Fatigue Plays a Key Factor in Multiple Sclerosis Daily Functioning


Patients with lower levels of disability tended to report fatigue as the most impactful symptom in daily life.

Lindsey L. Lair, MD, FAAN

Findings presented at MS Virtual 2020, the 8th Joint ECTRIMS-ACTRIMS meeting, September 11–13, 2020, suggest that fatigue occurs in most patients with relapsing multiple sclerosis (MS) and influences daily functioning.1

Presented by Lindsey L. Lair, MD, FAAN, senior Global Medical Affairs Leader-Neuroscience, Janssen Pharmaceuticals, the research aimed to measure MS fatigue and its impact on daily life in a real-world population using a survey that included that relapsing MS (RMS)-specific Fatigue Symptoms and Impacts Questionnaire-Relapsing Multiple Sclerosis (FSIQ-RMS).

On a score range from 0 to 100, higher scores indicated greater severity. Findings from the cohort of 142 patients with RMS revealed that fatigue levels are severe, with a mean FSIQ-RMS symptom domain score of 59.5 during a 7-day period.

Demographic and clinical questionnaires that included disease history and status, sleep, and social and emotional function were completed by the participants along with the FSIQ-RMS, which was administered daily for 7 days. Physical, cognitive/emotional, and coping subdomain scores were 45.1, 44.9, and 50.6, respectively, following the 7-day period.

Walking difficulties and fatigue were recorded as the 2 most impactful symptoms on daily functioning. Notably, 56% of the patient population experienced fatigue prior to MS diagnosis.

In total, 72% of patients were not currently relapsing and had a mean fatigue symptom domain score of 56.2, compared to 68 who had an active relapse. Lair and colleagues also noted that fatigue was rated the most impactful symptom on daily life by those with lower disability.

Patients without depression, which represented 56% of the population, still reported mean fatigue symptom domain scores of 53.7 compared to 67 in those with depression. Among those who reported a sleep disorder, a mean fatigue symptom domain score of 58.1 was recorded in 72% of the population. In contrast, those without a sleep disorder recorded a 63.3 mean fatigue symptom domain score.

The most common triggering factor for fatigue was heat exposure, which occurred in 82% of patients.

Disability and economic burden have both been associated with higher levels of fatigue in patients with MS. Another study presented at MS Virtual 2020 revealed that patients with relapsing-remitting MS who were stratified by high levels of fatigue had greater comorbidity and economic burdens compared to those with MS who had low levels of fatigue.2

The data from that study showed that the annualized number of outpatient visits, emergency room visits, and hospitalizations were greater for those with relapsing-remitting MS with high levels of fatigue compared to those with relapsing-remitting MS with low levels of fatigue.

Amy B. Sullivan, PsyD, ABPP, director of Behavioral Medicine at the Mellen Center for MS Treatment and Research at Cleveland Clinic, sat down with NeurologyLive at the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), and discussed how she approaches fatigue in MS from a behavioral standpoint. Watch the interview below.

1. Azoulai M, Levy-Heidmann T, Morisseau V, et al. A real-world study characterizing symptoms and impacts of fatigue in US adults with relapsing multiple sclerosis using a novel disease specific scale. Presented at: MS Virtual 2020 Joint ECTRIMS-ACTRIMS meeting; September 11–13, 2020. Abstract P1004.
2. Le H, Ken-Opurum J, Maculaitis M, Sheehan J. Comorbidity and economic burdens of fatigue among patients with relapsing-remitting multiple sclerosis in the United States. Presented at: MS Virtual 2020 Joint ECTRIMS-ACTRIMS meeting; September 11–13, 2020. Abstract P0857.
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