Multiple Sclerosis Fatigue


Many patients describe multiple sclerosis fatigue as their number one symptom. Different types of fatigue are discussed.

June Halper, MSN, MSCN: I’m thinking about the impact of fatigue. I know that one of the most prominent features of MS [multiple sclerosis], even early on before someone receives a diagnosis, is fatigue. Dr. Coyle, you find that the diagnosis of MS is sometimes stymied by the fatigue that people can’t figure out where it’s coming from and how it can impact the rest of the body, including cognition?

Patricia K. Coyle, MD: It’s very interesting. We now recognize that there’s a prodrome to MS that may take five to 10 years before neurological onset of the disease where there are health care issues not necessarily neurologic at all that are occurring. And there are studies that indicate fatigue, very significant fatigue leading to diagnoses of chronic fatigue, etcetera, may be part of the prodrome in the few years before somebody declares themselves as having MS. I think we recognize fatigue as often the number one symptom of MS, often rated as the worst symptom, reported ultimately in as high as 80% to 90% of individuals with MS. And there are different types of fatigue. There’s primary MS fatigue, and there are secondary types of fatigue. But the interesting thing is that the fatigue is not necessarily associated with obvious visible disability. It’s an invisible symptom, and you can have somebody that looks great and has normal strength and coordination, and yet they may not be able to work because of their profound primary MS fatigue. It is a very significant symptom that can have tremendous impacts on activities of daily living if it interferes with both physical activities and cognitive activities.

June Halper, MSN, MSCN: But how do you measure it though? Is there only patient self-reported? Is there a scale? Is there an exam you could do?

Patricia K. Coyle, MD: Well, there is no biomarker. It is based on patient-reported outcomes or PROs. There are a number of validated scales that one can use to rate the degree of fatigue. You are depending on the patient reporting it. We don’t have any blood tests that we can do to measure it at this point in time.

June Halper, MSN, MSCN: Are there specific disease-modifying therapies that you would avoid because of the side effect or is it just across the board that it doesn’t really matter your decision is going to be on the MS?

Patricia K. Coyle, MD: The only class of agents I might be concerned about would be the interferon betas. As a cytokine, sometimes you can see associations with fatigue with various cytokines. But we do not identify DMTs [disease modifying therapies] especially with causing worsening fatigue as a very, very common issue. Generally, that’s not a major factor and the primary MS fatigue we don’t understand. It’s related to various biological issues. It may connect to circuits, to inflammation within the central nervous system, to specific targeted areas being involved. And there may be multiple mechanisms that are involved in primary MS fatigue.

June Halper, MSN, MSCN: I want to thank you all for watching and joining us at this NeurologyLive® Cure Connections®. If you enjoyed this program, please subscribe to the e-newsletter to receive upcoming information about other programs. I’d like to thank you all for the time and I thank you all for this wonderful opportunity and hope to see you all again.

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