Cases reported "Fatigue"

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1/11. Exercise in 94 degrees F water for a patient with multiple sclerosis.

    BACKGROUND AND PURPOSE: The purpose of this case report is to describe the examination, intervention, and outcome of a patient with multiple sclerosis (MS) who participated in a comprehensive rehabilitation program that included aquatic therapy with a pool temperature of 94 degrees F. There are few descriptions of aquatic exercise programs on muscle force, exercise tolerance, and functional outcomes in individuals with MS, and most authors recommend a water temperature of less than 85 degrees F to prevent an exacerbation of symptoms. DESCRIPTION: The patient was a 33-year-old woman. Before, during, and after the aquatic program, she was monitored for body temperature, heart rate, blood pressure, and perceived exertion. She was also assessed for muscle force and functional abilities. OUTCOMES: The patient did not experience heat sensitivity or fatigue throughout the program, and her manual muscle test grades and mobility improved. DISCUSSION: This patient's participation in aquatic therapy, in conjunction with land-based interventions, may have been associated with the improvement in functional abilities.
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ranking = 1
keywords = multiple sclerosis, sclerosis
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2/11. central nervous system disease in patients with macrophagic myofasciitis.

    Macrophagic myofasciitis (MMF), a condition newly recognized in france, is manifested by diffuse myalgias and characterized by highly specific myopathological alterations which have recently been shown to represent an unusually persistent local reaction to intramuscular injections of aluminium-containing vaccines. Among 92 MMF patients recognized so far, eight of them, which included the seven patients reported here, had a symptomatic demyelinating CNS disorder. CNS manifestations included hemisensory or sensorimotor symptoms (four out of seven), bilateral pyramidal signs (six out of seven), cerebellar signs (four out of seven), visual loss (two out of seven), cognitive and behavioural disorders (one out of seven) and bladder dysfunction (one out of seven). brain T(2)-weighted MRI showed single (two out of seven) or multiple (four out of seven) supratentorial white matter hyperintense signals and corpus callosum atrophy (one out of seven). evoked potentials were abnormal in four out of six patients and CSF in four out of seven. According to Poser's criteria for multiple sclerosis, the diagnosis was clinically definite (five out of seven) or clinically probable multiple sclerosis (two out of seven). Six out of seven patients had diffuse myalgias. deltoid muscle biopsy showed stereotypical accumulations of PAS (periodic acid-Schiff)-positive macrophages, sparse CD8 T cells and minimal myofibre damage. Aluminium-containing vaccines had been administered 3-78 months (median = 33 months) before muscle biopsy (hepatitis b virus: four out of seven, tetanus toxoid: one out of seven, both hepatitis b virus and tetanus toxoid: two out of seven). The association between MMF and multiple sclerosis-like disorders may give new insights into the controversial issues surrounding vaccinations and demyelinating CNS disorders. deltoid muscle biopsy searching for myopathological alterations of MMF should be performed in multiple sclerosis patients with diffuse myalgias.
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ranking = 0.8
keywords = multiple sclerosis, sclerosis
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3/11. Engraftment syndrome: a common cause for rash and fever following autologous hematopoietic stem cell transplantation for multiple sclerosis.

    Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a therapy for patients with progressive multiple sclerosis (MS) at risk of debilitating neurological impairment. While preliminary results from a few studies have been reported, little is known about toxicities or outcome of HSCT for MS. We report a relatively frequent triad of non-infectious fever, rash and fatigue or lassitude that may also be associated with pruritis, pulmonary symptoms, and eosinophilia and frequently occurs around engraftment. This syndrome occurred in 26% of our series of patients (5/19) undergoing HSCT for multiple sclerosis. The engraftment syndrome is usually self-limited but may require intervention with systemic corticosteroids.
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ranking = 1.2
keywords = multiple sclerosis, sclerosis
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4/11. multiple sclerosis and oral care.

    multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.
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ranking = 0.23697886127557
keywords = multiple sclerosis, sclerosis
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5/11. Factors limiting maximal oxygen uptake in exertional monoparesis.

    Strength and maximal oxygen uptake (VO2max) for each leg were compared in a trained multiple sclerosis (MS) patient with exertional left monoparesis. Left quadriceps strength and left leg VO2max were 22% and 30% lower, respectively, compared to the right (control) leg. Because the same O2 delivery system served each leg during exercise, VO2max of the paretic leg was not limited by cardiorespiratory factors but rather by strength and/or muscle oxidative capacity. However, training with monoparesis likely enhanced O2 extraction and aerobic work capacity of the right leg.
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ranking = 0.2
keywords = multiple sclerosis, sclerosis
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6/11. Outcomes of an aquatic exercise program including aerobic capacity, lactate threshold, and fatigue in two individuals with multiple sclerosis.

