Related Experiment Video
Updated: Mar 11, 2026
The Effect of Anti-Fatigue Decoction on the Behaviors and Serological Indicators in a Central Fatigue Rat Model
Published on: April 12, 2024
The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple
Christian Veauthier1, Helge Hasselmann2, Stefan M Gold3
1Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Abstract:
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
Insights
Multiple sclerosis (MS) fatigue significantly impacts patients, yet effective treatments are scarce. This review explores individualized strategies, addressing comorbidities and utilizing diagnostic tools for better management of MS-related fatigue.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Multiple sclerosis (MS) fatigue affects over 80% of patients, representing a major cause of disability and reduced quality of life.
- Current therapeutic options for MS fatigue are limited, with a lack of evidence-based pharmacological treatments.
- The underlying mechanisms of MS fatigue are not well understood, hindering the development of objective diagnostic criteria.
Approach:
- This paper reviews existing treatments for MS-related fatigue, emphasizing the need for individualized therapeutic strategies that consider comorbid conditions.
- A comprehensive, cost-efficient approach is proposed, involving diagnostic interviews and validated questionnaires (Modified Fatigue Impact Scale, Epworth Sleepiness Scale, Beck Depression Inventory, Pittsburgh Sleep Quality Index) to identify contributing factors.
- In select cases, polygraphic or polysomnographic investigations may be warranted to further assess underlying causes.
Key Points:
- Fatigue in MS is a complex symptom, often unspecific and potentially indicative of other health issues like depression, sleep disorders, or medication side effects.
- Addressing underlying conditions such as sleep disorders and depression is crucial for managing MS fatigue.
- Pharmacological treatments (alfacalcidol, fampridine), exercise therapy, and cognitive behavioral therapy-based interventions show promise in alleviating MS fatigue.
Conclusions:
- Developing individualized treatment plans for MS fatigue requires a thorough assessment of contributing factors, including comorbidities and patient-reported outcomes.
- Further research is needed to elucidate the relationship between MS fatigue, brain atrophy, lesions, cognition, and disease course.
- Integrating diagnostic assessments with targeted interventions offers a pathway to improve the management of this debilitating symptom in multiple sclerosis patients.
