Tiivistelmä

Uupumus on merkittävä pesäkekovettumatautia (MS-tautia) sairastavan toimintakykyyn vaikuttava tekijä. Taudin kliininen oireisto ja vaikeusaste eivät korreloi uupumukseen. Uupumus on subjektiivista ja sen mittaaminen ja todentaminen esimerkiksi lausunnoissa on haastavaa. Tehokkaat oireenmukaiset hoidot tähän oireeseen puuttuvat.

Summary

Fatigue in multiple sclerosis (MS) is a highly debilitating symptom. About 80% of patients with MS suffer fatigue during their lifetime, some even before the diagnosis. The measuring of fatigue is difficult, because it is a very subjective symptom.

Fatigue may be primary and/or secondary. Primary fatigue has been considered to be caused by the pathological mechanisms of multiple sclerosis. The exact pathologic mechanism is not known. Furthermore, both structural and functional mechanisms are involved. Secondary fatigue may coexist with primary fatigue. Secondary fatigue can result, for example, from drug side effects, co-existing diseases, pain, depression or impaired motor function.

The Finnish version of the Fatigue Severity Scale questionnaire (FSS) has been shown to be a reliable method for measuring self-reported fatigue. Multiple Sclerosis Impact Scale (MSIS-29) can be used for measuring how patients experience fatigue affect their life both psychically and psychologically.

Treatment of MS-related fatigue can be pharmacological or non-pharmacological. Non-pharmacological interventions are based on influencing lifestyle, nutritional and environmental factors. For example, good physical fitness, a regular lifestyle, a healthy diet and proper timing of work may relieve symptoms and help to manage fatigue. Although many drugs have been tested in clinical trials, only amantadine is currently recommended for this indication. However, so far effective drugs are lacking as even the effect of amantadine is only moderate. Antidepressant drugs such as venlafaxine, bupropion, milnacipran and duloxetine may also be used for treating fatigue. Modafinil, a stimulant currently indicated for the treatment of narcolepsy, has also been tested in many clinical trials for patients with MS-related fatigue. However, the results have been controversial and modafinil has not been approved for treating MS-related fatigue.