title: Fatigue in multiple sclerosis: a rational approach to evaluation and treatment.
abstract: With the publication of the Multiple Sclerosis Council Guideline on the management of multiple sclerosis (MS) fatigue, there has been increased appreciation for the role fatigue can play in MS. Secondary fatigue is fatigue caused by other etiologies than those directly related to MS. Once these causes are ruled out, fatigue is related to MS. Secondary MS-related fatigue comes as result of the symptoms of MS that drain energy. Once secondary MS causes are ruled out, then the patient is deemed as having primary MS fatigue. Fatigue management is both nonpharmacologic and pharmacologic. Occupational therapists are the major allied health providers that address the role fatigue plays in MS patients. Over the past two decades, numerous clinical trials have been conducted on drugs for treating MS-related fatigue. Of these agents, amantadine has been studied for the longest period, and has shown efficacy in about one third of patients with MS-related fatigue on several commonly used scales. Two randomized -trials of the central nervous system stimulant pemoline have yielded unimpressive results; efficacy was seen at higher doses but coupled with an unacceptable risk of adverse events. The wake-promoting agent modafinil is the only agent to show efficacy compared with placebo on the Fatigue Severity Scale, a measure that is highly resistant to "impulse answering" and is thus viewed as one of the most difficult scales on which to show -benefit. This article reviews fatigue in MS and proposes a rational strategy for evaluation and management of this most common MS symptom.
authors.affiliation: The Neurology Center, 9850 Genesee, Suite 220, La Jolla, CA 92037, USA. Jhrosenb@san.rr.com
authors.forename: Jay H
authors.initials: JH
authors.lastname: Rosenberg
authors.forename: Renata
authors.initials: R
authors.lastname: Shafor
mesh_terms: D005221:Fatigue / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
references.citation: Psychoneuroendocrinology. 2003 Aug;28(6):780-95
references.pmid: 12812864
references.citation: Sleep. 1999 Sep 15;22(6):757-65
references.pmid: 10505821
references.citation: J Neuropsychiatry Clin Neurosci. 1993 Spring;5(2):200-5
references.pmid: 8508039
references.citation: J Neurol. 2002 Aug;249(8):983-7
references.pmid: 12195441
references.citation: Respiration. 1997;64(2):159-61
references.pmid: 9097352
references.citation: Sleep. 1991 Dec;14(6):540-5
references.pmid: 1798888
references.citation: Int J Neurosci. 1995 Dec;83(3-4):153-63
references.pmid: 8869424
references.citation: Can J Neurol Sci. 1987 Aug;14(3):273-8
references.pmid: 2889518
references.citation: J Neurosci. 2000 Nov 15;20(22):8620-8
references.pmid: 11069971
references.citation: Arch Phys Med Rehabil. 1988 Oct;69(10):846-9
references.pmid: 3178452
references.citation: Tissue Antigens. 1995 Oct;46(4):333-6
references.pmid: 8560455
references.citation: Arch Gen Psychiatry. 1961 Jun;4:561-71
references.pmid: 13688369
references.citation: Neurology. 1991 Mar;41(3):447-8
references.pmid: 2006018
references.citation: Proc Natl Acad Sci U S A. 1996 Nov 26;93(24):14128-33
references.pmid: 8943072
references.citation: J Neurol. 1993 Jul;240(7):446-8
references.pmid: 8410088
references.citation: J Neurol Neurosurg Psychiatry. 2002 Feb;72(2):179-83
references.pmid: 11796766
references.citation: Eur Neurol. 1994;34(6):320-3
references.pmid: 7851452
references.citation: Arch Neurol. 1992 May;49(5):517-24
references.pmid: 1580815
references.citation: Neurology. 1995 Nov;45(11):1956-61
references.pmid: 7501140
references.citation: J Sleep Res. 1995 Dec;4(4):212-228
references.pmid: 10607161
references.citation: Neurology. 2000 Mar 14;54(5):1166-75
references.pmid: 10720292
references.citation: Neurology. 1992 Aug;42(8):1468-71
references.pmid: 1641137
references.citation: Can J Neurol Sci. 1985 Aug;12(3):251-4
references.pmid: 3902184
references.citation: J Psychosom Res. 1993 May;37(4):325-31
references.pmid: 8510058
references.citation: Neurology. 1997 Jun;48(6):1566-71
references.pmid: 9191767
references.citation: Arch Neurol. 1989 Jun;46(6):676-80
references.pmid: 2730380