Assessment, pathophysiology and treatment of fatigue in multiple sclerosis.

Abstract:

:This review will update current views of the physiopathology and treatment of fatigue in multiple sclerosis. Fatigue is a common symptom in multiple sclerosis, being reported by about a third of the patients. For many of them it is the most disabling symptom, with negative consequences on working activity and daily life. There are no objective measures of fatigue which is essentially based on subjective complaints. Even if fatigue may be influenced by motor disturbances and depression, it is largely independent from both. Peripheral mechanisms, such as muscular disuse and deconditioning, joint abnormalities and metabolic changes of muscular fibers, have very little role in multiple sclerosis fatigue. All the available data indicate that fatigue is a 'central' phenomenon, due to multiple causes. Neurophysiological studies revealed an impairment of volitional drive to the descending motor pathways and functional imaging studies fund a selective involvement of frontal cortex and basal ganglia. Therefore, a dysfunction of the circuits between thalamus, basal ganglia and frontal cortex, affected by the multiple sclerosis lesions and/or disturbed in their function by the products of inflammation could be the substrate of fatigue. No specific treatments are available - management strategies include medications, exercise and behavioral therapy - in most cases a combined approach is suitable. Enhancers of vigilance, like amantadine and modafinil, were shown to be effective in class I and II trials, however their effects are modest. Aminopyridines may indirectly influence fatigue by reducing nerve conduction block in motor fibers. Some recent studies suggest the positive effects of drugs on fatigue may be via reducing the inflammatory activity, such as for glatiramer acetate.

journal_name

Expert Rev Neurother

authors

Comi G,Leocani L

doi

10.1586/14737175.2.6.867

subject

Has Abstract

pub_date

2002-11-01 00:00:00

pages

867-76

issue

6

eissn

1473-7175

issn

1744-8360

journal_volume

2

pub_type

杂志文章
  • Magnetic resonance markers for early diagnosis and progression of Alzheimer's disease.

    abstract::With increasing life expectancy, the early diagnosis and treatment of Alzheimer's disease has become critical in sustaining a healthy society. Noninvasive markers of disease progression starting from the earliest stages of pathologic involvement are required for determining the effectiveness of putative disease-modify...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.5.5.663

    authors: Kantarci K

    更新日期:2005-09-01 00:00:00

  • Clinical, etiological and therapeutic aspects of cerebral folate deficiency.

    abstract::Cerebral folate deficiency is defined as any neurological condition associated with low cerebrospinal fluid folate concentrations. It is becoming increasingly associated with several neurological diseases, either genetic or environmental. Treatment of cerebral folate deficiency by folate supplementation is generally e...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.2015.1055322

    authors: Molero-Luis M,Serrano M,O'Callaghan MM,Sierra C,Pérez-Dueñas B,García-Cazorla A,Artuch R

    更新日期:2015-01-01 00:00:00

  • Barriers to the use of genetic information for the development of new epilepsy treatments.

    abstract::Genetic analysis is providing new information on the biological basis of epilepsy at a rapid pace; this article identifies factors acting as major barriers to use of these data for therapy development. Disease heterogeneity is a primary obstacle since so many genes can cause or predispose to epilepsy and the clinical ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 社论,评审

    doi:10.1586/14737175.2016.1115718

    authors: Ferraro TN

    更新日期:2016-01-01 00:00:00

  • Supportive management of patients with brain tumors.

    abstract::Management issues for patients with brain tumors include peritumoral edema, symptomatic seizures, venous thromboembolism, headache, pain, fatigue and neuropsychological complaints. Vasogenic edema is typically ameliorated with the lowest dose possible of corticosteroid. Seizures are managed with attention to additiona...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.7.10.1327

    authors: Daly FN,Schiff D

    更新日期:2007-10-01 00:00:00

  • Evidence-based treatment of Tourette's disorder and chronic tic disorders.

    abstract::Introduction: Chronic Tic Disorders and Tourette's Disorder (collectively referred to as TD) are characterized by sudden, rapid, and repetitive motor movements or vocalizations called tics. Children, adolescents, and adults with TD often experience co-occurring psychiatric symptoms and impairments in multiple domains....

