Assessment of Fatigue in Multiple Sclerosis

Abstract

One of the most frequent symptoms in multiple sclerosis (MS) is fatigue. It has a major impact on quality of life as well as on professional activity. Even nowadays it is still unclear what constitutes an adequate assessment of the perceived fatigue.

The following overview will discuss different possibilities to assess fatigue with the help of questionnaires, clinical interviews or the objective measurement of cognitive performance. Furthermore, a structured guideline for the assessment of fatigue will be proposed. Clinical criteria for MS related fatigue include the main symptoms, their everyday relevance, the possible causal relation with the cause of disease (the underlying MS), as well as an exclusion of other possible somatic or psychological reasons. It is recommended to use the “Würzburger Erschöpfungs-Inventar bei Multipler Sklerose (WEIMUS)” (English: Würzburg Fatigue Inventory for Multiple Sclerosis) and especially the “Fatigue Scale for Motor and Cognitive Functions” (FSMC), as these questionnaires distinguish between motor and cognitive fatigue and due to the larger number of research studies using the FSMC. Moreover, the presence of depression, quality of sleep and daytime sleepiness should be assessed. In addition, general cognitive performance as well as performance during monotonous stimulation (vigilance) should be assessed. This may be relevant for the evaluation of a patient’s capacity to work, and for determining prognosis, as there are indications for a relation to relapse frequency, a change from a clinically isolated syndrome (CIS) to an MS diagnosis with an increase of brain atrophy.

All in all, it can be said, that despite the growing convergence of diagnostic criteria, the available studies of the objective as well as the subjective assessment of fatigue are still not sufficient and further research is needed.

