Fatigue in Multiple Sclerosis: Investigating Longitudinal Determinants

Fatigue is one of the most pervasive and debilitating symptoms of multiple sclerosis (MS), significantly impacting patients’ physical, mental, and emotional well-being. Despite available pharmacological and behavioral interventions, fatigue remains a persistent challenge for MS patients, influencing disease management and quality of life.

A recent study investigated the long-term evolution of fatigue among MS patients treated at the American University of Beirut Medical Center (AUBMC), analyzing key sociodemographic, clinical, and therapeutic determinants. Here’s an overview of the study.

Prevalence and Risk Factors for MS

The mechanisms underlying MS-related fatigue are multifactorial, involving both primary factors, which are direct effects of MS pathology and treatment, and secondary psychosocial and behavioral factors.

Fatigue is more commonly reported in patients with progressive MS subtypes, longer disease duration, and greater disability levels. Additional factors associated with higher fatigue levels include lower educational attainment and specific comorbidities such as depression, sleep disorders, migraines, mobility impairments, and irritable bowel syndrome.

These associations suggest that both neurological and psychosocial factors contribute to fatigue severity, necessitating a comprehensive approach to management.

The Study’s Objective and Methodology

This study aimed to assess fatigue evolution among 483 MS patients in Lebanon. It used the Modified Fatigue Impact Scale-5, a self-administered questionnaire that explores the existence of fatigue, its manifestations, and its impact on the patient. The study then looked at key determinants that may influence long-term fatigue prognosis, including:

• Sociodemographic status, including age, gender, and education level
• Behavioral aspects, including lifestyle and adherence to treatment
• Clinical variables, including disease duration, disability level, and comorbidities
• Treatment regimens

Researchers analyzed changes in fatigue scores during follow-up considering these factors to explore their association with fatigue.

The Study’s Findings

The study’s findings reaffirm the complex interplay between MS-related fatigue and multiple influencing factors, including:

• Disease duration and disability: Patients with longer MS duration and higher disability levels experienced greater fatigue persistence over time. Progressive MS subtypes exhibited the highest fatigue burden.
• Comorbid conditions: Depression, sleep disorders, and migraines significantly exacerbated fatigue.
• Sociodemographic influences: Lower educational levels correlated with increased fatigue, possibly due to limited health literacy, reduced access to healthcare, or socioeconomic stressors.
• Therapeutic regimens: Pharmacological treatments influenced fatigue outcomes variably, depending on their mechanism of action and side effect profiles. Certain disease-modifying therapies contributed to fatigue reduction, while others had negligible or negative effects.

Clinical Implications for Neurologists and Primary Care Physicians

Looking at the findings, the importance of multidisciplinary care is clear. When managing fatigue in MS patients, clinicians can incorporate various treatment strategies, including routine fatigue assessments using validated scales, which can help track symptom progression and tailor interventions, and personalized care plans that use appropriate therapies based on individual patient needs.

Additionally, addressing comorbidities like depression, sleep disturbances, and migraines can alleviate the burden of fatigue. Providing health literacy resources and psychosocial support can also empower patients to adopt self-management strategies, potentially mitigating fatigue impact.

By using comprehensive, personalized, and interdisciplinary approaches, neurologists and primary care physicians can improve fatigue outcomes, ultimately enhancing MS patients’ quality of life and overall disease management.

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