Friday, 25 January 2013

Defining Fatigue

Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research.


Fatigue is one of the big unmet problems with MS, this group is attempting to define it and indicates it is  not a simple task. With better definitions may come better treatments  but I hear you say this is not happening quick enough!

10 comments:

  1. Nothing is. Have just showered washed and dried hair. Wipe out. On bed for a while before I get dressed.

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  2. Illustration inaccurate. It's not about feeling sleepy or tired in the conventional way which I now recall with affection. It's the physical inability to lift your arms and legs and torso around the place as they are such a dead weight.

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  3. Maybe fatique is consequence of poor blood flow, hypoperfusion? Makes sense and pilot studies confirm - and me too.

    http://www.fondazionehilarescere.org/pdf/11-2460-ANGY.pdf
    "CONCLUSION: The reestablishment of cerebral venous return dramatically reduced CF perception in a group of MS patients with associated CCSVI, suggesting that CF is likely the symptom of CCSVI."


    http://www.medicalnewstoday.com/releases/214087.php

    "A year after doctors used either angioplasty or stents to open blocked veins of 30 MS patients, they suffered about half the fatigue, on average, than they had before the treatment, according to data being presented by Michael Dake, M.D"


    http://www.vasculardiseasemanagement.com/content/endovascular-treatment-chronic-cerebrospinal-venous-insufficiency-patients-multiple-sclerosi

    "Conclusion. Our results confirm the findings of the previous studies that have found a positive effect of endovascular treatment on chronic fatigue in multiple sclerosis patients. Despite all limitations of our study, improved fatigue, especially when severe, appears to be an encouraging finding, which warrants further study in this area."

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  4. "Maybe fatique is consequence of poor blood flow, hypoperfusion?"

    And more probably it isn't. Now moving on.......................

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  5. Probably blood flow and fatique are related, for example: http://www.ncbi.nlm.nih.gov/pubmed/21167506

    "CONCLUSION:
    The data extend our earlier observation that CFS patients as a group have broad decreases in CBF compared to healthy controls. However, as expected, the effect was not homogeneous in that 2 of the 11 patients studied showed actual increases in CBF relative to controls."

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    Replies
    1. Fatigue is commonly reported among MSers, difficult to measure, difficult to distinguish from overlapping issues such as depression, and lacking in any good treatments. More research on fatigue would be good.

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    2. ..and there are many studies finding that hypoperfusion is related to MS. In my opinion veins should be in focus of research in MS. There are interesting studies before Zamboni about abnormalities in veins and flow.. and now new imaging techniques give more detailed info about these interesting areas:

      http://msj.sagepub.com/content/early/2012/06/25/1352458512451941.abstract

      "Conclusion: High spatially resolving anatomical T2*-weighted MRI revealed vascular alterations in early stages of multiple sclerosis, presumably as a part of widespread haemodynamic and metabolic alterations"






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