Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The rationale for the use of interferon (IFN) in the treatment of multiple sclerosis (MS) is based on its recognized antiviral and immunomodulating actions. The pathogenesis of MS is generally believed to be due to an immunologic response in a genetically predisposed individual, localized within the CNS white matter, and triggered by exposure to an environmental agent such as a virus. In a randomized, double-blind, placebo-controlled, crossover trial of systemic natural alpha IFN in 24 patients with exacerbating-remitting MS, patients with a strictly exacerbating-remitting course showed a reduction in the frequency and severity of exacerbations, while those with exacerbations superimposed upon a chronic progressive course did not benefit from this treatment, primarily because of side effects that included fever, malaise, and fatigue. Since the performance of this study, it has been shown that the preparation of natural human alpha interferon used in this trial may lead to side effects in some individuals through the production of immune complexes (ICs). These ICs were due to the generation of antibodies reacting with residual Sendai virus proteins used in the preparation of the IFN, and retained in the final formulation. The encouraging results of this and other preliminary studies of alpha or beta IFN but not gamma IFN therapy in MS, coupled with the current availability of more highly purified interferon preparations, warrants further clinical trials of IFN in MS, focusing on beta interferon preparations in particular.
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PMID:Systemic interferon therapy of multiple sclerosis: the pros. 313 75

Multiple sclerosis patients with motor involvement of the lower extremities and the trunk often experience exertional dyspnea and generalized or leg fatigue on walking, and their walking performance is reduced. It has recently been suggested that a high energy cost of walking (Cw) may be an important contributing factor to the observed dyspnea and fatigue. The purpose of this study was to determine which factors influence Cw. Clinical tests were used to assess the major alterations of the motor system. Thirty-three patients (mean age 41 years, mean maximal speed 2.8 km/h, range 1.2 to 6.2 km/h) in a stable phase of their disease were examined. Cost of walking (mean +/- SE) at 1.8 km/h was 0.287 +/- 0.018 ml 02.kg-1.m-1 (normal value 0.163 +/- 0.007, p less than 0.001). A multivariate regression analysis showed that Cw was significantly related to spasticity of the lower extremities, whereas lower extremity and truncal weakness did not contribute to the observed high Cw.
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PMID:Increased energy cost of walking in multiple sclerosis: effect of spasticity, ataxia, and weakness. 317 52

Fatigue is a frequent symptom in multiple sclerosis (MS) that can interfere with a patient's daily functioning. The cause of MS fatigue, its clinical characteristics, and its relationship to other symptoms remain poorly understood. Structured interviews were conducted with 32 patients with MS and 33 normal healthy adults. Fatigue proved to be both more frequent and more severe among the patients with MS. Multiple sclerosis fatigue was unrelated to either depression or global impairment. Multiple sclerosis fatigue appears to be a distinct clinical entity, often disabling, that can be distinguished from normal fatigue, affective disturbance, and neurologic impairment.
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PMID:Fatigue in multiple sclerosis. 278 80

Reaction times (RT) were measured in 39 multiple sclerosis (MS) patients and 25 healthy controls, before and after comprehensive neuropsychological assessment lasting at least 4 h. The assessment required prolonged mental effort, which was assumed to induce fatigue. Simple and disjunctive RT were measured for visual and auditory stimuli. RT before and after prolonged effort were significantly longer in MS than in control subjects (with exception of auditory RT). This effect was related to disease duration and to simultaneous presence of brainstem, cerebellar and/or pyramidal signs. Age did not significantly contribute to the explanation of RT increase. In female patients, increasing distribution of functional lesions in the central nervous system was related with greater RT increase than in male patients. RT of MS and controls changed after prolonged mental effort and effort-related fatigue was experienced subjectively. Yet no differences in direction or degree of change in RT were found between controls and ambulant patients with stable MS who apparently had resources to overcome fatigue.
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PMID:Reaction time in ambulant multiple sclerosis patients. Part I. Influence of prolonged cognitive effort. 338 33

Pulmonary functions at rest and cardiorespiratory responses to low speed treadmill walking were investigated in 24 patients (P), (mean age, 38 years; range, 20 to 56 yr) with multiple sclerosis and compared with a control group (C). The following parameters were significantly (p less than 0.01) different in P from those in C. At rest in P, the residual volume to TLC ratio was 21% greater, respiratory muscle strength index was 28% lower, and heart rate (HR) was 11 beats/min-1 higher. During treadmill walking at a given speed, HR, minute ventilation (VE), and O2 consumption (VO2) were all elevated (37 to 119%). In addition, the energy cost of walking, per unit distance, above resting, was 2 to 3 times greater, with mean +/- SEM values for P of 0.299 +/- 0.019 and C of 0.147 +/- 0.006 at 2 km/h and 0.275 +/- 0.042 and 0.110 +/- 0.005 (for P and C, respectively) ml O2 kg-1 m-1 at 4 km/h; the HR and VE/VO2, also when referred to a given VO2, were higher. We conclude that a high energy cost of walking may be an important contributing factor to breathlessness and leg fatigue in patients with multiple sclerosis. Poor conditioning, altered cardiovascular control, and respiratory muscle weakness may play additional roles.
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PMID:Energy cost of walking and exertional dyspnea in multiple sclerosis. 377 62

