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Clinical characteristics associated with multiple sclerosis fatigue severity
Alexandra Balshi1, John P Dempsey2, Nova Manning1
1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Kirstein 215, Boston, MA, USA.
Background:
While clinical factors such as higher Expanded Disability Status Scale (EDSS) score, progressive disease subtype, older age, polysymptomatic onset, and depression have been shown to predict fatigue severity in people with multiple sclerosis (PwMS), their influences have not been evaluated simultaneously while controlling for broader MS severity risk factors and potential confounders.
Objective:
To concurrently assess which previously established MS fatigue risk factors affect fatigue severity after adjusting for MS severity, obstructive sleep apnea (OSA), and stimulant use, and to validate these findings using a second fatigue scale.
Methods:
We used multivariable linear regression to determine relationships between MS clinical data and MS-related fatigue as measured by the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS), controlling for OSA and stimulant use.
Results:
Polysymptomatic MS onset (MFIS β = 9.22, p = 0.027; FSS β = 5.90, p = 0.032), depression (MFIS β = 22.01, p < 0.001; FSS β = 13.51, p = 0.003), and higher Expanded Disability Status Scale (EDSS) scores (MFIS β = 2.32, p = 0.028) were associated with more severe fatigue in PwMS.
Conclusion:
Polysymptomatic MS onset, comorbid depression, and higher EDSS score remain independently associated with MS fatigue severity even when evaluated together adjusting for relevant controls. PwMS with these characteristics, especially those with all three, should be screened for fatigue and offered symptomatic treatment.
Insights
Polysymptomatic onset, depression, and higher disability scores independently predict fatigue severity in multiple sclerosis (MS) patients. Early screening and treatment are recommended for those with these risk factors.
Area of Science:
- Neurology
- Clinical Research
- Medical Science
Background:
- Fatigue is a common and disabling symptom in multiple sclerosis (MS).
- Previous studies identified several clinical factors predicting fatigue severity, but their simultaneous influence and control for confounders were not fully evaluated.
- Key factors include Expanded Disability Status Scale (EDSS) score, disease subtype, age, polysymptomatic onset, and depression.
Purpose of the Study:
- To assess which established MS fatigue risk factors impact fatigue severity concurrently.
- To adjust for MS severity, obstructive sleep apnea (OSA), and stimulant use in the analysis.
- To validate findings using two distinct fatigue scales: Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS).
Main Methods:
- Multivariable linear regression analysis was employed.
- Examined relationships between MS clinical data and fatigue measures (MFIS, FSS).
- Controlled for potential confounders including OSA and stimulant use.
Main Results:
- Polysymptomatic onset was significantly associated with increased fatigue severity (MFIS β = 9.22, p = 0.027; FSS β = 5.90, p = 0.032).
- Comorbid depression strongly predicted higher fatigue severity (MFIS β = 22.01, p < 0.001; FSS β = 13.51, p = 0.003).
- Higher Expanded Disability Status Scale (EDSS) scores correlated with greater fatigue (MFIS β = 2.32, p = 0.028).
Conclusions:
- Polysymptomatic onset, depression, and higher EDSS scores are independent predictors of MS fatigue.
- These factors remain significant even after adjusting for other MS severity factors and confounders.
- Patients with these characteristics, particularly those exhibiting all three, warrant proactive fatigue screening and symptomatic treatment.
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