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Abstract Details

Pharmacological, Non-pharmacological, and Neuromodulatory Interventions for Multiple Sclerosis-related Fatigue: An Overview of Reviews and Meta-review of Therapeutic Efficacy
Multiple Sclerosis
P1 - Poster Session 1 (8:00 AM-9:00 AM)
20-007

This study aimed to synthesize and appraise the current evidence for all interventions targeting MS-related fatigue and to highlight the most reliable treatment options

Multiple sclerosis (MS) is an autoimmune-mediated disorder of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. Fatigue is one of the most frequently reported and debilitating symptoms of MS, significantly impairing quality of life.
PubMed, Web of Science, Scopus, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was graded with AMSTAR-2. Systematic reviews with meta-analyses were included.
46 systematic reviews with meta-analyses covering 287 RCTs were included. Exercise provided the most consistent benefit: aerobic training produced a modest but reliable reduction in fatigue (SMD –0.32), while resistance exercise (–1.09) and yoga/mind–body formats (–0.70) showed larger but more heterogeneous effects. Cognitive behavioural therapy (CBT) and mindfulness/acceptance therapies yielded small to moderate improvements, while energy-conservation education showed a modest benefit. Cooling garments (–2.26) and massage (–1.62) showed significant effects, though based on a few heterogeneous trials. Vitamin D supplementation yielded a small effect (–0.18), whereas other drugs were ineffective. Among neuromodulation approaches, transcranial direct current stimulation (tDCS) demonstrated a significant short-term impact (–1.02) that disappeared at follow-up, while repetitive transcranial magnetic stimulation (rTMS) and pulsed electromagnetic field (PEMF) produced a modest benefit (–0.65).
Structured exercise supported by CBT or mindfulness offers the most dependable and clinically meaningful relief from MS-related fatigue. Cooling garments and massage may provide rapid but short-lived relief. Vitamin D repletion is prudent for general health, yet unlikely to substantially reduce fatigue, and current pharmacologic agents lack convincing efficacy. Neuromodulation can be considered an adjunct, but the benefits are transient and of low evidence quality. Future RCTs should adopt longer follow-up, harmonized fatigue outcomes, and direct head-to-head comparisons; an updated network meta-analysis is warranted.
Authors/Disclosures
Yousef A. Hawas
PRESENTER 		Mr. Hawas has a non-compensated relationship as a Faculty with 好色先生 Institution (AANI); NeuroBytes: Medical Students Series that is relevant to AAN interests or activities.
Mohamed Abouzid Mohamed Abouzid has nothing to disclose.
Abdullah Ashraf Hamad (Menoufia University) Dr. Hamad has nothing to disclose.
Mohamed El Moslemani, MD Dr. El Moslemani has nothing to disclose.
Habiba Tariq, MBBS Dr. Tariq has nothing to disclose.
Esraa Salama Mr. Salama has nothing to disclose.
Mohammad Al Diab Al Azzawi, MBBS Dr. Al Diab Al Azzawi has nothing to disclose.
Dalia Kamal Ewis, MD Miss Ewis has nothing to disclose.
Abdelfattah Arafa, MBBS Dr. Arafa has nothing to disclose.
Asmaa Z. Zakria (Al-Azhar university) Dr. Zakria has nothing to disclose.
Ahmed A. Abo Elnaga Dr. Abo Elnaga has nothing to disclose.
Mohamed M. Khalil, MBBS Dr. Khalil has nothing to disclose.
YASMIN NEGEDA, MD Dr. NEGEDA has nothing to disclose.