%0 Journal Article
%T Targeting Fatigue in Stroke Patients
%A Andrew W. Barritt
%A David G. Smithard
%J ISRN Neurology
%D 2011
%R 10.5402/2011/805646
%X Symptoms of fatigue are often reported by patients in both the acute and chronic stages of recovery following a stroke. It is commonly associated with low mood and sleep disturbances, but can arise in their absence. However, it has also been associated with poorer long-term outcome and, as such, its aetiology warrants a greater understanding. There is convincing evidence that inflammatory cascades and cytokine signalling precipitated by the infarct promote fatigue, and these pathways may harbour therapeutic targets in its management. 1. Introduction The repercussions of stroke can be devastating, given that it can suddenly and permanently impair some of the most basic functions we all take for granted, including our mobility, speech, and effective swallowing [1]. A national campaign by The Stroke Association [2], termed ¡°Act F.A.S.T.¡±, has recently promoted the swift presentation to healthcare services for any patient suspected of having acute stroke, with assessment for possible early thrombolysis. Gold standard care in hospital involves admission to a designated stroke unit. Here, a battery of investigations are performed to maximise secondary prevention, and a multidisciplinary team is able to coordinate timely rehabilitation and attention to ongoing medical, nutritional, and psychological needs. Amongst the risks of developing anxiety states and disorders of (usually low) mood, there exists a frequently occurring symptom of poststroke fatigue (PSF) which can blight stroke patients¡¯ recovery long after their physical disabilities have resolved. Within the nervous system, fatigue can be centrally or peripherally mediated [3]. The latter, for instance, is seen in neuromuscular junction disorders, such as myasthenia gravis, and does have definable parameters as a clinical sign¡ªthese being diminished postexertional muscle power on the Medical Research Council (MRC) scale and a 10% decrement of motor end-plate potentials on electromyography recordings. However, central fatigue is not so easily defined and symptomatically lies on a continuous spectrum encompassing a whole host of fluid terms including vitality, motivation, and mood. It has been described in multiple sclerosis patients as ¡°a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual or desired activities¡± [4] and is thus, by virtue of its own broad definition, a rather idiosyncratic experience open to personal interpretation. This is reflected by the large number of assessment scales or scoring systems for fatigue to be found
%U http://www.hindawi.com/journals/isrn.neurology/2011/805646/