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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite decades of aggressive research into the cause and cure of multiple sclerosis (MS), a direct management strategy remains lacking. As research continues, patients who strive for an improved quality of life may attain it through the improved management of symptoms. Symptoms occur in MS as a consequence of loss of myelin (primary symptoms), as the result of primary symptoms (secondary symptoms), and because of psychological dysfunction associated with MS (tertiary symptoms). This paper emphasizes the recent developments in the management of primary symptoms including visual loss, weakness, spasticity, urinary and sexual dysfunction, and fatigue. The adjective multiple emphasizes the numerous potential symptoms of MS. It is through their management that people with MS may lead happier, more productive lives until a cause and cure are found.
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PMID:Symptomatic therapy of multiple sclerosis. 808 16

We report a randomized, double-blind, placebo-controlled pilot trial of systemic high-dose recombinant interferon alfa-2a (rIFNA) in 20 patients with relapsing-remitting (RR) multiple sclerosis (MS). Patients received 9 million IU rIFNA (n = 12) or placebo (n = 8) intramuscularly every other day for 6 months. Clinical exacerbations or new or enlarging lesions on serial MRI occurred in two of 12 rIFNA-treated and in seven of eight placebo-treated patients (p < 0.005). There was only one enlarging MRI lesion in the rIFNA group, whereas 27 new or enlarging lesions were present in the placebo group (p < 0.01). Baseline lymphocyte interferon gamma production of 19.10 +/- 7.12 IU/ml significantly decreased to 3.03 +/- 0.66 IU/ml (p < 0.04) in the rIFNA group, whereas production was unchanged in the placebo group. The rIFNA was tolerated without dropouts or serious side effects, but fever, malaise, fatigue (interfering with daily activities in two patients), and leukopenia occurred frequently. Neuropsychological tests excluded neurotoxicity. High-dose systemic rIFNA might reduce clinical and MRI signs of disease activity in RR MS and should be investigated in larger trials.
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PMID:Chronic systemic high-dose recombinant interferon alfa-2a reduces exacerbation rate, MRI signs of disease activity, and lymphocyte interferon gamma production in relapsing-remitting multiple sclerosis. 814 6

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.
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PMID:Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. 814 58

The psychopathological status of 25 inpatients suffering from clinically definite multiple sclerosis (MS) according to Poser criteria was assessed by using standardized methods (Structured Clinical Interview for DSM-III-R, Inpatient Multidimensional Psychiatric Scale, Hamilton and Montgomery-Asberg Depression Rating Scales and the Structured Interview for the Diagnosis of Alzheimer Dementia and Dementias of other Aetiology (SIDAM). Magnetic resonance (MRT) (0.5 T; T2-weighted sequence) of the brain was analysed by measuring the ventricular brain ration (VBR), the area of the corpus callosum (CC) and the extension of hyperintense lesions of the brainstem, the temporal lobes and the brain at all. Six of 25 (24%) of these moderately disabled patients (mean Extended Disability Score (EDSS) 3.3) were diagnosed to suffer from depressive mood disorder (major depression or dysthymia); 2 were demented. In correlation analysis, depression was unrelated to age, gender, duration of illness, status of disability (EDSS) or the results of cognitive assessment. No relationship between the depression scores and the different MRT measures could be identified. The presence or absence of gadolinium enhancement was also uncorrelated to depressive symptoms. Fatigue as measured by the Fatigue Severity Scale was unrelated to depression or subcortical brain atrophy (increased VBR) but significantly correlated to the area of hyperintense MRT changes in brainstem and midbrain. Cognitive impairment (decreased SIDAM scores) was correlated to the total area of hyperintense MRT changes of the brain parenchyma. The type of clinical course (relapsing-remitting vs chronic progredient) was not found to influence the affective or cognitive state in our MS patient's sample.
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PMID:Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. 817 61

