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Nervenheilkunde 2011; 30(07): 470-475
DOI: 10.1055/s-0038-1628381
Multiple Sklerose
Schattauer GmbH

Fatigue bei Multipler Sklerose

Mögliche Ursachen und Zusammenhänge, sinnvolle Diagnostik und TherapieFatigue in multiple sclerosispotential causes, and pathophysiology, implications for diagnosis and therapy
C. Veauthier
1   Klinik für Neurologie, Geriatrie und Palliativmedizin, Hanse-Klinikum Stralsund
› Author Affiliations
Further Information

Publication History

Eingegangen am: 10 January 2011

angenommen am: 02 March 2011

Publication Date:
23 January 2018 (online)

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Zusammenfassung

Fatigue ist das häufigste Symptom bei Patienten mit Multipler Sklerose (MS). Die Ursachen der Fatigue sind unklar. Diskutiert wurden neuroendokrine Ursachen, ein Zusammenhang mit der Läsionslast und Hirnatrophie, Depressionen, Nebenwirkungen von Medikamenten, Schlafstörungen und andere Ursachen. Eine Medikation mit Amantadin und Modafinil wurde mit wechselndem Erfolg eingesetzt, wobei deren Wirksamkeit durch Studien nicht belegt wurde. An nicht medikamentösen Therapien sind verhaltenstherapeutische und physiotherapeutische Maßnahmen wirksam. Es existieren keine diagnostischen objektiven Kriterien, die eine sichere Unterscheidung zwischen der Fatigue und einer durch Schlafstörungen bedingten Müdigkeit ermöglichen. Zunächst sollte jeder Fatigue-Patient gezielt zu Schlafstörungen befragt werden. Anamnestisch zu eruierende Schlafstörungen (z. B. Insomnie, Restless-legs-Syndrom, Schmerzen, Nykturie) sollten behandelt werden. Bei ausbleibender Besserung der Fatigue ist eine Polysomnografie zum Ausschluss einer schlafbezogenen Atemstörung und periodischer Beinbewegungen im Schlaf zu empfehlen.

Summary

Fatigue is the most common symptom in MS. The mechanism of fatigue is not known. A neuroendocrine origin as well as an increased lesion load and atrophy of gray and white matter and a relationship with depression and side-effects of the medication have been described. No specific successful drug-therapy exists, but amantadine and modafinil could be a therapeutic option and behavior therapy and physical therapy as well. We don`t yet have objective measurements to discriminate fatigue from tiredness. At first an accurate medical history should be taken and insomnia and restless legs syndrome, nycturia and pain should be treated consequently. In case of therapy resistance a polysomnography is needed.

Schlüsselwörter

Fatigue - Multiple Sklerose - Schlafstörungen - Modified Fatigue Impact Scale

Keywords

Fatigue - multiple sclerosis - sleep disorders - modified fatigue impact scale
 

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