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

Fifteen epileptic patients with mild seizures of the narcolepsy type were treated with a combination of succinimide (average dose 750 mg) and dipropylacetate (average dose 1,200 mg), medication with each drug alone having brought no success. The combination of drugs stopped the seizures in eleven patients, in three they almost stopped and in one the frequency of seizures was halved. An E.E.G. was recorded in twelve, with improvement in each. Side effects occurred in five patients (nausea, vomiting, singultus and fatigue), but the drug had to be discontinued in only one instance.
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PMID:[Treatment of atypical absences with a combination of succinimide and dipropylacetate (author's transl)]. 80 2

In summary, the evaluation of the tired patient requires an awareness of the various meanings of tiredness. Furthermore, it is important to differentiate normal sleepiness that is a product of circadian rhythm variation in vigilance from pathologic sleepiness. Sleepiness that results from faulty habits, e.g., altered sleep scheduling, drugs, or sleep restriction, can be readily discerned with the aid of a sleep-wake diary. Because subjective sleepiness is often unappreciated, especially in patients with sleep apnea, methods that rely on self-ratings of the severity of sleepiness, e.g., visual analogue scale, 10-cm line, or SSS may not coincide with performance tasks, observer assessments, or such physiologic methods as the MSLT. Less commonly employed neurophysiologic methods include pupillometry and averaged evoked potentials. On the other hand, the MSLT is commonly used for the detection of physiologic sleepiness. Moreover, it is helpful in evaluating response to treatment. A variation of the MSLT, the MWT, which instructs the individual to remain awake, does not discriminate between sleep onset times for wakefulness and the MSLT for sleepiness in normal subjects. The MWT may be useful for the assessment of treatment responses for excessive daytime sleepiness, e.g., narcolepsy, and for determining the frequency of daytime sleep episodes. The differences that have been observed between behavioral measures and physiologic measures of sleepiness suggest that these techniques assess different aspects of sleepiness. HLA typing (DR2, DQw1) has been shown to be a useful method for corroborating narcolepsy-cataplexy, but the antigens are neither specific for the disorder nor for sleepiness alone.
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PMID:Evaluation of daytime sleepiness. 152 10

Modafinil, a novel stimulant which has several remarkable features that distinguish it from other stimulants, has been developed by Lafon, a French pharmaceutical company. Unlike the amphetamines, for example, modafinil is reported to have minimal peripheral side effects at therapeutic doses. It also appears to have a low abuse potential, does not interfere with normal sleep, and does not seem to produce tolerance. It improves vigilance especially in sleep-deprived subjects. It has been used clinically for up to 3 years in the treatment of narcolepsy and idiopathic hypersomnia. It could be an ideal replacement for amphetamine in short-term operations in which fatigue might threaten the successful completion of a mission. We recommend that military laboratories experienced in studying sustained performance include modafinil or perhaps a more selective alpha 1 receptor agonist in their investigations.
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PMID:Modafinil: the unique properties of a new stimulant. 167 50

This study attempted to evaluate the validity of self-reports of memory deficits in narcoleptics by comparing the scores of these patients with the scores of matched control subjects on standardized tests of memory function. After completing a short interview designed to elicit qualitative information about memory difficulties, 30 narcoleptic subjects and 30 control subjects completed the Wechsler Memory Scale (WMS), Rey-Auditory Verbal Learning Test, the Rey Complex Figure Test, Strub and Black's List of Letters, and the Symbol Digits Modalities Test (SDMT). In addition, the Profile of Mood States (POMS) was used to detect variation in performance due to anxiety or fatigue. Continuous polygraphic recordings were obtained during the testing to detect any changes in alertness. Subjects with narcolepsy experienced more difficulty in maintaining attention than control subjects, as evidenced by significantly more perseveration errors (p less than or equal to 0.01) on Strub and Black's List of Letters. Despite differences in their ability to sustain attention, there were no significant differences between narcoleptic and control subjects on measures of concentration (Digit Span from the WMS, and the SDMT). Furthermore, there was no objective evidence of memory impairment when the scores of narcoleptic and control subjects were compared on standardized tests of immediate and delayed recall, as well as on tests of verbal and visual memory.
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PMID:Tests of memory in narcoleptics. 230 68

Bright white light (500lx) for 4 h/day was applied to seven narcoleptic patients (age 47-65 years, mean 55 years). The effects of the light on the disturbed sleep-wake cycle in narcoleptics were investigated by the measurement of the following parameters: (1) excessive daytime sleepiness and sustained attention (multiple sleep latency test); (2) rest-activity cycles; (3) self-ratings (mood, anxiety, tiredness); (4) urinary cycles of 6-OH melatonin sulphate and cortisol; (5) sleep EEG. Treatment with bright light showed neither objective nor subjective changes in the clinical symptoms of narcolepsy. While similar "dosage" light applications can phase shift human circadian rhythms and improve depression and hypersomnia in winter depression, it is not an appropriate treatment for narcolepsy.
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PMID:Bright white light does not improve narcoleptic symptoms. 275 54

Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue. The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy). Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.
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PMID:Alpha-delta sleep in patients with a chief complaint of chronic fatigue. 797 34

