Research: Fatigue heralding multiple sclerosis

Firestormm

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Like my previous Lancet commentary highlighting non-ME psychiatric illnesses and the purstuit of biological markers, this is of interest to us perhaps but is not directly ME-related.

Therefore I haven't posted it in the research threads. This is - for obvious reasons - of particular interest to us nonetheless...

2013 Feb 25

Fatigue heralding multiple sclerosis.

Berger JR, Pocoski J, Preblick R, Boklage S.
Source

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

BACKGROUND:

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

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

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.
RESULTS:

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.
CONCLUSION:

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.
Dr Shepherd highlighted this one on MEA Facebook, his comment and my reply follow (for anyone who is interested):

Dr Shepherd:

"Disabling central fatigue is a very common symptom in MS but it's something that doesn't always appear in textbook descriptions of the illness. The nature of the fatigue has some interesting overlaps with ME/CFS - for example, in both conditions hot weather can exacerbate this symptom."
Firestormm:

"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."

A very interesting study, Charles. Speaks volumes as to possible misdiagnoses going undetected. Unless the key clinical symptoms are mentioned or observed in consultation then the scans that are generally warranted to make an MS diagnosis are presumably not ordered.

I doubt if there will ever be a time whereby misdiagnosis can be eliminated completely, but the more experts in ME are capable of spotting something that is different or not accounted for completely by what we know as being ME - the greater the chance of this referral for an MS scan.