title: [Therapy of fatigue in multiple sclerosis : A treatment algorithm].
abstract: BACKGROUND
  Fatigue is one of the most frequent symptoms of multiple sclerosis (MS) and one of the main reasons for underemployment and early retirement. The mechanisms of MS-related fatigue are unknown but comorbid disorders play a major role. Anemia, diabetes, side effects of medication and depression should be ruled out. Moreover, excessive daytime sleepiness (EDS) should be differentiated from fatigue. No approved medicinal therapy of MS fatigue is currently available.
  
  
  OBJECTIVE
  Presentation of current treatment strategies with a particular focus on secondary fatigue due to sleep disorders.
  
  
  METHODS
  A review of the literature was carried out.
  
  
  CONCLUSIONS
  All MS patients suffering from fatigue should be questioned with respect to EDS and if necessary sleep medical investigations should be carried out; however, pure fatigue without accompanying EDS can also be caused by a sleep disorder. Medications, particularly freely available antihistamines, can also increase fatigue. Furthermore, anemia, iron deficits, diabetes and hypothyroidism should be excluded. Self-assessment questionnaires show an overlap between depression and fatigue. Several studies have shown that cognitive behavioral therapy and various psychotherapeutic measures, such as vertigo training, progressive exercise training and individualized physiotherapy as well as fatigue management interventions can lead to a significant improvement of MS-related fatigue. There is currently no medication which is suitable for treatment of fatigue, with the exception of fampridine for the treatment of motor functions and motor fatigue.
authors.affiliation: Interdisziplinäres Schlafmedizinisches Zentrum, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. christian.veauthier@charite.de.|NeuroCure Clinical Research Center und Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland. christian.veauthier@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Veauthier
authors.affiliation: NeuroCure Clinical Research Center und Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland.|Experimental and Clinical Research Center (ECRC), Berlin, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Paul
mesh_terms: D000465:Algorithms; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D019091:Critical Pathways / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Insomnia; Polysomnography; Restless legs syndrome; Sleep disorders; Sleep medicine