Pathophysiology, assessment and management of multiple sclerosis fatigue: an update

ABSTRACT

Introduction: Fatigue is one of the most common symptoms associated with multiple sclerosis, affecting almost 80% of patients with 55% of them reporting it as one of the worst symptoms experienced, often independently of the level of disability.

Areas covered: We review the main pathophysiological hypothesis, fatigue assessment scales, and its management.

Expert commentary: Fatigue pathophysiology is complex and is often influenced by other secondary but relevant factors (e.g. psychological disturbances, musculoskeletal problems, sleep disorders and medication side effects) which may vary over time. Both peripheral and central mechanisms are implicated. The large heterogeneity of the assessment scales, which were used in the therapeutic trials, is partially responsible for the uncertainty of their results. To date, the best therapeutic approach seems to be from a multidisciplinary management involving exercise, rehabilitation and education in conjunction with medication.

KEYWORDS:

• Fatigue
• multiple sclerosis
• treatment
• scales
• pathophysiology

Declaration of interest

All authors report congress sponsorships and grants from Biogen Idec, Merck Serono, Genzyme, Teva, Bayer, Almirall and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.