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2019.1643236

    authors: Essoe JK,Grados MA,Singer HS,Myers NS,McGuire JF

    更新日期:2019-11-01 00:00:00

  • Laser interstitial thermal therapy in the management of brain metastasis and radiation necrosis after radiosurgery: An overview.

    abstract::With advances in stereotactic and neuroimaging techniques, various minimally invasive image-guided techniques have gained widespread acceptance in the field of neuro-oncology. Laser interstitial thermal therapy (LITT) is an image-guided technique that involves generation of high temperatures using a laser fiber, to ab...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.2016.1135736

    authors: Sharma M,Balasubramanian S,Silva D,Barnett GH,Mohammadi AM

    更新日期:2016-01-01 00:00:00

  • Analysis of recent failures of disease modifying therapies in Alzheimer's disease suggesting a new methodology for future studies.

    abstract:INTRODUCTION:Pharmaceutical companies and the NIH have invested heavily in a variety of potential disease-modifying therapies for Alzheimer's disease (AD) but unfortunately all double-blind placebo-controlled Phase III studies of these drugs have failed to show statistically significant results supporting their clinica...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2016.1194203

    authors: Amanatkar HR,Papagiannopoulos B,Grossberg GT

    更新日期:2017-01-01 00:00:00

  • Depression and randomized, controlled trials: problems and solutions.

    abstract::Research into what works in depression is in trouble. All treatments appear equally effective and what happens in research trials does not seem to translate into clinical practice or, to put it another way, clinical practice is not reflected in randomized controlled trials. We run the risk of designing cosmetic trials...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.6.1.41

    authors: Hatcher S

    更新日期:2006-01-01 00:00:00

  • Effect of acute and chronic alcohol abuse on pain management in a trauma center.

    abstract::The proper management of acute pain has been identified as a primary indicator of quality assurance in US trauma centers. Nearly half of all trauma patients are injured while intoxicated and 75% of these patients have chronic alcohol problems. The management of pain caused by injuries in patients with alcohol problems...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.9.2.271

    authors: Askay SW,Bombardier CH,Patterson DR

    更新日期:2009-02-01 00:00:00

  • Epilepsy in the elderly.

    abstract::Epilepsy is the most common serious neurological disorder in the elderly after stroke and dementia. It may be more important for elderly people because it is intermittent and unpredictable. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience. The situation i...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/ern.10.170

    authors: Johnston A,Smith PE

    更新日期:2010-12-01 00:00:00

  • Brivaracetam efficacy and safety in focal epilepsy.

    abstract::Introduction: Brivaracetam (BRV) is an analog of levetiracetam (LEV) with 15-30 times greater affinity to SV2A and greater brain permeability than LEV. These properties have stimulated interest in its clinical trial data and post-marketing experience. Areas covered: The authors provide a background on epilepsy and its...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2019.1631160

    authors: Makke Y,Abou-Khalil B

    更新日期:2019-10-01 00:00:00

  • Radiation-induced gliomas.

    abstract::Radiation-induced gliomas represent a relatively rare but an extensively published entity in the neuro-oncologic literature. Extensive retrospective cohort data in pediatric populations after therapeutic intracranial radiation show an increased risk in glioma incidence that is both patient age- and radiation dose/volu...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1002/pmic.200800802

    authors: Prasad G,Haas-Kogan DA

    更新日期:2009-10-01 00:00:00

  • Fentanyl for breakthrough pain: a systematic review.

    abstract::The purpose of this article is to systematically review the use of fentanyl as an analgesic for breakthrough pain. This article found that the oral transmucosal fentanyl (OTFC) had a quicker onset to analgesia than oral immediate-release opioids. Intranasal fentanyl (INFS) had a quicker onset to analgesia than buccal ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/ern.11.63

    authors: Davis MP

    更新日期:2011-08-01 00:00:00

  • Paroxysmal movement disorders - practical update on diagnosis and management.

