The Biological Substrates of Poststroke Fatigue: a Qualitative Meta-Analysis for the Pathogenesis and Treatment of Poststroke Fatigue
Main Article Content
Abstract
Stroke is the leading cause of physical disability worldwide and represents a black hole that drains the global health economy. Pathological post-stroke fatigue (PSF) is one of the most common sequelae, affecting up to 85% of stroke patients. Intractable PSF is the worst or one of the worst stroke symptoms in 40% of stroke survivors due to the overwhelming perceptual shortage of energy for physical and mental activities. The pathogenesis of PSF is blurred by a vast array of comorbidities inherent to this group of patients, which can precipitate fatigue regardless of the cerebrovascular injury. Fatigue is a subjective experience that may elude the quantification of uniform metrics. Quantitative meta-analysis on PSF studies is enigmatic due to the inconsistent study designs, methodology of fatigue assessment, and heterogeneity of patient characteristics.
This thematic meta-analysis scrutinizes the evidence for factors involved in PSF pathogenesis and constructs a clinical framework to approach PSF. Moreover, a treatment paradigm is proposed based on the compound evidence-weighted extractions of data from prospective studies on PSF. Moreover, proactive testing for autonomic reflexes and postural hypotension is of paramount importance, and judicious selection and titration of antihypertensives may correct subclinical orthostatism that manifests seamlessly as morbidly chronic fatigue. PSF may hinder rehabilitation and impact morbidity and mortality. Embracing the proposed treatment paradigm and tracing the pathogenic factors will minimize morbidity and redeem the global economy layers and years of additional costs in stroke care.
Methods: Qualitative Meta-analysis.
Keywords:
Poststroke Fatigue
Article Details
How to Cite
ALADDIN, Dr. Yasser.
The Biological Substrates of Poststroke Fatigue: a Qualitative Meta-Analysis for the Pathogenesis and Treatment of Poststroke Fatigue.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5975>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.5975.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. De Groot MH, Phillips SJ, Eskes GA. Fatigue associated with stroke and other neurologic conditions: implications for stroke rehabilitation. *Arch Phys Med Rehabil*. 2003;84(11):1714-1720.
4. Aali G, Drummond A, Das Nair R, Shokraneh F. Post-stroke fatigue: a scoping review [version 2; peer review: 2 approved]. *F1000Research*. 2020;9:242.
5. Cumming TB, Packer M, Kramer SF, English C. The prevalence of fatigue after stroke: a systematic review and meta-analysis. *Int J Stroke*. 2016;11: 968-977. doi:10.1177/1747493016669861.
6. Kirchberger I, Wallner F, Linseisen J, et al. Factors associated with early and late post-stroke fatigue in patients with mild impairment: results from the Stroke Cohort Study Augsburg. *Front Neurol*. 2022;13:852486. doi:10.3389/fneur.2022.852486.
7. Wu S, Mead G, Macleod M, Chalder T. Model of understanding fatigue after stroke. *Stroke*. 2015; 46:893-898. doi:10.1161/STROKEAHA.114.006647.
8. Duncan F, Greig C, Lewis S, Dennis M, MacLullich A, Sharpe M, et al. Clinically significant fatigue after stroke: a longitudinal cohort study. *J Psychosom Res*. 2014;77:368-373. doi:10.1016/j. jpsychores.2014.06.013.
9. Schepers VP, Visser-Meily AM, Ketelaar M, Lindeman E. Post-stroke fatigue: course and its relation to personal and stroke-related factors. *Arch Phys Med Rehabil*. 2006;87:184-188. doi:10.1016/j.apmr.2005.10.005.
10. Snaphaan L, van der Werf S, de Leeuw FE. Time course and risk factors of post-stroke fatigue: a prospective cohort study. *Eur J Neurol*. 2011; 18:611-617. doi:10.1111/j.1468-1331.2010.03217.
11. van Eijsden HM, van de Port IG, Visser-Meily JM, Kwakkel G. Post-stroke fatigue: who is at risk for an increase in fatigue? *Stroke Res Treat*. 2012;2012:863978. doi:10.1155/2012/863978.
12. Radman N, Staub F, Aboulafia-Brakha T, Berney A, Bogousslavsky J, Annoni JM. Post-stroke fatigue following minor infarcts: a prospective study. *Neurology*. 2012;79:1422-1427. doi:10.12 12/WNL.0b013e31826.
13. McDonald O, Mead G. The time-course of post-stroke fatigue: a systematic review of longitudinal cohort studies. *Health Sci Rev*. 2023;7:100095.
14. Ingles JL, Eskes GA, Phillips SJ. Fatigue after stroke. *Arch Phys Med Rehabil*. 1999;80(2):173-178.
15. Lerdal A, Gay CL. Fatigue in the acute phase after first stroke predicts poorer physical health 18 months later. *Neurology*. 2013;81:1581-1587. doi:10.1212/WNL.0b013e3182a9f471.
16. Glader EL, Stegmayr B, Asplund K. Post-stroke fatigue: a 2-year follow-up study of stroke patients in Sweden. *Stroke*. 2002;33:1327-1333.
17. Naess H, Lunde L, Brogger J, Waje-Andreassen U. Fatigue among stroke patients on long-term follow-up: the Bergen Stroke Study. *J Neurol Sci*. 2012;312(1-2):138-141. doi:10.1016/j. jns.2011.08.002.
18. Naess H, Nyland H. Post-stroke fatigue and depression are related to mortality in young adults: a cohort study. *BMJ Open*. 2013;3(3):e002404. doi:10.1136/bmjopen-2012-002404.
19. Mead GE, Graham C, Dorman P, et al. Fatigue after stroke: baseline predictors and influence on survival. Analysis of data from UK patients recruited in the International Stroke Trial. *PLoS One*. 2011; 6(3):e16988. doi:10.1371/journal.pone.0016988.
20. Lynch J, Mead G, Greig C, Young A, Lewis S, Sharpe M. Fatigue after stroke: the development and evaluation of a case definition. *J Psychosom Res*. 2007;63(5):539-544.
21. Christensen D, Johnsen SP, Watt T, Harder I, Kirkevold M, Andersen G. Dimensions of post-stroke fatigue: a two-year follow-up study. *Cerebrovasc Dis*. 2008;26(2):134-141.
22. Crosby GA, Munshi S, Karat AS, Worthington E, Lincoln NB. Fatigue after stroke: frequency and effect on daily life. *Disabil Rehabil*. 2012; 34(8):633-637.
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