The Persistence Of Fatigue In Chronic Fatigue Syndrome And Multiple Sclerosis
Development Of A Model
Vercoulen JH, Swanink CM, Galama JM, Fennis JF, Jongen PJ, Hommes OR, van der Meer JW, Bleijenberg G
J Psychosom Res 1998 Dec;45(6):507-17
Univ Hospital Nijmegen, Dept of Medical Psychology, The Netherlands
PMID# 9859853; UI# 99075196
The cause of Chronic Fatigue Syndrome (CFS) is unknown. With respect to factors perpetuating Fatigue, on the other hand, a model has been postulated in the literature.
In which Behavioral, Cognitive, and Affective factors play a role in perpetuating Fatigue.
In the present study, this hypothesized model was tested on patients with CFS and on Fatigued patients with Multiple Sclerosis (MS).
The model was formulated in terms of cause-and-effect relationships and an integral test of this model was performed by the statistical technique, "structural equation modeling," in 51 patients with Chronic Fatigue Syndrome and 50 patients with Multiple Sclerosis matched for age, gender, and education.
Attributing complaints to a somatic cause produced low levels of physical activity, which in turn had a causal effect on Fatigue severity. Depression had to be deleted from the model.
Sense of control over symptoms and focusing on bodily symptoms each had a direct causal effect on Fatigue. The model showed an excellent fit for CFS patients, but was rejected for MS patients.
Therefore, a new model for MS patients had to be developed in which sense of control had a causal effect on Fatigue.
In the MS model, no causal relationship was found between the physical state as measured by the Expanded Disability Status Score (EDSS) and Fatigue or functional impairment.
The present study shows that Cognitive and Behavioral factors are involved in the persistence of Fatigue. Treatment should be directed at these factors.
The processes involved in the subjective experience of Fatigue in CFS were different from the processes related to Fatigue in MS.
Fatigue In Multiple Sclerosis
Interrelations Between Fatigue Complaints, Cerebral MRI Abnormalities And Neurological Disability
van der Werf SP, Jongen PJ, Lycklama a Nijeholt GJ, Barkhof F, Hommes OR, Bleijenberg G
J Neurol Sci 1998 Oct 8;160(2):164-70
Univ Hospital Nijmegen, Dept of Medical Psychology, The Netherlands
PMID# 9849800; UI# 99065052
Although Fatigue is a frequent complaint of patients with Multiple Sclerosis (MS), little is known about the origins of Multiple-Sclerosis-associated Fatigue.
Our primary focus was to study if the extent of Cerebral abnormalities, as shown on Magnetic Resonance Imaging (MRI), had any relation with the frequency and intensity of Fatigue complaints of patients with a definite diagnosis of MS.
Fatigue severity was rated by the patients with the use of a 2-week diary and a Fatigue questionnaire, while conventional T1- and T2-weighted MRI provided several measures for Cerebral abnormalities.
In total, 72% of 45 patients reported to be seriously Fatigued, at least several times a week over the last 3-month period.
Fatigue severity was not related to the total extent of Cerebral abnormalities, or to MRI-based atrophy measures. Regional lesion load did not differ between Fatigued and non-Fatigued subjects.
Although Neurological Disability, as measured by the Expanded Disability Status Scale (EDSS) and Neurological Rating Scale (NRS), did correlate significantly with most MRI measures, it showed no relation with Fatigue severity.
Neurological progression rates and number of exacerbations in the 2-year period prior to assessment were not significantly associated with the Fatigue measures.
Therefore, our findings suggest that differences in levels of self-reported Fatigue in patients with Multiple Sclerosis cannot merely be explained by the degree of clinical disease activity, Neurological disability or the extent of MRI abnormalities.
These results are compared to other research findings and the possible role of alternative factors influencing Fatigue in Multiple Sclerosis are discussed.
Fatigue And Magnetic Resonance Imaging Activity In Multiple Sclerosis
Mainero C, Faroni J, Gasperini C, Filippi M, Giugni E, Ciccarelli O, Rovaris M, Bastianello S, Comi G, Pozzilli C
J Neurol 1999 Jun;246(6):454-8
UnivLa Sapienza Rome, Dept of Neurological Sciences, Italy
PMID# 10431770; UI# 99358717
Fatigue is a frequent and often severe symptom in Multiple Sclerosis. Pathogenic mechanisms proposed for Fatigue include the release of ProInflammatory Cytokines.
Which is thought to have an important effect on changes in the Blood-Brain Barrier (BBB).
To investigate whether Fatigue is related to BBB disruption we studied 11 Relapsing/Remitting MS patients participating in a multicenter longitudinal study.
Comparing the sensitivity of monthly enhanced Magnetic Resonance Imaging (MRI) after standard-dose and triple-dose injection of Gadolinium-diethylene triaminopentoacetic acid (Gd-DTPA).
Serial Gd-enhanced MRI studies were performed in two separate sessions every 4 weeks for 3 months. An expanded version of the Fatigue Severity Scale, including 29 items, was administered 24 h before each MRI examination.
No relationship was found between the number and volume of Gd-enhancing lesions and Fatigue scores at any monthly examination over the study period.
Furthermore changes in MRI activity were not significantly related to changes in Fatigue scores.
These results were obtained on triple-dose delayed scanning, which is more sensitive than standard-dose scanning in detecting areas of BBB disruption.
Our preliminary results thus do not support the hypothesis of a relationship between BBB alterations and Fatigue severity in Multiple Sclerosis.
Fatigue In Multiple Sclerosis Is Associated
With Specific Clinical Features
Colosimo C, Millefiorini E, Grasso MG, Vinci F, Fiorelli M, Koudriavtseva T, Pozzilli C
Acta Neurol Scand 1995 Nov;92(5):353-5
UnivLa Sapienza, Dept of Neurological Sciences, Rome, Italy
PMID# 8610485; UI# 96191736
Fatigue is a common and disabling symptom in Multiple Sclerosis (MS). In this study we evaluated if Fatigue is associated with different demographic and clinical features of MS.
A survey was performed on 507 consecutive patients affected by Clinically Definite MS referred to our center between January 1 and December 31, 1993.
During the examination patients were asked to answer a brief Fatigue questionnaire.
To evaluate the probability of the occurrence of Fatigue in association with several covariant factors.
Age, sex, duration, disease form, disease severity, month of examination, functional sub-systems on the Expanded Disability Status Scale (EDSS), a logistic regression analysis was performed.
We confirmed that Fatigue is common in MS, recorded in 53% of patients.
Patients affected by a more severe disability, by Progressive MS, both Primary and Secondary, with an older age at examination, and assessed during spring, had a significantly higher risk of Fatigue. Sex was not associated with the occurrence of fatigue.
When the single items of EDSS were considered, we found that Fatigue is also associated with the occurrence of Cerebellar, Sphincteric, Pyramidal and sensitive Signs.
But not with BrainStem, Visual and Cognitive Impairment.
Fatigue in MS is more frequent in association with specific clinical features.