Multiple Sklerose: Fatigue

Zusammenfassung

Fatigue, eine vermehrte Ermüdbarkeit und subjektiver Mangel an Energie, ist eines der häufigsten und beeinträchtigendsten Symptome bei der Multiplen Sklerose. Sie beeinflusst wesentlich die Alltagsaktivitäten. Fatigue zeigt nur eine schwache Korrelation mit dem Grad der physischen Behinderung, ist aber häufig mit einer Depression vergesellschaftet. Die zu Grunde liegende genaue Pathophysiologie ist bislang unbekannt. Ursächlich werden das Ausmaß des axonalen Verlustes bzw. der Hirnatrophie, neuroendokrine Veränderungen durch proinflammatorische Prozesse sowie ein erhöhter Energiebedarf diskutiert. Die Therapie sollte multimodal und schrittweise gestaltet werden. Dazu stehen Verhaltensmodifikationen (z.B. Vermeidung von Überwärmung, Energieökonomie, Pausen, Schafregulation), moderates körperliches Training (aerobe Fitness), die Behandlung begleitender depressiver Symptome (Psychotherapie, Antidepressiva) sowie der Einsatz symptomatischer Medikamente, vor allem Amantadin oder Modafinil, zur Verfügung.

Summary

Tiredness and a subjective lack of energy, labelled as fatigue, is one of the most frequent and disabling symptoms in multiple sclerosis. It usually interferes with activities of daily life. Fatigue is only weakly correlated with physical impairment but is often associated with depression. The underlying pathophysiology remains unknown. The axonal loss leading to brain atrophy, some neuroendocrine changes induced by pro-inflammatory cytokines, and an increased energy cost are discussed as possible etiopathological factors. Therapeutical approaches should be multimodal and performed step by step including behavioral changes (e.g. avoiding heat, energy saving, breaks, sleep regulation), modest physical training (aerobic fitness), treatment of concomitant depression (psychotherapy, antidepressants), and stimulating drugs (e.g. amantadine, modafinil).

Schlüsselwörter

Multiple Sklerose - Fatigue - Müdigkeit - Depression

Keywords

Multiple sclerosis - fatigue - tiredness - depression

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