Guide to Diagnosis and Management
B. Krupp, MD
Medical Publishing, Feb 2004,
This practical guide for
physicians and other health care professionals discusses the impact of fatigue on the
individual with MS, the potential etiologies underlying MS-related fatigue, its workup and
diagnosis, and pharmacologic and nonpharmacologic management strategies.
Fatigue is perhaps the single most prevalent
and disabling symptom of the multiple sclerosis, and limits patients" activity
more than any other MS symptom. The identification of fatigue as a distinct
clinical entity requires both art and science, and most of all a willingness and
ability to listen carefully to patients and their families. The physician"s
ability to obtain a comprehensive history requires a full understanding of the
circumstances in which fatigue occurs (physical, cognitive, and psychosocial), and demands
consideration of the large number of disorders, including anxiety, depression,
excessive daytime sleepiness, pain, and spasticity, all of which may mimic or
contribute to fatigue.
While fatigue is almost exclusively a
subjective experience, depending on the patient"s ability to understand and
report this symptom, there are effective methods for identifying the existence of
fatigue, determining its severity, and distinguishing it from related or
contributing disorders such as depression, pain, and sleep disorders.
Readers will learn that fatigue need not be
tolerated by the MS patient. Various therapies, support systems, and treatment of
underlying affective disorders can all alleviate fatigue or reduce its
impact, restoring the patient"s energy levels and ability to participate in life.
Virtually every MS patient with fatigue can benefit from intervention, and failing to
treat the symptom of fatigue with the respect that it deserves is a serious
detriment to patient care.
Introduction; What is Multiple
Sclerosis-related fatigue?; The Measurement of Fatigue; The Pathophysiology of Multiple
Sclerosis-Related Fatigue; Depression and Fatigue; The Examination and Diagnosis of
Fatigue; Nonpharmacologic Approaches to Fatigue Management; The Pharmacologic
Management of Fatigue; Appendix. Ensuring Patient Adherence to an Exercise Program
Dr. Lauren B.
Krupp is Professor of Neurology at the State University of New York"s Stony Brook
Multiple Sclerosis Center. She lectures widely on the management of multiple