Skip to main content

Advertisement

SpringerLink
Log in

Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

While fatigue is found to be an impairing symptom in functional motor disorders (FMD) in clinical practice, scientific evidence is lacking. We investigated fatigue severity and subtypes in FMD compared to organic neurological disease. Furthermore, the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated. Data from 181 patients participating in the self-help on the internet for functional motor disorders, randomised Trial were included. Data from 217 neurological controls with neuromuscular disorders (NMD) originated from a historical cohort. Fatigue was measured using the checklist individual strength (CIS). Motor symptom severity, depression and anxiety were correlated to fatigue. For multivariable regression analyses, physical functioning and pain were additionally taken into account. Severe fatigue was, respectively, present in 78 and 53% of FMD and NMD patients (p < 0.001). FMD patients scored higher than NMD patients on all fatigue subdomains (p < 0.001). In the FMD group, fatigue subdomains were correlated to depression, anxiety and partly to motor symptom severity. Quality of life was negatively associated with fatigue [OR 0.93 (0.90–0.96), p < 0.001] and depression [OR 0.87 (0.81–0.93), p < 0.001], but not self-rated motor symptom severity. Self-rated health was negatively associated with fatigue [OR 0.92 (0.88–0.96), p < 0.001] and pain [OR 0.98 (0.97–0.99), p < 0.001]. Fatigue was found to be a prevalent problem in FMD, more so than in organic neurological disease. It significantly affected quality of life and self-rated health, while other factors such as motor symptom severity did not. Fatigue should be taken into account in clinical practice and treatment trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Edwards MJ, Fotopoulou A, Pareés I (2013) Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol 26:442–447. https://doi.org/10.1097/WCO.0b013e3283633953

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Carson AJ, Stone J, Hansen CH, Duncan R, Cavanagh J, Matthews K, Murray G, Sharpe M (2014) Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients. J Neurol Neurosurg Psychiatr 86:295–301. https://doi.org/10.1136/jnnp-2014-308234

    Article  Google Scholar 

  3. Nielsen G, Ricciardi L, Demartini B, Hunter R, Joyce E, Edwards MJ (2015) Outcomes of a 5-day physiotherapy programme for functional (psychogenic) motor disorders. J Neurol 262:674–681. https://doi.org/10.1007/s00415-014-7631-1

    Article  PubMed  CAS  Google Scholar 

  4. Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, Ricciardi L, Marsden J, Joyce E, Edwards M (2017) Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatr 88:484–490. https://doi.org/10.1136/jnnp-2016-314408

    Article  CAS  Google Scholar 

  5. Kalkman JS, Zwarts MJ, Schillings ML, van Engelen BGM, Bleijenberg G (2008) Different types of fatigue in patients with facioscapulohumeral dystrophy, myotonic dystrophy and HMSN-I. Experienced fatigue and physiological fatigue. Neurol Sci 29:238–240. https://doi.org/10.1007/s10072-008-0949-7

    Article  Google Scholar 

  6. Kalkman JS, Schillings ML, Van Der Werf SP, Padberg GW, Zwarts MJ, Van Engelen BGM (2005) Experienced fatigue in facioscapulohumeral dystrophy, J Neurol Neurosurg Psychiatr 76:1406–1410. https://doi.org/10.1136/jnnp.2004.050005

    Article  CAS  Google Scholar 

  7. Stocchi F, Amelio MD, De Pandis MF, Fabbrini G, Pacchetti C, Pezzoli G, Iannacone C, Zappia M (2014) Prevalence of fatigue in Parkinson disease and its clinical correlates. Neurol July 83:215–220. https://doi.org/10.1212/WNL.0000000000000587

    Article  Google Scholar 

  8. Alschuler KN, Jensen MP, Goetz MC, Smith AE, Verrall AM, Molton IR (2012) Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy Disabil Health J 5:277–283. https://doi.org/10.1016/j.dhjo.2012.07.002

    Article  PubMed  Google Scholar 

  9. Cantor F (2010) Central and peripheral fatigue: exemplified by multiple sclerosis and myasthenia gravis PMRJ. 2:399–405. https://doi.org/10.1016/j.pmrj.2010.04.012

    Article  Google Scholar 

  10. Pittion-vouyovitch S, Debouverie M, Guillemin F, Vandenberghe N (2006) Fatigue in multiple sclerosis is related to disability, depression and quality of life, J Neurol Sci 243:39–45. https://doi.org/10.1016/j.jns.2005.11.025

    Article  PubMed  CAS  Google Scholar 

  11. Anderson KE, Gruber-Baldini AL, Vaughan CG, Reich SG, Fishman PS, Weiner WJ, Shulman LM (2007) Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord 22:2204–2209. https://doi.org/10.1002/mds.21687

    Article  PubMed  Google Scholar 

  12. Vercoulen JHMM., a Swanink CM, Fennis JFM, Galama JMD, Van Der Meer JWM, Bleijenberg G (1994) Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 38:383–392. https://doi.org/10.1016/0022-3999(94)90099-X

    Article  PubMed  CAS  Google Scholar 

  13. Beurskens AJHM., Bültmann U, Kant I, Vercoulen JHMM., Bleijenberg G, Swaen GMH (2000) Fatigue among working people: validity of a questionnaire measure. Occup Environ Med 57:353–357

