Frequency and characteristics of chronic fatigue syndrome in multiple sclerosis patients at a university hospital in Eastern Saudi Arabia 2024 AlAmri+

Abstract

BACKGROUND:
Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease that affects various parts of the central nervous system. Fatigue, a common symptom, transient, prolonged, or chronic experienced by individuals with MS, can significantly impact daily functioning. It can be associated with underlying pathological processes or can have an idiopathic cause, such as chronic fatigue syndrome (CFS). The study aimed to assess the presence and etiology of fatigue in MS patients and its relationship with CFS.

MATERIALS AND METHODS:
This cross-sectional study was conducted in the Eastern Province of Saudi Arabia. Data were collected using a questionnaire from a sample of 225 MS patients receiving care at our university hospital. The questionnaire included the Centers for Disease Control and Prevention (CDC) criteria for diagnosing CFS and the Expanded Disability Status Scale to evaluate fatigue in MS patients.

RESULTS:
Of the total of 225 MS patients who participated in this study, 87.1% were diagnosed with relapsing-remitting MS, 6.7% with primary progressive MS, 3.6% with clinically isolated syndrome, and 2.7% with secondary progressive MS. About 53% had experienced fatigue that persisted for over 6 months. Analysis of CFS diagnosis revealed that 7.3% of patients met both CDC criteria and self-reported answers while 17.5% reported having CFS despite not meeting the CDC criteria. These findings highlight a significant lack of agreement between patient-reported diagnoses and established criteria, indicating poor agreement (P = 0.028).

CONCLUSION:
The study found an association between CFS and MS, and a significant impact on daily functioning. The study revealed lack of agreement between patient-reported diagnoses and established criteria for CFS. This emphasizes the need for a standardized approach to diagnosis and evaluation of fatigue in MS patients.

Open access, https://journals.lww.com/jfcm/fullt...and_characteristics_of_chronic_fatigue.9.aspx

 

I suspect that they use Chronic Fatigue Syndrome but more mean chronic fatigue.

"Various assessment tools have been developed to assist in the distinction between fatigue and CFS. One of the most used tools is the Expanded Disability Status Scale (EDSS), developed by Kurtzke for the evaluation of the functionality of the central nervous system.[11] This clinician-administered assessment scale is used in MS patients to determine disease progression and response to therapeutic measures.[11] The symptom inventory, or what is commonly known as the Fukuda 1994 criteria, is another tool developed to assess the presence, severity, and frequency of eight main symptoms described by Fukuda et al., in 1994.[3] This research conducted a cross-sectional study using a survey based on the Centers for Disease Control-Symptom Inventory (CDC-SI/Fukuda 1994) criteria and the EDSS. The study’s aim was to assess the presence and etiology of fatigue and its association with CFS in MS patients being followed up or treated in the neurology department."

"Memory or concentration impairments were reported by 52.4% of patients, muscle pain by 50.7%, postexertional malaise by 29.8%, joint pain by 25.3%, new headaches by 20.0%, and tender lymph nodes by 3.1%."

 

It certainly tells us that vague and bland self-reported symptom assessment based on outdated criteria means little.

It seems that they are assessing the diagnosis via Fukuda (which they also call CDC criteria). According to this study 24% of patients with MS meet this criteria, once again suggesting that it can't seperate ME/CFS from other conditions (of course there might also be some people with MS that have ME/CFS and vice versa).

The diagnostic criteria for MS are also not 100% sensitive or specific and post-Mortem studies have suggested that 5% of pwMS in fact have a different condition (things like anti-MOG disease).