• References

• 1 Hadjimichael O, Vollmer T, Oleen-Burkey M. et al. Fatigue characteristics in multiple sclerosis: the North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes 2008; 6: 100
• 2 Kister I, Bacon TE, Chamot E. et al. Natural history of multiple sclerosis symptoms. Int J MS Care 2013; 15: 146-158
• 3 Krupp LB, Christodoulou C. Fatigue in multiple sclerosis. Curr Neurol Neurosci Rep 2001; 1: 294-298
• 4 Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: Proposal for a unified taxonomy. Neurology 2013; 80: 409-416
• 5 Kluger BM, Herlofson K, Chou KL. et al. Parkinson's disease-related fatigue: A case definition and recommendations for clinical research. Mov Disord 2016; 31: 625-631
• 6 Flachenecker P, Kumpfel T, Kallmann B. et al. Fatigue in multiple sclerosis: A comparison of different rating scales and correlation to clinical parameters. Mult Scler 2002; 8: 523-526
• 7 Learmonth YC, Dlugonski D, Pilutti LA. et al. Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale. J Neurol Sci 2013; 331: 102-107
• 8 Amtmann D, Bamer AM, Noonan V. et al. Comparison of the psychometric properties of two fatigue scales in multiple sclerosis. Rehabil Psychol 2012; 57: 159-166
• 9 Krupp LB, LaRocca NG, Muir-Nash J. et al. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-1123
• 10 Tellez N, Rio J, Tintore M. et al. Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS?. Multiple Scler 2005; 11: 198-202
• 11 Penner IK, Raselli C, Stocklin M. et al. The Fatigue Scale for Motor and Cognitive Functions (FSMC): Validation of a new instrument to assess multiple sclerosis-related fatigue. Mult Scler 2009; 15: 1509-1517
• 12 Guidelines MSCP . Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Washington D.C.: Paralyzed Veterans of America; 1998
• 13 Khan F, Amatya B, Galea M. Management of fatigue in persons with multiple sclerosis. Front Neurology 2014; 5: 177
• 14 Flachenecker P, Muller G, Konig H. et al. Fatigue bei Multipler Sklerose: Validierung des "Würzburger Erschöpfungs-Inventar bei Multipler Sklerose (WEIMUS). Nervenarzt 2006; 77: 165-166 168–170, 172–164
• 15 Sander C, Eling P, Hanken K. et al. The impact of ms-related cognitive fatigue on future brain parenchymal loss and relapse: A 17-month follow-up Study. Front Neurol 2016; 7: 155
• 16 Flachenecker P, Muller G, Konig H. et al. "Fatigue" in multiple sclerosis. Development and and validation of the "Wurzburger Fatigue Inventory for MS". Nervenarzt 2006; 77: 165-166 168–170, 172–164
• 17 Johansson S, Ytterberg C, Hillert J. et al. A longitudinal study of variations in and predictors of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2008; 79: 454-457
• 18 Svenningsson A, Falk E, Celius EG. et al. Natalizumab treatment reduces fatigue in multiple sclerosis. Results from the TYNERGY trial; a study in the real life setting. PloS one 2013; 8: e58643
• 19 Moller F, Poettgen J, Broemel F. et al. HAGIL (Hamburg Vigil Study): A randomized placebo-controlled double-blind study with modafinil for treatment of fatigue in patients with multiple sclerosis. Mult Scler 2011; 17: 1002-1009
• 20 Lehmann P, Eling P, Kastrup A. et al. Self-reported sleep problems, but not fatigue, lead to decline in sustained attention in MS patients. Mult Scler 2013; 19: 490-497
• 21 Hanken K, Eling P, Hildebrandt H. Is there a cognitive signature for MS-related fatigue?. Mult Scler 2015; 21: 376-381
• 22 DeLuca J. Fatigue, cognition, and mental effort. In: Fatigue as a window to the brain. Cambridge: MIT Press; 2005: 37-57
• 23 Morrow SA, Weinstock-Guttman B, Munschauer FE. et al. Subjective fatigue is not associated with cognitive impairment in multiple sclerosis: Cross-sectional and longitudinal analysis. Mult Scler 2009; 15: 998-1005
• 24 Bol Y, Duits AA, Hupperts RM. et al. The psychology of fatigue in patients with multiple sclerosis: a review. J Psychosom Res 2009; 66: 3-11
• 25 Pierard C, Liscia P, Chauveau F. et al. Differential effects of total sleep deprivation on contextual and spatial memory: Modulatory effects of modafinil. Pharmacol Biochem Behav 2011; 97: 399-405
• 26 Neumann M, Sterr A, Claros-Salinas D. et al. Modulation of alertness by sustained cognitive demand in MS as surrogate measure of fatigue and fatigability. J Neurol Sci 2014; 340: 178-182
• 27 Weinges-Evers N, Brandt AU, Bock M. et al. Correlation of self-assessed fatigue and alertness in multiple sclerosis. Mult Scler 2010; 16: 1134-1140
• 28 Claros-Salinas D, Bratzke D, Greitemann G. et al. Fatigue-related diurnal variations of cognitive performance in multiple sclerosis and stroke patients. J Neurol Sci 2010; 295: 75-81
• 29 Claros-Salinas D, Dittmer N, Neumann M. et al. Induction of cognitive fatigue in MS patients through cognitive and physical load. Neuropsychological rehabilitation 2013; 23: 182-201
• 30 Hildebrandt H, Hahn HK, Kraus JA. et al. Memory performance in multiple sclerosis patients correlates with central brain atrophy. Mult Scler 2006; 12: 428-436
• 31 Flachenecker P. Fatigue bei Multipler Sklerose. Nervenheilkunde 2015; 34: 685-689
• 32 Claros-Salinas D. Zurück in den Beruf-subjektive und objektive Perspektiven berufsorientierter Neurorehabilitation. Neurol Rehabil 2012; 18: 275-290
• 33 Rotstein D, O'Connor P, Lee L. et al. Multiple sclerosis fatigue is associated with reduced psychomotor vigilance. Can J Neurol Sci 2012; 39: 180-184
• 34 Walker LA, Berard JA, Berrigan LI. et al. Detecting cognitive fatigue in multiple sclerosis: method matters. J Neurol Sci 2012; 316: 86-92
• 35 Beck AT, Ward CH, Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571
• 36 Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003; 1: 29
• 37 Buysse DJ, Reynolds 3rd CF, Monk TH. et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213
• 38 Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540-545
• 39 Sehle A, Vieten M, Sailer S. et al. Objective assessment of motor fatigue in multiple sclerosis: The Fatigue index Kliniken Schmieder (FKS). J Neurol 2014; 261: 1752-1762
• 40 Runia TF, Jafari N, Siepman DA. et al. Fatigue at time of CIS is an independent predictor of a subsequent diagnosis of multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86: 543-546
• 41 Yaldizli O, Atefy R, Gass A. et al. Corpus callosum index and long-term disability in multiple sclerosis patients. J Neurol 2010; 257: 1256-1264
• 42 Marrie RA, Fisher E, Miller DM. et al. Association of fatigue and brain atrophy in multiple sclerosis. J Neurol Sci 2005; 228: 161-166
• 43 Voelter HUHH, Kastrup A. MS-assoziierte Fatigue – Welche Immuntherapie hilft?. Akt Neurol 2016; 43: 511-518