Fatigue is the symptom which has been high on the agenda for research into its cause and cure.
It seems this is a sickness behaviour as a consequence of inflammation within the CNS.
It is probable that it is caused, at least in part, by inflammatory cytokines. Therefore, if you get rid of inflammation, fatigue may be reduced.
We first saw this with natalizumab and so it is the cases haematopoetic stem cell therapy and so.
Bose G, Atkins HL, Bowman M, Freedman MS. Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis. Mult Scler. 2018. doi: 10.1177/1352458518802544. [Epub ahead of print] BACKGROUND: Fatigue is a common problem in multiple sclerosis (MS) affecting as many as 90% of patients. The Fatigue Impact Scale (FIS) is a validated measure of fatigue in MS patients. The cause of fatigue in MS is likely multifactorial, with some evidence that ongoing central nervous system (CNS) inflammation is a contributing factor. Immunoablation and autologous hematopoietic stem cell transplantation (aHSCT) have been shown to halt ongoing CNS inflammation.
OBJECTIVE: To investigate whether halting all ongoing inflammation with aHSCT impacts FIS scores in patients with severe MS.
METHODS: In the Canadian aHSCT study ( ClinicalTrials.gov , NCT01099930), 23 patients underwent aHSCT and had FIS prospectively collected every 6 months for 36 months of follow-up. Change in FIS was analysed by repeated-measures analysis of variance (RMANOVA) with multiple linear regression to determine independent predictors.
RESULTS: The median FIS score decreased 36%, from 36 to 23 ( p = 0.001), and four patients had 100% reduction. Improvement in FIS correlated with lower age and Expanded Disability Status Scale at baseline, as well as increased independence as evidenced by a return to gainful employment and even driving.
CONCLUSION: Patients had significantly less fatigue on average after aHSCT. This may serve to better understand the contribution of ongoing CNS inflammation to fatigue peculiar to MS.