Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
Neuromuscular Physiotherapy, Clinical Genetics, West of Scotland Genetic Services, Queen Elizabeth University Hospital, Glasgow, UK.
J Neuromuscul Dis. 2018;5(3):373-385. doi: 10.3233/JND-170299.
BackgroundFatigue in myasthenia gravis (MG) is common and difficult to manage. Unlike myasthenic weakness it is not amenable to drug therapies.ObjectiveOur primary aim was to investigate whether a combination of physical and psychological therapy would help address symptoms of fatigue in MG patients, who have stable disease but residual problematic fatigue. Our secondary aim was to quantitate fatigue by applying different scores and to ascertain which would be most relevant to apply in MG.MethodsWe recruited 10 MG patients with stable disease and who suffer from fatigue. Nine of these 10 patients participated in a 10-week program that involved physical and psychological intervention. We quantified their fatigue using the modified fatigue impact scale (MFIS), the visual analogue fatigue scale (VAFS) and the fatigue severity scale (FSS) at the start of the study, at various intervals during the program and 3 months later.ResultsDuring the program, there was a small improvement in the physical and psychosocial subscale of the MFIS. There was a significant improvement (p < 0.01) in the VAFS at the end of the program. No clear improvement was noted in FSS. Three months later, all fatigue scores declined to baseline but 50% of patients had made some life-style changes.ConclusionsThis is a small pilot study, which utilized a combined approach with physical and psychological therapy, and showed some benefit in improving fatigue in patients with MG. The improvement was small and unsustained. Because of the small patient cohort, one cannot derive any firm conclusions and a larger study is required to investigate this further.
重症肌无力（MG）患者常出现疲劳症状，且难以管理。与肌无力不同，疲劳症状不能通过药物治疗得到改善。
我们旨在研究针对疾病稳定但仍存在严重疲劳问题的 MG 患者，联合应用躯体和心理治疗是否有助于改善疲劳症状。次要目的是应用不同评分方法对疲劳进行定量评估，并确定哪种评分方法与 MG 相关性最强。
我们招募了 10 名病情稳定但存在疲劳症状的 MG 患者，其中 9 名患者参与了为期 10 周的躯体和心理干预项目。在研究开始时、项目进行过程中的不同时间点和 3 个月后，我们使用改良疲劳影响量表（MFIS）、视觉模拟疲劳量表（VAFS）和疲劳严重程度量表（FSS）对患者的疲劳情况进行定量评估。
在项目进行过程中，MFIS 的躯体和社会心理亚量表略有改善。VAFS 在项目结束时显著改善（p<0.01）。FSS 未见明显改善。3 个月后，所有疲劳评分均降至基线水平，但 50%的患者改变了生活方式。
这是一项小型试点研究，采用躯体和心理治疗联合方法，显示对改善 MG 患者的疲劳症状有一定益处。但改善程度较小且无法持续。由于患者队列较小，目前无法得出任何确切结论，需要进一步开展更大规模的研究。
