Fatigue in multiple sclerosis: definition, pathophysiology and treatment

Area of Science:

• Neurology
• Neuroscience

Background:

• Fatigue is a prevalent and disabling symptom in multiple sclerosis (MS).
• It is characterized as exhaustion, distinct from depression or weakness, significantly impacting quality of life and employment.
• Current assessment methods, including self-report and performance measures, do not fully capture the complexity of MS fatigue.

Purpose of the Study:

• To review the multifaceted nature of fatigue in MS.
• To explore proposed pathological mechanisms underlying MS fatigue.
• To discuss current and potential therapeutic strategies for managing MS fatigue.

Main Methods:

• Literature review of studies on MS fatigue.
• Analysis of proposed neurobiological and pathological mechanisms.
• Evaluation of current treatment modalities, including pharmacological and non-pharmacological interventions.

Main Results:

• MS fatigue is associated with unemployment, loss of control, psychological distress, and neurological impairment.
• No definitive neuroimaging or biological markers for MS fatigue have been identified.
• Proposed mechanisms involve neuronal dysfunction, neuroendocrine disruption, neurotransmitter alterations, and immune response dysregulation.

Conclusions:

• MS fatigue requires a multidisciplinary treatment approach.
• Amantadine and modafinil show positive results in clinical trials for MS fatigue.
• Further research into fatigue measurement and pathogenesis is crucial for developing improved therapies.