One of the presentations at the Consortium for Multiple Sclerosis Centers (CMSC) conference in Montreal was on fatigue in MS, and how this symptom may present years before an MS diagnosis.
Fatigue was one of the most disabling symptoms for my husband, and he suffered from this and depression for about three years before his first "official" MS flare. Here's the report from Montreal:
MONTREAL -- Months or even years before demyelinating events are recognized, patients later diagnosed with multiple sclerosis often turn up in their doctors' offices complaining of fatigue, a researcher said here.
Among patients receiving MS diagnoses after 2005, records of nearly 30% indicated that they had reported fatigue to their physicians beforehand, said Joseph Berger, MD, of the University of Kentucky in Lexington, in a presentation at the annual meeting of the Consortium of Multiple Sclerosis Centers.
Berger noted that fatigue is a common symptom of MS, reported by many patients to be their biggest problem with the disease. Numerous previous studies have examined risk factors for fatigue and its relationship to disease progression following diagnosis.
But his study is the first to examine the presence of fatigue before a formal MS diagnosis, he said.
Berger and colleagues examined a large medical claims database maintained by Thompson Reuters, comprising records of major U.S. employers and health plans. It included 5,305 patients who were diagnosed with MS in 2005 to 2008 and who had three years of coverage prior to diagnosis as well as at least one year of coverage afterward.
"Careful history and physical examination for features suggestive of multiple sclerosis is mandated in any patient presenting with unexplained fatigue," Berger told CMSC attendees.
He also suggested that the study's numerical findings were almost certainly underestimates of the frequency of fatigue, insofar as many physicians, including himself, rarely record it with a specific ICD-9 code on their patients' charts.
He said his group was planning additional studies to pin down the role of fatigue as a precursor to, or predictor of, MS. These include a comparative analysis of fatigue preceding other conditions such as depression, asthma, hypothyroidism, anemia, and rheumatoid arthritis as well as MS.
Also on tap is a study to see if pre-MS patients reporting fatigue as the sole symptom are otherwise different from those complaining of multiple MS-related symptoms.
And, he added, it would also be useful to compare the incidence of fatigue in patients going on to MS with the population of all patients labeled with fatigue, Berger said.
Mark Freedman, MD, of the University of Ottawa, commented during the question-and-answer session that the latter study would be especially important, insofar as most patients with such complaints in the current study were probably seen in primary care.
"You would want to know what percentage of that population with general malaise don't go on to develop multiple sclerosis," he said.
Such an analysis would shed light on the degree to which fatigue should heighten physicians' suspicions of MS, Freedman suggested.
http://www.medpagetoday.com/MeetingCoverage/CMSC/26848
_____________________________________________________________________
To Dr. Berger and Dr. Freedman, I would like to suggest that they connect and work with the IRs currently treating CCSVI to learn more about the connection with venous insufficiency and fatigue. My husband was one of many who received a profound and immediate relief from fatigue from venoplasty. He is now working full days again, able to drive, stay up all day, sleep peacefully at night, and wake up refreshed in the morning. I can hear his beautiful music coming from his office as I write these words. It makes me so happy. The only change has been the opening of his two malformed jugular veins and stenotic dural sinus.
Here is Dr. Dake regarding this connection. My husband is one of the patients he is refers to.
Among those conducting CCSVI research is Dr. Michael Dake, a professor of cardiothoracic surgery at Stanford University School of Medicine.
Dake followed 30 people with MS who had stents implanted to open their veins. Two months after surgery, they reported feeling 50 percent less fatigued than before surgery, Dake said. They continued to be less fatigued at the one-year mark, even improving slightly from where they were two months after surgery, he said.
http://health.usnews.com/health-news/managing-your-healthcare/treatment/articles/2011/01/18/vein-opening-treatment-for-ms-stirs-controversy?PageNr=1
And now at 2 years, Jeff is able to work all day and go out at night after that. He goes the full day without a nap, or needing a break. He's even pulled a few "all-nighters" to get music out on deadline. This was impossible for him prior to angioplasty. He had to take a nap after 2 hour of being upright. This crippling fatigue is a distant and horrible memory. He continues to comment on how wonderful it is to be awake and alive again.
Slowed blood flow through the brain (hypoperfusion) and a decrease of essential O2 and glucose to the brain could certainly cause fatigue. Dr. Haacke and Dr. Hubbard's tests are showing improved cortical blood flow after angioplasty. The evidence is there. Will these researchers listen??? Ask them.
Joan