempi than their preferred walking cadence, and lower fatigue perception with music. Coupling walking to music could be a promising functional walking training strategy.
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Affiliation(s)
- Lousin Moumdjian
- 1 Hasselt University, REVAL Rehabilitation Research Center, Hasselt, Belgium.,2 Gent University, IPEM Institute of Psychoacoustics and Electronic Music, Gent, Belgium
| | - Bart Moens
- 2 Gent University, IPEM Institute of Psychoacoustics and Electronic Music, Gent, Belgium
| | - Pieter-Jan Maes
- 2 Gent University, IPEM Institute of Psychoacoustics and Electronic Music, Gent, Belgium
| | | | - Bart Van Wijmeersch
- 1 Hasselt University, REVAL Rehabilitation Research Center, Hasselt, Belgium.,4 Rehabilitation & MS Centre Overpelt, Belgium
| | - Marc Leman
- 2 Gent University, IPEM Institute of Psychoacoustics and Electronic Music, Gent, Belgium
| | - Peter Feys
- 1 Hasselt University, REVAL Rehabilitation Research Center, Hasselt, Belgium
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Salemi G, Vazzoler G, Ragonese P, Bianchi A, Cosentino G, Croce G, Gangitano M, Portera E, Realmuto S, Fierro B, Brighina F. Application of tRNS to improve multiple sclerosis fatigue: a pilot, single-blind, sham-controlled study. J Neural Transm (Vienna) 2019; 126:795-799. [PMID: 31054015 DOI: 10.1007/s00702-019-02006-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Abstract
We evaluated the effects of transcranial random noise stimulation (tRNS) on fatigue in 17 subjects with relapsing-remitting multiple sclerosis with low physical disability. Two different patient groups underwent real or sham stimulation for 10 days, targeting the primary motor cortex of the dominant side or contralateral to the most compromised limb. In the 'real group', beneficial effects were observed using the Modified Fatigue Impact Scale (p = 0.04; physical subscale: p = 0.03), the subscales 'change in health' (p = 0.006) and 'role limitations due to physical problems' (p = 0.001) of the Multiple Sclerosis Quality of Life-54, and by assessing the patient impression of perceived fatigue (p = 0.005).
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Affiliation(s)
- Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Giulia Vazzoler
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.
| | - Alessia Bianchi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Giuseppe Cosentino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Croce
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Erika Portera
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Sabrina Realmuto
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Brigida Fierro
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Gaetano La Loggia 1, 90129, Palermo, Italy
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Differential multiple sclerosis treatment allocation between Australia and New Zealand associated with clinical outcomes but not mood or quality of life. Mult Scler Relat Disord 2019; 30:25-32. [DOI: 10.1016/j.msard.2019.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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Lazo-Gomez R, Velázquez GDLLG, Mireles-Jacobo D, Sotomayor-Sobrino MA. Mechanisms of neurobehavioral abnormalities in multiple sclerosis: Contributions from neural and immune components. Clin Neurophysiol Pract 2019; 4:39-46. [PMID: 30911699 PMCID: PMC6416523 DOI: 10.1016/j.cnp.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/21/2018] [Accepted: 01/10/2019] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis-related neurobehavioral abnormalities are one of the main components of disability in this disease. The same pathological processes that explain demyelination periods and neurodegeneration also allow the comprehension of neurobehavioral abnormalities. Inflammation in the central nervous system caused by cells of the immune system, especially lymphocytes, and by resident cells, such as astrocytes and microglia, directly modulate neurotransmission and synaptic physiology, resulting in behavioral changes (such as sickness behavior) and amplifying the degenerative mechanisms that occur in multiple sclerosis. In addition, neuronal death caused by glutamate-mediated excitotoxicity, alterations in GABAergic, serotonergic, and dopaminergic neurotransmission, and the mechanisms of axon damage are of foremost importance to explain the reduction in brain volume and the associated cognitive decline. Neuroinflammation and neurodegeneration are not isolated phenomena and various instances of interaction between them have been described. This presents attractive targets for the development of therapeutic strategies for this neglected component of multiple sclerosis related disability.
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Affiliation(s)
- Rafael Lazo-Gomez
- Neuroscience franchise, Novartis Pharma México, Calzada de Tlalpan 1779, San Diego Churubusco, 04120 Coyoacán, CDMX, Mexico
| | | | - Diego Mireles-Jacobo
- Neuroscience franchise, Novartis Pharma México, Calzada de Tlalpan 1779, San Diego Churubusco, 04120 Coyoacán, CDMX, Mexico
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Adamopoulou F, Alikari V, Zyga S, Tsironi M, Tzavella F, Giannakopoulou N, Theofilou P. The Effect of Fatigue and Pain Self- Efficacy on Health-Related Quality of Life Among Patients with Multiple Sclerosis. Mater Sociomed 2019; 31:40-44. [PMID: 31213954 PMCID: PMC6511379 DOI: 10.5455/msm.2019.31.40-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Health-related quality of life is a major issue among patients with Multiple sclerosis (MS). Aim: To explore the effect of fatigue and pain self-efficacy on health-related quality of life among patients with MS. Methods: Between March and May 2018, 85 MS patients from a large Hospital of Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001. Results: Fatigue might predict the dimension of quality of life “Function” while Pain Self-Efficacy might, also, predict the dimension of quality of life “Interpersonal”. A strong correlation was found between the dimensions of quality of life “Well-being” and “Transcendent” and between “Interpersonal” and Pain Self-Efficacy. The total score of fatigue was strongly correlated with Physical Fatigue and very strongly correlated with Mental Fatigue. Conclusion: Fatigue and Pain Self-Efficacy are important predictors of the dimensions of quality of life among patients with MS. Pain in MS has to be taken into serious consideration in every patient with MS.
