Levocarnitine administration in multiple sclerosis patients with immunosuppressive therapy-induced fatigue.
Nutritional factors and comedications are among the postulated causes of fatigue, a highly prevalent symptom in the multiple sclerosis (MS) population, with serious impact on patients' quality of life. Deficiency of carnitine may play a role by reducing energy production through fatty acid oxidation and numerous MS therapies can induce fatigue syndrome. The aim of this prospective open-labelled study was to collect and study serum carnitine levels in MS patients with and without disease-modifying treatment-induced fatigue syndrome. We investigated whether restoration of the carnitine pool might improve treatment-induced fatigue in MS patients. In our study, there was no statistical difference in fatigue frequency between treated and untreated patients (P=0.5). Matched to age, gender and treatments, carnitine levels were lower for MS treated patients compared to untreated MS patients (P <0.05) or controls (P <0.001). Consecutive patients with low plasma carnitine levels who experienced fatigue were substituted. Treatment consisted of oral levocarnitine, 3-6 g daily. All patients achieved normal plasma carnitine levels. For 63% of patients treated with immunosuppressive or immunomodulatory therapies, oral levocarnitine adjunction decreased fatigue intensity, especially in patients treated with cyclophosphamide and interferon beta.
Lebrun
C
C
Department of Neurology, Hôpital Pasteur, 30 voie romaine, 06002 Nice, France. lebrun.c@chu-nice.fr
Alchaar
H
H
Candito
M
M
Bourg
V
V
Chatel
M
M
D000108:Acetylcarnitine / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D003520:Cyclophosphamide / Q000009:adverse effects; D005221:Fatigue / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007372:Interferons / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D018697:Nootropic Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D018697:Nootropic Agents; D000108:Acetylcarnitine; D003520:Cyclophosphamide; D007372:Interferons; D008942:Mitoxantrone