    abstract::Introduction: Paroxysmal dyskinesias and episodic ataxias are often caused by mutations in genes related to cell membrane and synaptic function. Despite the exponential increase in publications of genetically confirmed cases, management remains largely clinical based on non-systematic evidence. Areas covered: The auth...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2019.1648211

    authors: De Gusmao CM,Silveira-Moriyama L

    更新日期:2019-09-01 00:00:00

  • Risk factors for schizophrenia.

    abstract::Over the last decade, much progress has been made towards identifying risk factors for schizophrenia. It is now thought that many genes of small effect contribute towards risk of developing schizophrenia and some of these probably confer susceptibility to environmental factors. Large population-based studies, using re...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章

    doi:10.1586/14737175.1.2.183

    authors: Boydell J

    更新日期:2001-11-01 00:00:00

  • Stem cell therapy for Parkinson's disease.

    abstract::The aim of stem cell therapy for Parkinson's disease is to reconstruct nigro-striatal neuronal pathways using endogenous neural stem/precursor cells or grafted dopaminergic neurons. As an alternative, transplantation of stem cell-derived dopaminergic neurons into the striatum has been attempted, with the aim of stimul...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.7.6.667

    authors: Takahashi J

    更新日期:2007-06-01 00:00:00

  • Therapeutic options for cervicogenic headache.

    abstract::The term cervicogenic headache (CeH) describes a syndrome originating from the cervical spine. There are a variety of therapeutic approaches used for the management of CeH, but scientific evidence of their effectiveness is scarce. No medication drug has proven to be effective. The evidence for greater occipital nerve ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.2014.863710

    authors: Fernández-de-las-Peñas C,Cuadrado ML

    更新日期:2014-01-01 00:00:00

  • Anaplastic astrocytomas: biology and treatment.

    abstract::Anaplastic astrocytomas (AA), WHO grade III gliomas, comprise 10-15% of all glial neoplasms. Currently, the only factors that have been shown to influence prognosis in patients with AA are age and Karnofsky performance status. Attempts have been made to identify biological prognostic factors for response to therapy an...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章

    doi:10.1586/14737175.8.4.575

    authors: Chamberlain MC,Chowdhary SA,Glantz MJ

    更新日期:2008-04-01 00:00:00

  • Advances in understanding spontaneous intracerebral hemorrhage: insights from neuroimaging.

    abstract::Spontaneous (non-traumatic) symptomatic intracerebral hemorrhage is a devastating form of stroke, with very high overall mortality and morbidity. Even with the best current medical or surgical treatment, outcomes still remain poor. By contrast with ischemic stroke, the incidence of intracerebral hemorrhage is not decr...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.2014.918506

    authors: Wilson D,Charidimou A,Werring DJ

    更新日期:2014-06-01 00:00:00

  • An update on the recognition and treatment of non-convulsive status epilepticus in the intensive care unit.

    abstract:INTRODUCTION:Non-convulsive status epilepticus (NCSE) is a complex and diverse condition which is often an under-recognised entity in the intensive care unit. When NCSE is identified the optimal treatment strategy is not always clear. Areas covered: This review is based on a literature review of the key literature in t...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2017.1369880

    authors: Kinney MO,Kaplan PW

    更新日期:2017-10-01 00:00:00

  • Pathogenic role of mitochondrial [correction of mitochondral] amyloid-beta peptide.

    abstract::Metabolic dysfunction is one of the early features in Alzheimer's disease (AD) affected brain. Amyloid-beta peptide (Abeta), a major peptide deposited in neuritic plaques, has been considered as an important initiating molecule in the pathogenesis of AD. However, the pathogenic role of Abeta remains to be determined. ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.7.11.1517

    authors: Chen JX,Yan SD

    更新日期:2007-11-01 00:00:00

  • Cognitive-behavioral therapy for bipolar disorder.

    abstract::Bipolar disorder is one of the most serious and prevalent psychiatric disorders. The aim of the present article is to review the efficiency of cognitive-behavioral therapy (CBT) for bipolar patients. Some studies show consistent evidence that cognitive therapy, concomitant to psycho-education and pharmacological treat...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/ern.10.75

    authors: da Costa RT,Rangé BP,Malagris LE,Sardinha A,de Carvalho MR,Nardi AE

    更新日期:2010-07-01 00:00:00

  • Brain-derived neurotrophic factor and neuroplasticity in bipolar disorder.