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Affiliation(s)
| | - Victoria Alikari
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Maria Tsironi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Fotini Tzavella
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | | | - Paraskevi Theofilou
- Ministry of Health, Athens, Greece.,Institution for Counseling & Psychological Studies, Athens, Greece
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Goyal V. Multiple Sclerosis in India. Ann Indian Acad Neurol 2018; 21:95-97. [PMID: 30122832 PMCID: PMC6073974 DOI: 10.4103/aian.aian_296_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation. Curr Neurol Neurosci Rep 2017; 16:98. [PMID: 27662896 DOI: 10.1007/s11910-016-0700-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Signs and symptoms of multiple sclerosis are usually attributed to demyelinating lesions in the spinal cord or cerebral cortex. The hypothalamus is a region that is often overlooked yet controls many important homeostatic functions, including those that are perturbed in multiple sclerosis. In this review we discuss how hypothalamic dysfunction may contribute to signs and symptoms in people with multiple sclerosis. While dysfunction of the hypothalamic-pituitary-adrenal axis is common in multiple sclerosis, the effects and mechanisms of this dysfunction are not well understood. We discuss three hypothalamic mechanisms of fatigue in multiple sclerosis: (1) general hypothalamic-pituitary-adrenal axis hyperactivity, (2) disordered orexin neurotransmission, (3) abnormal cortisol secretion. We then review potential mechanisms of weight dysregulation caused by hypothalamic dysfunction. Lastly, we propose future studies and therapeutics to better understand and treat hypothalamic dysfunction in multiple sclerosis. Hypothalamic dysfunction appears to be common in multiple sclerosis, yet current studies are underpowered and contradictory. Future studies should contain larger sample sizes and standardize hormone and neuropeptide measurements.
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Fatigue in Multiple Sclerosis: Is it related to cytokines and hypothalamic-pituitary-adrenal axis? Mult Scler Relat Disord 2017. [DOI: 10.1016/j.msard.2017.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tai chi for health benefits in patients with multiple sclerosis: A systematic review. PLoS One 2017; 12:e0170212. [PMID: 28182629 PMCID: PMC5300172 DOI: 10.1371/journal.pone.0170212] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS). After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL) and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients.
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Ebrahimi A, Eftekhari E, Etemadifar M. Effects of whole body vibration on hormonal & functional indices in patients with multiple sclerosis. Indian J Med Res 2016; 142:450-8. [PMID: 26609037 PMCID: PMC4683830 DOI: 10.4103/0971-5916.169210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background & objectives: Multiple sclerosis (MS) is a neurodegenerative disease, which affects the patients’ mobility, and exercise training is considered to be beneficial for these patients. The aim of this study was to determine the effects of 10 wk of low intensity exercise and whole body vibration (WBV) training on fatigue, quality of life, functional and physical indices, and serum levels of ghrelin, leptin, and testosterone in MS patients. Methods: Thirty four MS patients with mild to moderate disability were recruited and randomly divided into two groups, the training group (n=17) and control group (n=17). Patients in the training group did low intensity exercise and WBV training programme three times a week for 10 wk. The control group continued their routine life. Intended variables like expanded disability status scale (EDSS), fatigue, quality of life, functional and physical indices consisted of balance, walking speed, functional mobility, functional muscle endurance, and walking endurance, and serum levels of ghrelin, leptin, and testosterone were measured before and after the protocol. Results: Thirty subjects completed the study (23 females, 7 males; mean age =38.80 ± 9.50 yr). Statistical analysis demonstrated that EDSS in the WBV training group was significantly decreased (P=0.01), balance (P=0.01), and walking endurance significantly increased (P=0.01) in MS patients (P<0.05). Interpretation & conclusions: The results suggest that low intensity exercise and WBV training have some beneficial impact on functional and physical indices of MS patients.
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Affiliation(s)
| | - Elham Eftekhari
- Department of Physical Education & Sport Sciences, Najafabad Branch, Islamic Azad University, Isfahan, Iran
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Patejdl R, Penner IK, Noack TK, Zettl UK. Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration. Autoimmun Rev 2016; 15:210-20. [DOI: 10.1016/j.autrev.2015.11.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
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Fragoso YD, Gomes S, Goncalves MVM, Machado SCN, Morales RDR, Oliveira FTMD, Oliveira JFD, Olmo NRS, Parolin MKF, Siquineli F, Stoney PN. Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:828-33. [DOI: 10.1590/0004-282x20150117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/01/2015] [Indexed: 11/22/2022]
Abstract
Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.
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Affiliation(s)
| | - Sidney Gomes
- Hospital Beneficencia Portuguesa, Brazil; Hospital Paulistano, Brazil
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