Document Type : Original Article
Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Fraser Health Multiple Sclerosis Clinic, Burnaby Hospital, University of British Columbia, BC, Canada
Background: Fatigue is a common complaint of patients with multiple sclerosis (MS), adversely affecting their quality of life. There is a lot of evidence showing that carnitine deficiency is linked to fatigue development and severity in some conditions. This study aimed to evaluate the association between free L-carnitine serum levels and the severity of fatigue in patients with MS.
Methods: This case-control study included 30 patients with relapsing-remitting MS (RRMS) in two age-matched equal-number groups according to the presence or absence of fatigue. Fatigue was scored using the valid questionnaire of Fatigue Severity Scale (FSS) and serum level of free L-carnitine was measured simultaneously. Finally, the association between serum level of free L-carnitine and fatigue severity was evaluated in patients with MS.
Results: The mean value of FSS in patients with fatigue was 48.80 ± 8.55, which was nearly two-fold higher than the group without fatigue. We found a significant correlation between the serum level of free L-carnitine and FSS and showed that the patients with fatigue had a significantly lower serum level of free L-carnitine compared to patients without fatigue (P < 0.001).
Conclusion: Present study demonstrated that patients with lower serum levels of free L-carnitine were more likely to experience fatigue. We recommend that a higher dietary intake of carnitine might be a useful complementary treatment for MS-related fatigue.
- Weinshenker BG. The natural history of multiple sclerosis. Neurol Clin 1995; 13(1): 119-46.
- Krupp LB, Pollina DA. Mechanisms and management of fatigue in progressive neurological disorders. Curr Opin Neurol 1996; 9(6): 456-60.
- Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in multiple sclerosis. Arch Neurol 1988; 45(4): 435-7.
- Flachenecker P, Meissner H. Fatigue in multiple sclerosis presenting as acute relapse: Subjective and objective assessment. Mult Scler 2008; 14(2): 274-7.
- Braley TJ, Chervin RD. Fatigue in multiple sclerosis: Mechanisms, evaluation, and treatment. Sleep 2010; 33(8): 1061-7.
- Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: The impact of fatigue and depression. J Neurol Sci 2002; 205(1): 51-8.
- Kent-Braun JA, Sharma KR, Miller RG, Weiner MW. Postexercise phosphocreatine resynthesis is slowed in multiple sclerosis. Muscle Nerve 1994; 17(8): 835-41.
- Kent-Braun JA, Sharma KR, Weiner MW, Miller RG. Effects of exercise on muscle activation and metabolism in multiple sclerosis. Muscle Nerve 1994; 17(10): 1162-9.
- Cruciani RA, Dvorkin E, Homel P, Malamud S, Culliney B, Lapin J, et al. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: A phase I/II study. J Pain Symptom Manage 2006; 32(6): 551-9.
- Reuter SE, Evans AM. Carnitine and acylcarnitines: pharmacokinetic, pharmacological and clinical aspects. Clin Pharmacokinet 2012; 51(9): 553-72.
- Anty R, Marjoux S, Bekri S, DeGalleani L, Dainese R, Gelsi E, et al. Plasma carnitine is associated with fatigue in chronic hepatitis C but not in the irritable bowel syndrome. Aliment Pharmacol Ther 2011; 33(8): 961-8.
- Lebrun C, Alchaar H, Candito M, Bourg V, Chatel M. Levocarnitine administration in multiple sclerosis patients with immunosuppressive therapy-induced fatigue. Mult Scler 2006; 12(3): 321-4.
- Tomassini V, Pozzilli C, Onesti E, Pasqualetti P, Marinelli F, Pisani A, et al. Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial. J Neurol Sci 2004; 218(1-2): 103-8.
- Yang TT, Wang L, Deng XY, Yu G. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017; 380: 256-61.
- Fukazawa T, Sasaki H, Kikuchi S, Hamada T, Tashiro K. Serum carnitine and disabling fatigue in multiple sclerosis. Psychiatry Clin Neurosci 1996; 50(6): 323-5.
- Kos D, Nagels G, D'Hooghe MB, Duportail M, Kerckhofs E. A rapid screening tool for fatigue impact in multiple sclerosis. BMC Neurol 2006; 6: 27.
- Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162-73.
- Harirchian MH, Nasergivechi S, Maddah M, Meysamie A, Amini H, Shandiz EE, et al. Evaluation of the Persian version of modified fatigue impact scale in Iranian patients with multiple sclerosis. Iran J Neurol 2013; 12(1): 32-4.
- Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46(10): 1121-3.
- Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
- MacAllister WS, Krupp LB. Multiple sclerosis-related fatigue. Phys Med Rehabil Clin N Am 2005; 16(2): 483-502.
- Okubo H, Ando H, Ishizuka K, Kitagawa R, Okubo S, Saito H, et al. Carnitine insufficiency is associated with fatigue during lenvatinib treatment in patients with hepatocellular carcinoma. PLoS One 2020; 15(3): e0229772.
- Hockenberry MJ, Hooke MC, Gregurich M, McCarthy K. Carnitine plasma levels and fatigue in children/adolescents receiving cisplatin, ifosfamide, or doxorubicin. J Pediatr Hematol Oncol 2009; 31(9): 664-9.
- Ledinek AH, Sajko MC, Rot U. Evaluating the effects of amantadin, modafinil and acetyl-L-carnitine on fatigue in multiple sclerosis--result of a pilot randomized, blind study. Clin Neurol Neurosurg 2013; 115(Suppl 1)s: S86-S89.