    abstract::Initial descriptions of bipolar disorder (BD) emphasized that patients returned to a baseline condition after acute episodes. Such definitions were operational in teasing bipolar disorder apart from schizophrenia, where patients were described to be permanently impaired after the initial episodes. However, this view o...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.8.7.1101

    authors: Kapczinski F,Frey BN,Kauer-Sant'Anna M,Grassi-Oliveira R

    更新日期:2008-07-01 00:00:00

  • Prognosis of multiple sclerosis: clinical factors predicting the late evolution for an early treatment decision.

    abstract::With the development of new immunomodulating therapies, with which early use is strongly encouraged, it is crucial to be in possession of reliable clinical predictors of multiple sclerosis evolution. Prognostic factors are important to patients wanting to be informed about their prospects; to the clinician needing to ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.6.3.357

    authors: Bergamaschi R

    更新日期:2006-03-01 00:00:00

  • Special biological issues in the management of women with schizophrenia.

    abstract::Schizophrenia is a debilitating and pervasive mental illness with devastating effects on psychological, cognitive and social wellbeing, and for which current treatment options are far from ideal. Gender differences and the influence of the female reproductive life cycle on the onset, course and symptoms of schizophren...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/ern.12.62

    authors: Kulkarni J,Gavrilidis E,Hayes E,Heaton V,Worsley R

    更新日期:2012-07-01 00:00:00

  • Evaluation and management of headache in primary care.

    abstract::Headache disorders are ubiquitous, common, disabling and to a very large extent treatable in primary care. In this review, the important headache disorders are described together with their impact on public health. Suggestions are set out for their optimal management, although many of these are necessarily based more ...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.4.3.425

    authors: Steiner TJ

    更新日期:2004-05-01 00:00:00

  • Use of antiepileptic drugs in pregnancy.

    abstract::Babies born to mothers exposed to antiepileptic drugs (AEDs) are at increased risk for major congenital malformations, cognitive impairment and fetal death. For the millions of women with epilepsy, maintaining the safest drug that will successfully prevent seizures during pregnancy remains a primary consideration. The...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.6.7.1077

    authors: Tatum WO

    更新日期:2006-07-01 00:00:00

  • Antiepileptic drug therapy and recommendations for withdrawal in patients with seizures and epilepsy due to neurocysticercosis.

    abstract:INTRODUCTION:Neurocysticercosis (NCC) is a leading causes of secondary epilepsy worldwide. There is increasing evidence on the epileptogenic role of NCC, and the presence of edema, calcified scars, gliosis and hippocampal sclerosis support this phenomenon. AREAS COVERED:We summarized principles of antiepileptic drug (...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1080/14737175.2016.1194757

    authors: Bustos JA,García HH,Del Brutto OH

    更新日期:2016-09-01 00:00:00

  • Developing drug strategies for the neuroprotective treatment of acute ischemic stroke.

    abstract::Developing new treatment strategies for acute ischemic stroke in the last twenty years has offered some important successes, but also several failures. Most trials of neuroprotective therapies have been uniformly negative to date. Recent research has reported how excitatory amino acids act as the major excitatory neur...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章,评审

    doi:10.1586/14737175.2015.1101345

    authors: Tuttolomondo A,Pecoraro R,Arnao V,Maugeri R,Iacopino DG,Pinto A

    更新日期:2015-01-01 00:00:00

  • Neuromodulation for central pain.

    abstract::Central pain, which follows brain and spinal cord injury remains an ill-treated entity affecting approximately 1-2 million people worldwide. When oral drugs fail, either immediately or in the long run, the only therapeutic option is neuromodulation, via either electrical or chemical means. The whole spectrum of neurom...

    journal_title:Expert review of neurotherapeutics

    pub_type: 杂志文章

    doi:10.1586/14737175.3.5.591

    authors: Canavero S,Bonicalzi V

    更新日期:2003-09-01 00:00:00