This chapter has reviewed some of the methodological and theoretical issues in research linking the social environment to medical illnesses. The second part of the chapter has focused on three specific neurological entities to examine evidence for a possible association between neurological illness and life stress. There is some suggestion that certain vulnerable epileptic patients can experience convulsions in response to acute emotional upheaval or certain types of cognitive challenges. More commonly, it is probable that social stress and emotional tension can produce lowering of seizure threshold by increasing levels of fatigue and disrupting sleep. The latter factor, in particular, is known to lower seizure threshold. In the case of stroke, several dramatic cases of intracranial hemorrhage have been related to disastrous life circumstances. A general association between life stress and stroke has yet to be established. The case for a link between life events and onset of exacerbation of multiple sclerosis seems stronger. Events which produce emotional upset seem capable of worsening symptoms in patients with existing disease, and several studies have reported unusual life stresses in the period preceding onset of symptoms in this disorder.
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PMID:The social environment and neurological disease. 389 69

We carried out a double blind control study of fatigue in 32 patients with multiple sclerosis, comparing amantadine hydrochloride 100 mg twice a day and placebo. On amantadine 31% had marked improvement; 15.6% moderate improvement; 15.6% mild improvement; and 36.5% unchanged. On placebo, none noted marked improvement; one claimed moderate improvement on either amantadine or placebo. 18.7% reported mild improvement on placebo; and most of them had similar or more response to amantadine. No patient selected placebo over amantadine at the end of the trial. Overall improvement was seen in 62.5% of patients on amantadine and 21.8% on placebo. Additional experience up to two years suggests continued benefit but common and important side-effects.
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PMID:Amantadine therapy for fatigue in multiple sclerosis. 390 84

A new provocative test for early diagnosis of Multiple Sclerosis (MS) is presented. It is based on the recording of pattern visual evoked responses (VER) before and after exposing patients to a high luminance background. All 13 patients tested showed a biphasic enlargement of the P100 wave after bleaching even in the absence of an increased P100 latency. This biphasic enlargement can be interpreted as a fatigue or a saturation-like phenomenon as can be seen psychophysically. The saturation-like effect involves probably only affected fibers. No change in the VER was observed in 20 Normal observers examined in the same way. This test can be usefully employed in dubious cases of MS where routine VER do not provide reliable results.
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PMID:Provocative test for early diagnosis of multiple sclerosis. 407 57

Visual evoked potential (VEP) abnormality is widely used as an objective indication of visual pathophysiology in the diagnosis of multiple sclerosis. One major limitation of this test is that VEP abnormality is not specific to multiple sclerosis. In an attempt to explore ways of making the VEP test more specific, changes were measured in VEPs caused by superimposing upon the VEP stimulus either a flicker or a moving pattern. The rationale was to test for visual fatigueability, since it is known that some demyelinated axons fatigue rapidly. Of 10 patients with multiple sclerosis, 90% showed VEP fatigue, while none fatigued in the groups of 10 patients with glaucoma and 10 with Parkinson's disease. Fatigue is, however, not completely specific for multiple sclerosis, since three of 10 patients with ocular hypertension showed VEP fatigue.
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PMID:Visual fatigue and visual evoked potentials in multiple sclerosis, glaucoma, ocular hypertension and Parkinson's disease. 608 42

A questionnaire study on sexual problems occurring with multiple sclerosis (MS) was carried out with 217 patients who had previously participated in the University of Washington Multiple Sclerosis Project. More than one-half of the participating subjects were ambulatory without aids and nearly 75% did not use a wheelchair. Sexual dysfunction was reported by 56% of the women and 75% of the men. Among the women, the most commonly occurring sexual symptoms (in decreasing order of frequency) were fatigue, decreased sensation, decreased libido, decreased frequency or loss of orgasm and difficulty with arousal. Men reported the most common problem was erectile dysfunction, followed by decreased sensation, fatigue, decreased libido, and orgasmic dysfunction. Although loss of mobility, weakness and depression are not significantly associated with sexual dysfunction, spasticity and bladder dysfunction appear to be associated. However, even where these symptoms were absent, sexual dysfunction was perceived in at least 50% of the cases. The data indicate that sexual dysfunction can be anticipated in at least 50% of the women and about 75% of the men affected by MS, regardless of mobility level. It is most likely to occur in patients with spasticity and bladder dysfunction.
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PMID:Sexual dysfunction in multiple sclerosis. 670 86


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