Fatigue

Written By Tanja Goltnik

Fatigue is a prevalent symptom linked to FND, appearing as a primary, secondary, or associated neurological issue (Penner and Paul, 2017). Described as intense exhaustion, fatigue significantly hinders treatment progress and impacts an individual's quality of life negatively. Various studies highlight that fatigue is the primary factor affecting the quality of life in FND patients (Butler et al., 2021; Nicholson et al., 2020; Teodoro et al., 2018). 

The factors that trigger and maintain fatigue are complex and mutually reinforcing. Treating and managing fatigue requires a multidisciplinary and individualised approach. 

Some general guidelines for managing fatigue:

  • Identifying the level of activity

    (Many patients with FND have boom and boost cycle, which refers to alternating between levels of increased activity and levels of complete inactivity due to fatigue and perceived pain.)

  • Identification of negative thought patterns and beliefs related to rest (e.g. perfectionism, equating taking time off with laziness, feelings of inferiority.)

  • Introducing enjoyable and relaxing activities into the daily routine, which represent rest

    (e.g. listening to relaxing music, reading a book, various breathing and meditation techniques.)

  • Managing symptoms that trigger fatigue

    (e.g. sleep deprivation, associated psychological disorders.)

  • Eating an anti-inflammatory diet

    (When inflammation is present in the body, the brain has less energy available, due to a metabolic change in chemical pathways. This results in lower energy levels and an increase in free radicals, which can also damage brain tissue. Foods that increase inflammation in the body therefore prevent energy from reaching the brain. Therefore, it is recommended to increase the intake of omega-3 fats, reduce the intake of saturated fats, increase the intake of vegetables, fruits, complex carbohydrates and polyphenols. Polyphenols are antioxidants found in dark chocolate, green tea, ground flaxseeds, cinnamon, etc.).

  • Proper distribution of daily activities and potential reduction in the number of daily activities

 
 

    • Butler, M., Shipston-Sharman, O., Seynaeve, M., Bao, J., Pick, S., Bradley-Westguard, A., ... and Nicholson, T. (2021). International online survey of 1048 individuals with functional neurological disorder. European Journal of Neurology, 28(11), 3591-3602.

    • Naidoo, U (2020). The food mood connection. Little, Brown spark, US.

    • Nicholson, T. R., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., Mildon, B., ... in FND-COM (Functional Neurological Disorders Core Outcome Measures) Group. (2020). Outcome measures for functional neurological disorder: a review of the theoretical complexities. The Journal of neuropsychiatry and clinical neurosciences, 32(1), 33-42.

    • Penner, I.-K., in Paul, F. (2017). Fatigue as a symptom or comorbidity of neurological diseases. Nature Reviews Neurology, 13(11), 662-675. doi:10.1038/nrneurol.2017.117

    • Teodoro, T., Edwards, M. J., and Isaacs, J. D. (2018). A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: a systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 89(12), 1308-1319.

Tanja Goltnik
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