Department of Neurology, Selçuk University School of Medicine, Konya, Turkey
Fatigue Can Be Objectively Measured in Multiple Sclerosis: Multipl Sklerozda Yorgunluk Objektif Olarak Ölçülebilir
Multiple Sclerosis (MS), is a chronic inflammatory demyelinating disorder affecting the white matter in the central nervous system (CNS), seen usually among young adults (20-40 years of age). Fatigue is an important symptom that affects a large portion of the patient population. The reason for fatigue seen in MS patients is still not well-known. Fatigue is a subjective and non-specific symptom; therefore, it is quite difficult to evaluate fatigue. This symptom has been reported in 75-87% of patients with multiple sclerosis (MS) and two-thirds of these patients indicated fatigue as one of the worst three common symptoms they experienced. In this review, objective measurement methods of fatigue which is a subjective complaint will be discussed.
Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Germany
Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities
Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventy-one PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities. Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck's Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS). The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18). The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance. Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations.
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