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Fatigue

Fatigue (tiredness) is a common symptom of MND. It is caused by a number of factors:

  • as MND attacks motor neurones, they become unable to send commands from the brain to the muscle cells that they control-movements must then be performed by a depleted number of nerve and muscle cells. This means that muscles tire quickly
  • other metabolic changes take place and the person with MND can feel very tired
  • weight loss and reduced food intake due to swallowing difficulties are likely to affect the person’s energy levels
  • when MND affects breathing muscles, less air is drawn into the lungs. When activity increases, it becomes more difficult for the lungs to supply enough oxygen to the body causing general fatigue (MND Australia 2011).

MND Australia 2011

Management

  • rest following physical activity and in the later stages of MND washing or dressing or using the hoist may exhaust the person and it may take some time for them to recover
  • health professionals, such as respiratory specialists, nurses, physiotherapists and rehabilitation staff can advise on energy conservation techniques, labour- saving devices and respiratory support options

Ramirez and others 2008

Fatigue is frequent in patients with ALS and has a progressive course; it presents an inverse relationship with age and does not present correlation with other studied factors, indicating that it is possibly an independent factor and should deserve specific investigation and treatment.

Miller and others 2009b

What pharmacologic interventions reduce fatigue?

  • Fatigue may be a symptom of depression, poor sleep, abnormal muscle activation, immobility, or respiratory dysfunction.
  • Fatigue was a side effect of therapy in 26% of patients taking riluzole vs 13% taking placebo (p = 0.07; number needed to harm = 8) (Class III). Asthenia occurred in 18% of patients taking riluzole vs 12% of patients taking placebo in a larger study (p = 0.004; number needed to harm = 17) (Class III).
  • Conclusions
    • There are no controlled studies of pharmacologic agents relieving fatigue in ALS. Riluzole possibly causes fatigue in some patients (2 Class III studies)
  • Recommendation
    • In patients developing fatigue while taking riluzole, once risks of fatigue vs modest survival benefits have been discussed, withholding the drug may be considered (Level C).