PMID- 28991714
DCOM- 20180611
LR  - 20180611
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 381
DP  - 2017 Oct 15
TI  - The pharmacological and non-pharmacological interventions for the management of
      fatigue related multiple sclerosis.
PG  - 41-54
LID - S0022-510X(17)30497-5 [pii]
LID - 10.1016/j.jns.2017.08.012 [doi]
AB  - AIM: The clinical aim was to provide up-to-date evidence-based recommendations
      for the treatment of MS-related fatigue (MSRF). The scientific aim was to
      prioritise topics for future randomised clinical trials with sufficient power.
      METHODS: A systematic search of review based research that considered MSRF in
      adults (18years and over) was undertaken in May 2016. Data from reviews was
      extracted, critically appraised and synthesised using four specific techniques.
      RESULTS: A total of 24 reviews were identified (17 non-pharmacological, 5
      pharmacological, 2 combining both), which contained 339 studies on interventions 
      deigned to improve MSRF. The methodological quality of the reviews was identified
      by an average AMSTAR score of 6.5 (SD=1.87: 95% CI=5.75-7.25). No pharmacological
      intervention had strong evidence for improving MSRF. Limited/conflicting evidence
      was found for Amantadine and Prokarin and potential benefits for Modafinil were
      identified. Pemoline and Carnitine contained unclear/no evidence for fatigue
      management. Non-pharmacological interventions produced mixed conclusions
      regarding the effectiveness of the intervention to improve MSRF. Education
      (energy conservation and fatigue management) and exercise had supporting evidence
      for reducing MSRF but mixed conclusions gathered from subtypes of exercise.
      Reviews considering psycho-behavioural interventions (CBT and mindfulness) had
      limited information considering effectiveness. Finally, a single intervention
      combining physical and cognitive strategies showed more promising results.
      CONCLUSION: Further research into Pharmacological interventions for MSRF is
      required notably considering the potential of Modafinil. Yoga and energy
      conservation/fatigue management programs had strong evidence supporting use in
      management of MSRF. Due to the dissimilar interventions used in combined training
      the subtype of exercise cannot be recommended. Future research into Amantadine,
      psycho-behavioural interventions is vital to justify the current National
      Institute for Health and Care Excellence guidelines. The methodological quality
      of studies inhibited the ability of this review to provide other recommendations.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Miller, Philippa
AU  - Miller P
AD  - School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, 
      Edgbaston, Birmingham B15 2TT, UK. Electronic address:
FAU - Soundy, Andrew
AU  - Soundy A
AD  - School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, 
      Edgbaston, Birmingham B15 2TT, UK. Electronic address:
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170812
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
SB  - IM
MH  - Disease Management
MH  - Fatigue/*etiology/physiopathology/*therapy
MH  - Humans
MH  - Multiple Sclerosis/*complications/physiopathology/therapy
EDAT- 2017/10/11 06:00
MHDA- 2018/06/12 06:00
CRDT- 2017/10/10 06:00
PHST- 2017/02/14 00:00 [received]
PHST- 2017/07/20 00:00 [revised]
PHST- 2017/08/08 00:00 [accepted]
PHST- 2017/10/10 06:00 [entrez]
PHST- 2017/10/11 06:00 [pubmed]
PHST- 2018/06/12 06:00 [medline]
AID - S0022-510X(17)30497-5 [pii]
AID - 10.1016/j.jns.2017.08.012 [doi]
PST - ppublish
SO  - J Neurol Sci. 2017 Oct 15;381:41-54. doi: 10.1016/j.jns.2017.08.012. Epub 2017
      Aug 12.