Neurology 2001 Aug 28;57(4):676-681
Giovannoni G, Thompson AJ, Miller
DH, Thompson EJ.
Departments of Neurochemistry (Drs. Giovannoni and E. Thompson), Clinical Neurology (Drs. Giovanni, A. Thompson, and Miller), and Neurorehabilitation (Dr. A. Thompson), Institute of Neurology, London, United Kingdom.
BACKGROUND:
The pathogenesis of fatigue in patients
with MS is poorly understood. OBJECTIVE: To test the hypothesis that fatigue
in MS is related to inflammatory disease activity as measured by systemic
markers of inflammation.
METHODS:
Fatigue as assessed by the Fatigue
Questionnaire Scale (FQS) and Krupp's Fatigue Severity Scale (KFSS) was
correlated with several inflammatory markers in 38 patients with MS (16
relapsing-remitting [RR; 7 of whom had benign MS), 9 secondary progressive
[SP], 13 primary progressive [PP]). The markers included daily urinary
neopterin excretion, a marker of interferon-gamma-activated macrophage
activity, and serum C-reactive protein (CRP) and soluble intercellular
adhesion molecule-1 (sICAM-1) levels. Urinary neopterin excretion was measured
daily for 2 weeks.
RESULTS:
No correlation was found between
urinary neopterin excretion, CRP, or sICAM-1 and the fatigue scores. However,
patients with a raised serum CRP level had higher KFSS, but not FQS, scores
than patients with normal CRP levels (KFSS, 50 +/- 8 vs 41 +/- 14, p =
0.05; FQS, 13 +/- 4 vs 11 +/- 5, p = NS). When assessed using the FQS,
patients with RR and SP MS were more fatigued than patients with PP MS
(RR = 12.5 [4 to 23] vs SP = 13 [8 to 18] vs PP = 9 [7 to 14], p = 0.02).
The patients with benign MS were as fatigued as patients with nonbenign
disease.
CONCLUSION:
The pathogenesis of fatigue in MS
is complex and does not appear to be directly related to systemic markers
of inflammatory disease activity. Interestingly, patients with PP MS were
less fatigued than patients with RR disease.
PMID: 11524478 [PubMed - in process]