Objective: To investigate fatigue severity and the nature of fatigue in functional motor disorders (FMD). Secondarily, to determine the relationship between fatigue, quality of life, depression and sleep.

Background: In clinical practice, fatigue seems to be a major problem for patients with FMD. In chronic neurological disorders like Multiple Sclerosis and Parkinson’s Disease fatigue has been found highly impairing, but studies on this topic in FMD are scarce.

Methods: Baseline data of the ongoing SHIFT-study (Self-Help on the Internet for FMD, a randomised trial), was used. Patients with FMD who were 18 years and older, able to read Dutch and provide informed consent, were recruited by neurologists from all over the Netherlands. Patients filled out an online questionnaires including several validated scales, before randomisation for the trial.

Results: 106 FMD patients were included, with a mean age of 48 years (SD 14). Functional motor symptoms consisted of gait disorder (30%), tremor/jerky movements (35%), dystonia (16%) and paresis (18%). Mean CIS fatigue total score was 89 (SD26), scores on the subscales were fatigue severity 41 (SD12) (max 56), concentration 20 (SD9) (max 35), motivation 14 (7)(max 28) and physical activity 13 (SD5)(max 21). Severe fatigue, (> 35 on the fatigue severity subscale) was present in 72% of patients.

Fatigue severity was a significant factor contributing to dichotomised QoL (poor/very poor/neutral (67% of cases) versus good/very good (33% of cases)) in a binary logistic model (p=0,006, odds ratio 0,948 (0,914-0,985)), corrected for depression on the PHQ-9, the SF36 subscale for physical functioning and sleep disturbance. Depression was correlated to fatigue severity (Spearman p<0,001).

Conclusions: Fatigue is highly prevalent among patients with FMD and is significantly correlated to impaired quality of life. A preliminary comparison with data from Kalkman et al. (2005) in fatigue in neuromuscular disorders, showed a similar percentage of patients (69%) had severe fatigue (chi square, p=0,564). Compared to the largest studied neuromuscular group, myotonic dyostrophia (n=322), Fatigue severity and physical activity were the same, while concentration was more severely impaired (p=0,013) and motivation was less impaired (p=0,0001).

References: Kalkman JS, Schillings ML et al. Experienced fatigue in facioscapulohumeral dystrophy,myotonic dystrophy, and HMSN-I. J Neurol Neurosurg Psychiatry 2005;76:1406–1409

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MDS Abstracts - https://www.mdsabstracts.org/abstract/fatigue-in-functional-motor-disorders/