Fatigue in MS: The most common but neglected symptom
BAIRAKTARIS HRISOSTOMOS

Fatigue in MS: The most common but neglected sympton. Although fatigue is revognized as a disabling symptom in many diseases generally (Systemic Lupus Erythematosus, Rheumatoid arthritis, Hypothyreodismetc) and especiallyin neurological diseases since now we can't define or study it extensively as an entity.

One of the diseases that fatigue is a major and often severe symptom is Multiple Sclerosis (MS). 76-92% of MS patients say that they experience fatigue whereas 14-21% consider it as the most disabling symptom and 55-75% of them classified it among their three most severe symptoms. Fatigue is an irresistible feeling of tiredness, lack of energy and has to be differentiated from depression and muscular weakness.

There is contradiction regarding the pathogenesis of the disease (nerve conduction abnormalities, immune system disorders, psychological factors etc) as well as with the ability to use a scale in an objevtive manner (Visual Analogue Scale, Rand Index of Vitality, Fatigue impact scale, Fatigue severity Scale).

Since fatigue is a disabling symptom it is necessary the detailed evaluation with thorough history case, clinical neurological examination, haematological and biochemical parameter check and MRI of the brain. Apart from changes in life style, exercise, sleep hygiene in the management of fatigue we use several pharmaceutical agents as amantadine (Symmetrel) and CNS stimulants (as amphetamines or the novel non amphetamine selective CNS stimulant modafinil (Modiodal) and with antidepressents if depression coexists.