Fatigue is a complaint often made by multiple sclerosis patients. Description of the symptom varies from patient to patient. This paper proposes a descriptive and quantitative scale for assessing fatigue in these patients. Eighty patients classified as having Poser's type I multiple sclerosis were asked to respond to a questionnaire on the characteristics and variations in fatigue (character, intensity, frequency, periodicity, consequences, mitigating and aggravating factors). Based on the questionnaire, a scale was designed to assess the symptom's spontaneity, nature, severity, frequency of occurrence and existence of Uhthoff's phenomenon. A formula is given for arriving at a global score in the range of 0-17. The scale was then validated by asking two different examiners to apply it prospectively to 32 patients and then calculating the correlation with another quantitative scale of fatigue (Krupp's FSS). The proposed scale had a significant reproducibility (kappa > 0.53) as well as evident correlation with the other scale applied (p < 0.01). The proposed scale is a clear improvement toward a standardized description of fatigue. It is easy to apply, validated and offers advantages over exclusively quantitative scales.
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PMID:[Proposal of a new scale for assessing fatigue in patients with multiple sclerosis]. 820 66

Amantadine has found use primarily as an antiviral agent and in the symptomatic treatment of parkinsonism. However, the use of amantadine for the subjective alleviation of fatigue in multiple sclerosis and in the treatment of agitated aggressive behavior in the traumatic brain injured patient has also been described. Side effects of amantadine are primarily related to the central nervous system and include hallucinations, confusion, and nightmares. Toxic manifestations include acute psychosis, coma, cardiovascular toxicity, and death. Amantadine toxicity is a particular problem in patients with renal insufficiency because 90% of an oral dose is excreted unchanged in the urine. We present a case of amantadine-induced coma in a patient with multiple sclerosis and end-stage renal disease. Moreover, this degree of amantadine toxicity was profoundly apparent at a drug level usually not associated with such a severe presentation.
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PMID:Amantadine-induced coma. 821 67

The aim of this study was to investigate whether fatigue and sleep disturbances in multiple sclerosis (MS) patients might be due to disrupted circadian sleep wake regulation. Actigraphy and a multiple sleep latency test (MSLT) were performed in 16 MS patients with both prominent sleep complaints and fatigue. Actigraphy scores did not differ from control values, whereas sleep onset latency values were altered in subgroups of MS patients. No evidence was found for a generalized circadian disturbance in MS patients.
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PMID:Fatigue, sleep disturbances and circadian rhythm in multiple sclerosis. 841 88

In this past year, there has only been modest progress in the search for an effective treatment for multiple sclerosis and its complications, although a number of carefully designed trials are in progress. No treatment predictably slows the course of active disease. The marginal benefits previously claimed for azathioprine have been strengthened by a meta-analysis of previously published work. Methylprednisolone may have a minor role in the treatment of very severe, acute optic neuritis but prednisone use may predispose patients to recurrent optic neuritis. 4-Aminopyridine and 3,4-diaminopyridine may prove useful for the symptomatic treatment of some multiple sclerosis patients; pemoline may be an alternative to amantadine for the control of fatigue; and acetazolamide may be an alternative to carbamazepine and phenytoin for the treatment of painful tonic spasms.
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PMID:Clinical trials in multiple sclerosis. 848 65

We studied the effect of fatigue within a 10 degree visual field measured with automated perimetry in normal volunteers (10 eyes), patients who have recovered from optic neuritis with multiple sclerosis (10 eyes), and patients with glaucoma (10 eyes). Using an Octopus 201, the visual field was tested with Program 61, which was centered (0.0), and 25 test locations were determined three times. Eight of the 25 points were selected for the evaluation. The mean sensitivity of the eight points was compared among the three measurements. Normal subjects and patients with optic neuritis showed no effect of fatigue within the 10 degrees visual field, but the patients with glaucoma indicated fatigue during the third measurement.
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PMID:Fatigue effect within 10 degrees visual field in automated perimetry. 848 56

Chronic fatigue syndrome (CFS), a controversial clinical entity characterized by severe fatigue and constitutional symptoms, has been associated with a variety of psychiatric disorders. To further understand the psychiatric profile of CFS, the authors compared patients with CFS, multiple sclerosis (MS), and major depression by using diagnostic interviews and self-report measures of Axis I disorders and personality disorders. CFS patients differed from patients with major depression, with significantly less depression and fewer personality disorders. Compared with MS patients, CFS patients did not differ with regard to personality disorders. However, they did have significantly more frequent current depression than MS patients, particularly following onset of their illness.
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PMID:A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression. 850 39


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