Fatigue in multiple sclerosis

The storage and release of DA can be modified irreversibly by reserpine (3.1), just as in vesicles containing other catecholamines and serotonin. Dopamine release can be blocked specifically by y-hydroxybutyrate (4.78) or its precursor, butyrolactone, which can cross the blood-brain barrier. High doses of amphetamines do deplete the storage vesicles, but this is not their principal mode of action. Apparently, amantadine (4.79), an antiviral drug that is likewise beneficial in parkinsonism (and also perhaps to relieve fatigue in multiple sclerosis), may also act by releasing DA. 

Rammohan KW, Rosenberg JH, Lynn DJ, Blumenfeld AM, Poliak CP, Nagaraja HN. Efficacy and safety of modafmil (Provigil) for the treatment of fatigue in multiple sclerosis a two centre phase 2 study. J Neurol Neurosurg Psychiatry 2002 72(2) 179-83. 

Gillsori G, Richar-d TL, Smitli RB, Wright JV (2002) A double-blind pilot study of tlie effect of Prokai-in on fatigue in multiple sclerosis. Mult Scler Feb 8(l) 20-25. 

The general toxicity of interferon beta is very similar to that of interferon alfa (2), with no apparent differences between the two recombinant preparations with any route of injection (SEDA-20, 332) (3-6). In multiple sclerosis, fatigue and a transient flu-like syndrome responsive to paracetamol or the combination of paracetamol plus prednisone have been observed in about 60% of patients during the first weeks of treatment, and tachyphylaxis usually developed after several doses (7). Patients with chronic progressive disease are more likely to discontinue treatment because of adverse effects (8). 

Fatigue accompanies viral infection, sepsis, trauma or major surgery. The cause of this fatigue is not known it may be peripheral, central or both. Studies on biopsy samples of patients with trauma show a reduction in the muscle ATP concentration, which could be responsible for peripheral fatigue, as explained above (Chapter 18 Table 13.3). Central fatigue has been identified in three different clinical conditions, post-polio syndrome, multiple sclerosis and after spinal cord injury, but has not been investigated in other conditions. 

May be useful to treat fatigue In patients with depression as well as other disorders, such as multiple sclerosis, myotonic dystrophy, HIV/AIDS... 

The nervous system is particularly susceptible to chemical abuse. Damage to the peripheral nervous system can cause numbness, weakness, and muscle paralysis. Many inhalants have been shown to damage the myelin sheath (Figure 6.1), the protective coat around nerve cells. This causes symptoms like those seen in individuals with multiple sclerosis, including abnormal fatigue, vision problems, loss of muscle coordination, slurred speech, and tremors. Direct damage to the brain... 

Multiple Sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) a chronic, inflammatory, demyelinating disease that affects the central nervous system (CNS). MS can cause a variety of symptoms, including changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating, and pain. 

In a 9-week, single-blind, placebo-controlled pilot study in 72 patients with multiple sclerosis who took modafinil 200 mg/day for 2 weeks, there was significant improvement in fatigue compared with placebo run-in treatment (8). The most frequent adverse effects were headache, nausea, and anxiety, and these were rated as either mild or moderate. 

In an evaluation of the frequency and clinical characteristics of the underlying connective tissue disorders associated with silicone breast implants, 300 women with silicone breast implants were studied (45). In addition to a history and physical examination, C reactive protein, rheumatoid factor, and autoantibodies were determined. Criteria for fibromyalgia and/or chronic fatigue syndrome were met by 54% connective tissue diseases were detected in 11% and undifferentiated connective tissue disease or human adjuvant disease in 10.6%. A variety of disorders, such as angioedema, frozen shoulder, and a multiple sclerosis-like syndrome, were also found. Several other miscellaneous conditions, including recurrent and unexplained low grade fever, hair loss, skin rash, symptoms of the sicca sjmdrome, Rajmaud s phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breath were also seen. Of 93 patients who underwent explantation, 70% reported improvement in their systemic symptoms. 

IFN-P shares 29% amino acid homology with IFN-a and has been used in the treatment of multiple sclerosis. Type 1 interferons (a and P) differ from Type II interferons (y) in biochemical properties, biological function, and receptor specificity. Side effects common to both classes of interferons include chills, fever, rigors, headache, myalgia s, hypotension, nausea, vomiting, anorexia, constipation, fatigue, neutropenia, and elevated transaminases. This constellation of symptoms frequently results in mild to moderate hypotension and volume depletion and could potentially contribute to prerenal azotemia or acute tubular necrosis. 

The efficacy and safety of vitamin D supplementation in the treatment of multiple sclerosis has been evaluated in a systematic review including five studies. The most common adverse events reported were diarrhoea, constipation, dyspepsia, fever, fatigue and headache. No serious adverse events occurred [71 ]. 

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