Review Article

Fatigue as a symptom or comorbidity of neurological diseases

  • Nature Reviews Neurology volume 13, pages 662675 (2017)
  • doi:10.1038/nrneurol.2017.117
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Abstract

Fatigue, best described as an overwhelming feeling of tiredness and exhaustion, occurs in the context of various neurological diseases. The high prevalence of fatigue as either a symptom or a comorbidity of neurological disease must be taken seriously, as fatigue interferes with patients' activities of daily living, has a remarkable negative impact on quality of life, and is a major reason for early retirement. The tremendous consequences of fatigue are consistent across neurological diseases, as is the uncertainty concerning its underlying pathophysiological mechanisms. Inconsistencies in defining fatigue contribute to the present situation, in which fatigue represents one of the least-studied and least- understood conditions. Tools for assessing fatigue abound, but few can be recommended for clinical or research use. To make matters worse, evidence-based pharmacological treatment options are scarce. However, non-pharmacological approaches are currently promising and likely to become of increasing importance. In sum, fatigue is challenging for both health-care professionals and patients. The present article aims to provide a comprehensive review of the literature on fatigue in neurological disease, and to reveal its complexity, as well as weaknesses in the concept of fatigue itself.

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Acknowledgements

The authors' work is supported by Deutsche Forschungs-gemeinschaft (grant DFG Exc 257 to F.P.) The authors thank Hanna Zimmermann for her valuable editorial support in preparing the manuscript.

Author information

Affiliations

  1. Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.

    • Iris-Katharina Penner
  2. COGITO Centre for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Merowingerplatz 1, 40225 Düsseldorf, Germany.

    • Iris-Katharina Penner
  3. NeuroCure Clinical Research Centre and Clinical and Experimental Multiple Sclerosis Research Centre, Department of Neurology, Charité — Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

    • Friedemann Paul
  4. Experimental and Clinical Research Centre, Max Delbrück Centre for Molecular Medicine and Charité – Universitätsmedizin Berlin, Lindenberger Weg 80, 13125 Berlin, Germany.

    • Friedemann Paul

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Contributions

I.-K.P. and F.P. researched data for the article; contributed substantially to discussions of its content, wrote the manuscript, and undertook review or editing of the manuscript before submission.

Competing interests

The authors declare that I.-K.P. has received honoraria for speaking at scientific meetings, serving on scientific advisory boards and consulting activities from Adamas Pharma, Bayer Pharma, Biogen, Genzyme, Merck Serono, Novartis, Roche, Teva Pharmaceuticals; and that she has received research support from Novartis, the German Multiple Sclerosis Society, and Teva Pharmaceuticals. F.P. declares that he has served on scientific advisory boards for MedImmune and Novartis; received speaker honoraria and travel funding from Alexion, Bayer, Biogen Idec, Chugai, MedImmune, Merck Serono, Novartis, Sanofi-Aventis/Genzyme, Teva Pharmaceuticals, and Shire; is an academic editor of PLoS ONE and an associate editor of Neurology Neuroimmunology & Neuroinflammation; has consulted for Alexion, Biogen Idec, MedImmune, Sanofi-Aventis/Genzyme and Shire; and received research support from Alexion, Arthur Arnstein Stiftung Berlin, Bayer, Biogen Idec, EU FP7 Framework Program, German Ministry of Education and Research, German Research Council, Guthy-Jackson Charitable Foundation, Merck Serono, National Multiple Sclerosis Society of the USA, Novartis, Sanofi-Aventis/Genzyme, Teva Pharmaceuticals, and Werth Stiftung of the City of Cologne.

Corresponding author

Correspondence to Iris-Katharina Penner.