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Worm-smeitink M, Gielissen M, Bloot L, Van Laarhoven HWM, Van Engelen BGM (2017) The assessment of fatigue: psychometric qualities and norms for the checklist individual strength. J Psychosom Res 98:40–46. https://doi.org/10.1016/j.jpsychores.2017.05.007

    Article  PubMed  CAS  Google Scholar 

  15. Group THEW. (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment, Psychol Med 28:551–558

    Article  Google Scholar 

  16. Jones SG, O’ Brien TJ, Adams SJ, Mocellin R, Kilpatrick CJ, Yerra R, Lloyd JH, Velakoulis D (2010) Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosom Med 72:487–497. https://doi.org/10.1097/PSY.0b013e3181d96550

    Article  PubMed  Google Scholar 

  17. Karakis I, Montouris GD, Piperidou C, Luciano MS, Meador KJ, Cole AJ (2014) Patient and caregiver quality of life in psychogenic non-epileptic seizures compared to epileptic seizures. Seizure 23:47–54. https://doi.org/10.1016/j.seizure.2013.09.011

    Article  PubMed  Google Scholar 

  18. Zutt R, Gelauff JM, Smit M, van Zijl JC, Stone J, Tijssen MAJ (2017) The presence of depression and anxiety do not distinguish between functional jerks and cortical myoclonus. Park Relat Disord 45:90–93. https://doi.org/10.1016/j.parkreldis.2017.09.023

    Article  CAS  Google Scholar 

  19. Babyak MA (2004) What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 66:411–421. https://doi.org/10.1097/01.psy.0000127692.23278.a9

    Article  PubMed  Google Scholar 

  20. Sharpe M, Walker J, Williams C, Stone J, Cavanagh J, Murray G, Butcher I, Duncan R, Smith S (2011) Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Carson Neurol 77:564–572. https://doi.org/10.1212/WNL.0b013e318228c0c7

    Article  CAS  Google Scholar 

  21. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, Bottacchi E, Cannas A, Ceravolo G, Ceravolo R, Cicarelli G, Gaglio RM, Giglia RM, Iemolo F, Manfredi M, Meco G, Nicoletti A, Pederzoli M, Petrone A, Pisani A (2009) The Priamo Study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’ s disease Mov Disord 24:1641–1649. https://doi.org/10.1002/mds.22643

    Article  PubMed  Google Scholar 

  22. Müller B, Assmus J, Herlofson K, Larsen JP, Tysnes OB (2013) Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson’s disease. Park Relat Disord 19:1027–1032. https://doi.org/10.1016/j.parkreldis.2013.07.010

    Article  Google Scholar 

  23. Smit M, Kamphuis ASJ, Bartels AL, Han V, Stewart RE, Zijdewind I(2016) Fatigue, sleep disturbances, and their influence on quality of life in cervical dystonia patients, Mov Disord Clin Pract 4:517–523 https://doi.org/10.1002/mdc3.12459

    Article  Google Scholar 

  24. Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V (2011) Psychopathology and psychogenic movement disorders. Mov Disord 26:1844–1850. https://doi.org/10.1002/mds.23830

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kuppuswamy A (2017) The fatigue conundrum fatigue: the unexplained phenomenon. Brain 140:2240–2245. https://doi.org/10.1093/brain/awx153

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pareés I, Brown H, Nuruki A, Adams RA, Davare M, Bhatia KP, Friston K, Edwards MJ (2014) Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain 137:2916–2921. https://doi.org/10.1093/brain/awu237

    Article  PubMed  Google Scholar 

  27. Edwards MJ, Adams Ra, Brown H, Pareés I, Friston KJ (2012) A Bayesian account of “hysteria”. Brain 135:3495–3512. https://doi.org/10.1093/brain/aws129

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ (2010) Fatigue, mood and quality of life improve in MS patients after progressive resistance training. Multiple Sclerosis J 16:480–490. https://doi.org/10.1177/1352458509360040

    Article  CAS  Google Scholar 

  29. Dodd KJ, Taylor NF, Shields N, Prasad D, Mcdonald E (2011) Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial. Multiple Sclerosis J 17:1362–1374. https://doi.org/10.1177/1352458511409084

    Article  CAS  Google Scholar 

  30. Grossman P, Kappos L, Gensicke H, D’Souza M, Mohr DC, Penner IK, Steiner C (2010) MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology 75:1141–1149. https://doi.org/10.1212/WNL.0b013e3181f4d80d

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Funding

J.M. Gelauff has received a Grant from the University Medical Center Groningen GSMS graduate school funding her PhD and an unrestricted research grant from the Fund ‘Fonds Psychische Gezondheid’ for conducting the SHIFT study.

Author information

Authors and Affiliations

  1. Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    J. M. Gelauff, E. M. Kingma, R. Bezemer & M. A. J. Tijssen

  2. Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    J. S. Kalkman

  3. Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands

    B. G. M. van Engelen

  4. Department of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, EH4 2XU, UK

    J. Stone

  5. Departments of Psychiatry and Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    J. G. M. Rosmalen

Authors
  1. J. M. Gelauff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. M. Kingma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. S. Kalkman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Bezemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. G. M. van Engelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. A. J. Tijssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. G. M. Rosmalen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. M. Gelauff.

Ethics declarations

Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gelauff, J.M., Kingma, E.M., Kalkman, J.S. et al. Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders. J Neurol 265, 1803–1809 (2018). https://doi.org/10.1007/s00415-018-8915-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8915-7

Keywords

Search

Navigation