Sleep and fatigue characteristics were evaluated in 72 patients who met major criteria for the chronic fatigue syndrome (CFS), 57 multiple sclerosis (MS) patients preselected for fatigue complaints, and 40 healthy controls. Using previously validated rating scales, CFS patients had significant elevations in fatigue and sleep disturbance compared to the MS and healthy control groups. To confirm these subjective measures, polysomnography was carried out in a subgroup of CFS patients who included sleep disturbance as one of their symptoms on initial clinical interview. In 10 of 16 (62.5%) polysomnography revealed clinically significant and potentially treatable sleep abnormalities. Their sleep disorders included periodic movement disorder (4), excessive daytime sleepiness (3), apnea (2), and narcolepsy (1). We conclude that subjective sleep disturbance is common in CFS and some CFS patients may have objective sleep disorders.
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PMID:Sleep disturbance in chronic fatigue syndrome. 851 58

Since the discovery of melatonin as the principal hormone of the pineal gland in 1963, scientists have come to recognize that melatonin is a "master hormone" involved in the control of circadian rhythms and other biological functions. Although little is known about the influence of the pineal gland on motor control, important clues may be obtained by considering the pattern of melatonin secretion during the sleep cycles and particularly during rapid eye movement (REM) sleep when melatonin plasma levels are at their lowest. Since REM sleep is characterized by the occurrence of profound atonia which results in an almost complete paralysis of striated muscles, it is suggested that there might be a causal relationship between inhibition of melatonin secretion during REM sleep and the development of REM sleep atonia. This relationship is supported by the findings that melatonin regulates the activity of brainstem serotonin (5-HT) neurons which characteristically cease to fire during REM sleep and which faciliate the development of REM sleep atonia. Moreover, as the muscular atonia of REM sleep is physiologically and pharmacologically indistinguishable from cataplexy, it is possible that the pineal gland also influences to the development of cataplexy. Cataplexy is an ancillary symptom of narcolepsy and also occurs in multiple sclerosis (MS). In fact, it is believed that several of the neurological symptoms experienced by patients with MS such as weakness in the legs, feeling of collapsing knees, paroxysmal sudden falling, weakness in the neck, extreme fatigue, intermittent paresthesias, slurring of speech and intermittent blurring of vision, which often are exacerbated by stress and other emotional influences, may reflect the manifestations of cataplexy. Thus, several of the clinical features of MS may reflect a dissociated state of wakefulness and sleep and may improve by the administration of anticataplectic drugs.
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PMID:The pineal gland, cataplexy, and multiple sclerosis. 886 24

To measure vigilance disorders in healthy normals or in patients (narcolepsy, sleep apnea syndrome) is difficult, time-consuming and hardly objective with present methods. Recording and analysis of spontaneous pupillary behaviour in darkness by infrared video pupillography is an objective and time-saving method to measure daytime sleepiness. However, certain external conditions must be satisfied (avoid light, noise, stress) to get reliable results. Spontaneous pupillary oscillations are recorded in darkness over 10 min and data are analyzed by fast Fourier transformation, with additional calculation of the mean pupillary diameter for each time segment (approx. 1 min). While in the alert normal, pupil remains dilated during the measurement in darkness and oscillates with an amplitude below 0.3 mm and a frequency about 1 Hz, there are characteristic changes in fatigue: (1) low-frequency components dominate the spontaneous pupillary oscillations, with an amplitude reaching several millimeters, and (2) pupil diameter decreases with time. Infrared video pupillography could play a role as a screening method and therapy control for hypersonic patients (most frequent: sleep apnea syndrome) with excessive daytime sleepiness. An objective, time-saving method like infrared video pupillography would be useful in sleep medicine and psychiatry when testing the level of vigilance, and in psychology or industrial medicine as well, providing informations about acute vigilance problems in healthy normals.
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PMID:[Pupillography for objective vigilance assessment. Methodological problems and possible solutions]. 896 45

From a database of 4,129 patients with sleep-disordered breathing (SDB), we found 207 subjects (43 women) that still complained of daytime tiredness, fatigue, and/or sleepiness despite treatment. In 25 subjects the sleepiness developed 1 to 36 months following treatment and was related to noncompliance (8 subjects), significant weight increase and/or inappropriate treatment (10 subjects), or development of new medical problems (7 subjects). In the remaining 182 subjects, sleepiness was noted within 1 month after what was judged appropriate treatment for SDB. In this group, the reason for persistent complaint was divided into four categories: 1) inappropriate treatment as a result of not using the measurement of esophageal pressure (Pes) in the initial diagnosis (41 subjects), 2) nonfunctional treatment (3 subjects), 3) associated narcolepsy-like syndrome (2 subjects), and 4) emergence of obesity and/or periodic leg movements as significant factors (135 subjects). The 135 subjects in this last category could be subdivided into three subgroups: 1) younger subjects, severely overweight with lower mean nocturnal saturated arterial oxygen (SaO2) values; 2) older subjects, of normal weight, with high numbers of periodic leg movements (PLM); and 3) moderately overweight subjects, with a combination of PLM and lower mean SaO2 values than expected. Treatments were aimed at eliminating the identified problems; they included standard medications for PLM and nasal bilevel positive airway pressure (BiPAP) for low SaO2 measurements. These treatments were not effective in specific cases, and stimulant medications had to be prescribed.
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PMID:Tiredness and somnolence despite initial treatment of obstructive sleep apnea syndrome (what to do when an OSAS patient stays hypersomnolent despite treatment). 912 68


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