    BACKGROUND AND PURPOSE: fatigue in individuals with multiple sclerosis (MS) may be exacerbated by poor cardiovascular fitness. Although aqua aerobic exercise is often recommended, little research has been conducted on the efficacy of aqua aerobic exercise in improving cardiovascular fitness in patients with MS. The purpose of this case report is to describe changes in cardiovascular fitness and fatigue for 2 people with MS following an aqua aerobics class. CASE DESCRIPTIONS: The participants were 2 females, both with MS for over 10 years and mild disability. Participant A (40 years old and EDSS = 2.5/10) reported fatigue, numbness in her hands and feet, and occasional blurred vision. Participant B (51 years old and EDSS = 3.0/10) reported the same problems as Participant A plus stiffness in her right lower extremity. The participants performed aqua aerobics at an intensity equivalent to their lactate threshold twice a week for 8 weeks. Lactate threshold is the exercise intensity just prior to the accumulation of blood lactate during graded exercise. OUTCOMES: A graded exercise test (with measurements of gas exchange) and a test of fatigue were administered before and after the intervention. Initially, both participants had poor cardiovascular fitness as demonstrated by their low peak oxygen consumption (VO2peak) and low lactate threshold (LT). After the intervention, both participants achieved a higher peak workload (their VO2peak increased) and they could sustain a higher submaximal workload without accumulation of acid substances causing fatigue (their LT increased). Changes in fatigue following the intervention were equivocal with Participant A reporting decreased fatigue and Participant B reporting no change. SUMMARY: This report describes the use of exercise testing to guide clinical decision making for dosing of an aqua aerobic fitness intervention and illustrates positive effects of the intervention on cardiovascular fitness in 2 people with MS.
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ranking = 1
keywords = multiple sclerosis, sclerosis
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7/11. tryptophan-induced eosinophilia-myalgia syndrome.

    Eight patients who became ill while taking tryptophan had myalgia, fatigue, rash, fever, edema, alopecia, arthralgias, diminished joint motion, skin tightening, muscle cramping, and distal paresthesias. Three had shortness of breath, and one had pulmonary hypertension. Laboratory abnormalities included peripheral eosinophilia, leukocytosis, thrombocytosis, raised erythrocyte sedimentation rate, and elevated serum levels of aldolase, lactate dehydrogenase, and liver enzymes. Of 4 chest radiographs, 3 were abnormal. Of 5 skin and muscle biopsies, 4 showed sclerosis or mixed inflammatory cell infiltration of the dermis, subcutis, and fascia. eosinophils were often present, but vasculitis was absent. Muscle inflammation was minimal. We conclude that the "eosinophilia-myalgia syndrome" is related to the ingestion of tryptophan and that abnormalities in the secretion of lymphokines may be important in its pathogenesis.
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ranking = 0.0073957722551135
keywords = sclerosis
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8/11. eye movement fatigue in myasthenia gravis.

    An 18-year-old woman presented with dissociated nystagmus that was first attributed to multiple sclerosis. When she attempted to maintain 30-degree horizontal gaze deviation in either direction, there was progressive weakness of the adducting eye and increasing amplitude of nystagmus in the abducting eye. The amplitude and maximum velocity of repetitive one-per-second 30-degree saccades progressively decreased over a 3-minute period. Intravenous edrophonium completely abolished the dissociated nystagmus and adducting muscle weakness, and returned the saccade maximum velocity to normal. Her subsequent response to pyridostigmine and thymectomy confirmed the diagnosis of myasthenia gravis.
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ranking = 0.2
keywords = multiple sclerosis, sclerosis
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9/11. Establishing a physiological basis to multiple sclerosis-related fatigue: a case report.

    OBJECTIVE: Although fatigue is a common debilitating complaint in multiple sclerosis (MS), its relationship to the cardiopulmonary exercise response has yet to be defined. DESIGN: A patient with MS manifested primarily by profound fatigue undergoes complete pulmonary function testing and a maximal incremental cycle ergometry study with gas exchange measurements and determination of ejection fractions. SETTING: Outpatient, community hospital pulmonary function laboratory. RESULTS: The patient is found to have respiratory muscle weakness and a severely depressed exercise performance. The latter was associated with an early anaerobic threshold but a normal central cardiovascular response (radionuclide ventriculography), implying problems in peripheral O2 distribution/utilization. The respiratory muscle involvement, although substantial, was nonlimiting to the exercise performance. CONCLUSIONS: Despite its central neuropathophysiology, MS as it relates to fatigue may be associated with an abnormal peripheral exercise response, namely, problems in peripheral O2 utilization. Such a concept could prove invaluable as it would provide a physiological basis for defining the severity and therapy of "MS fatigue."
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ranking = 1
keywords = multiple sclerosis, sclerosis
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10/11. Treatment with weak electromagnetic fields improves fatigue associated with multiple sclerosis.

    It is estimated that 75-90% of patients with multiple sclerosis (MS) experience fatigue at some point during the course of the disease and that in about half of these patients, subjective fatigue is a primary complaint. In the majority of patients fatigue is present throughout the course of the day being most prominent in the mid to late afternoon. Sleepiness is not prominent, but patients report that rest may attenuate fatigability. The pathophysiology of the fatigue of MS remains unknown. Delayed impulse conduction in demyelinated zones may render transmission in the brainstem reticular formation less effective. In addition, the observation that rest may restore energy and that administration of pemoline and amantadine, which increase the synthesis and release of monoamines, often improve the fatigue of MS suggest that depletion of neurotransmitter stores in damaged neurons may contribute significantly to the development of fatigue in these patients. The present report concerns three MS patients who experienced over several years continuous and debilitating fatigue throughout the course of the day. fatigue was exacerbated by increased physical activity and was not improved by rest. After receiving a course of treatments with picotesla flux electromagnetic fields (EMFs), which were applied extracranially, all patients experienced improvement in fatigue. Remarkably, patients noted that several months after initiation of treatment with EMFs they were able to recover, after a short period of rest, from fatigue which followed increased physical activity. These observations suggest that replenishment of monoamine stores in neurons damaged by demyelination in the brainstem reticular formation by periodic applications of picotesla flux intensity EMFs may lead to more effective impulse conduction and thus to improvement in fatigue including rapid recovery of fatigue after rest.
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ranking = 1
keywords = multiple sclerosis, sclerosis
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