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Fatigue preceding a multiple sclerosis diagnosis


Senior Member
Fatigue heralding multiple sclerosis.


Mult Scler. 2013 Feb 25. [Epub ahead of print]
Fatigue heralding multiple sclerosis.
Berger JR, Pocoski J, Preblick R, Boklage S.

Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA.


Fatigue is a common symptom in multiple sclerosis (MS) and is an important determinant of overall well-being and disability.

To assess the frequency with which fatigue precedes the diagnosis of MS using a retrospective database analysis.

Between January 1, 2003 and September 30, 2008, patients diagnosed with fatigue with and without fatigue-related medications within a 3-year period prior to newly diagnosed MS were identified from the MarketScan Databases. All statistical analysis was performed using SAS.

Of the 16,976 patients with MS in the overall population, 5305 (31.3%) were newly diagnosed with MS and had three years of continuous healthcare coverage prior to MS diagnosis. Of these patients, 1534 (28.9%) were labeled with chronic fatigue syndrome (ICD9-780.71) or malaise or fatigue (ICD9-780.79) prior to the diagnosis of MS. One-third of these patients were labeled with fatigue one to two years before the diagnosis; 30.8% were diagnosed only with fatigue and had no other MS symptoms prior to their MS diagnosis. Among the patients diagnosed with fatigue, 10.4% were also prescribed medication for fatigue.

This study demonstrates that fatigue may herald MS, often by years. A careful history for transient neurological symptoms and a physical examination is warranted in any patient presenting with fatigue.

[PubMed - as supplied by publisher]

Patients should be aware of the fact that their Chronic Fatigue Syndrome could be a precursor for MS. They should monitor this condition with their neurologists during the first years of onset of symptoms.



Senior Member
Neurologists are supposed to monitor us? Huh, I thought neurologists are for when we haven't had enough abuse lately and want to be told we have a psychosomatic disorder and need to exercise until it goes away.

LOL :)


Senior Member
Wow. In the UK you would be lucky to see an Neuologist in year one. Then if he did arrange a repeat appointment it would probably be in another year. I've never had an neurologist show the slightest bit of interest in monitoring any of my symptoms and that includes the neurological ones.


Senior Member
Or you may just achieve a visit to a Neurologist in the UK, have all the tests - come out with a note of various abnormalities like "high signal changes" on your brain MRI scan and go nowhere except crawl back into bed.


Senior Member
My nuerologists have either misdiagnosed me with mild stroke (confirmed incorrect when symptoms continued to worsen and six MRIs failed to show anything) or refused to see me without a psychiatric confirmation that I wasn't insane. sigh. I'm not up to going back for more abuse or expensive useless tests.


Senior Member
Here, we review recent neuroimaging and neuroimmunological findings, which indicate that dysfunctional reward processing might represent a shared functional mechanism fostering the symptom cluster of fatigue, depression, and pain in MS

The frequent co-occurrence of fatigue, depression, and pain already in the prodromal phase8 and in early MS as well as their parallel development over time suggest a common etiology.5 Moreover, these symptoms share decreased motivation and a lack of positive affect,1,2,9 which are essential signs of anhedonia.10,11 Anhedonia is the reduced ability to strive for and to experience pleasure,10,11 and has been attributed to deficits in reward processing.12 Importantly, it is a core feature of many neuropsychiatric disorders, including chronic fatigue syndrome,10 major depression,10,11 and chronic pain,9 and has been associated with poor long-term outcomes and treatment responses.11

Neuroimaging studies in MS patients with fatigue, depression, and pain have indicated gray matter atrophy and decreased functional connectivity in the prefrontal cortex, the basal ganglia, and the limbic system. These structures are core areas of the mesocorticolimbic system, a key structure in valence and reward processing that strongly depends on monoaminergic neurotransmission. Thus, fatigue, depression, and pain in MS are associated with functional disruption and, ultimately, degeneration of mesocorticolimbic pathways.

Fatigue, depression, and pain in multiple sclerosis: How neuroinflammation translates into dysfunctional reward processing and anhedonic symptoms - Henrik Heitmann, Till F M Andlauer, Thomas Korn, Mark Mühlau, Peter Henningsen, Bernhard Hemmer, Markus Ploner, 2022 (sagepub.com)