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Fatigue Due to Multiple Sclerosis: A Comparison Between Persian Medicine and Conventional Medicine

Hossein Rezaeizadeh, Roja Rahimi, Maryam Abbasi

Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and its definite pathophysiology is unclear. Studies have suggested some correlates for it including dysfunction or atrophy in different parts of the brain. This narrative review study compares the viewpoint of conventional medicine and Persian medicine (PM) about fatigue due to MS and introduces the treatments used for this complaint in PM with an evidence-based approach. PM scholars have used the term I’ya equal to fatigue and stated that I’ya might be due to exertion or not, while the latter (spontaneous I’ya) can be prodromal of a disease. This pathologic fatigue can be seen in a wide variety of neurologic diseases, though it is the most common in MS patients. Fatigue in MS can be considered one of the equivalents of spontaneous I’ya. According to PM texts, neurotonic herbs like Ferula, Citrus medica, Asarum europaeum, Ficus carica, and Juglans regia may be beneficial in alleviating fatigue by brain reinforcement. Different pharmacological mechanisms have been introduced for these plants including antioxidant and/or anti-inflammatory activities. The medicinal plants can be assumed as a valuable source for discovering new medicines for fatigue in MS. Designing preclinical and clinical studies evaluating the effects of mentioned medicinal herbs in fatigue is proposed for obtaining more conclusive results.[GMJ.2019;8:e1139] 

Fatigue; Medicinal Herbs; Multiple Sclerosis; Medicinal Plants; Traditional Medicine
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Fatigue Guidelines Development Panel of the Multiple Sclerosis Council for Clinical Practice Guidelines. Fatigue and Multiple Sclerosis. Evidence-Based Management Strategies for Fatigue in Multiple Sclerosis. Washington, DC: Paralyzed Veterans of America; 1998.

Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: Proposal for a unified taxonomy. Neurol. 2013;80(4):409-16.

https://doi.org/10.1212/WNL.0b013e31827f07be

PMid:23339207 PMCid:PMC3589241

Lukkahatai N, Saligan LN. Association of Catastrophizing and Fatigue: A Systematic Review. J Psychosom Res. 2013;74(2):100-9.

https://doi.org/10.1016/j.jpsychores.2012.11.006

PMid:23332523 PMCid:PMC3553502

Kos D, Kerckhofs E, Nagels G, D'hooghe MB, Ilsbroukx S. Origin of Fatigue in Multiple Sclerosis: Review of the Literature. Neurorehabil Neural Repair. 2008;22:91-100.

https://doi.org/10.1177/1545968306298934

PMid:17409388

Abdolhamid H et al. Ghamous Al-Ghanoon (Dictionary of the Canon). Tehran: Iran University of Medical Sciences.

Ibn Sina H. Men moallefte Ibn Sina Al-Tebbia (from the Avicenna's medical writings). one ed. Damascus: Maahad ol-Torase el-Elmie el-Tebbi; 1983.

Razhes M Z. Al-havi fi tibb. Lebanon: Dar ehya al-tourath al-arabi press; 2002.

Aghili M H. Kholasat Ol- Hikmah. 1st ed. Qom: Esmaeilian; 2006.

Ibn Sina H. The Canon of medicine. Lebanon: Alaalami press; 2005.

Ahvazi A. Kamel-al-Sanaat al-Tibbiah (The Perfect Art of Medicine). Qom: Jalaoddin; 2008.

Alizadeh Vaghasloo M, Zareian MA, Soroushzadeh SMA. The Concept of Nozj. Trad Integr Med. 2016;1(4):133-5.

Rezaeizadeh H, Alizadeh M, Naseri M, Shams Ardakani MR. The Traditional Iranian Medicine Point of View on Health and Disease. Iranian J Publ Health. 2009;38(Suppl.1):169-72.

Avicenna H. The Canon of Medicine. Newyork: AMS Press; 1973.

Ibn Rushd. [Kulliyat or Colliget]. Lebanon: Dar al-kotob aliilmiyah; 2005.

Parviz M, Sahraian MA, Rezaeizadeh H. Historical issues of optic neuritis and sensory disorder in Persian traditional medicine. Iranian J Publ Health. 2013;42(6):644-5.

Swain MG. Fatigue in chronic disease. Clin Sci. 2000;99:1-8.

https://doi.org/10.1042/cs0990001

PMid:10887052

Zwarts MJ, Bleijenberg G, van Engelen BGM. Clinical neurophysiology of fatigue. Clin Neurophysiol. 2007;119(1):2-10.

https://doi.org/10.1016/j.clinph.2007.09.126

PMid:18039594

Braley TJ, Chervin RD. Fatigue in Multiple Sclerosis: Mechanisms, Evaluation, and Treatment. Sleep. 2010;33(8):1061-7.

https://doi.org/10.1093/sleep/33.8.1061

Krupp L. Editorial. Mult Scler. 2006;12:367-8.

https://doi.org/10.1191/135248506ms1373ed

PMid:16900749

Cantor F. Central and peripheral fatigue: exemplified by multiple sclerosis and myasthenia gravis. PM&R. 2010 May;2(5):399-405.

https://doi.org/10.1016/j.pmrj.2010.04.012

PMid:20656621

Sharma K R, Kent-Braun J, Mynhier M A, Weiner M W, Miller R. G. Evidence of an abnormal intramuscular component of fatigue in multiple sclerosis. Muscle Nerve. 1995;18:1403-11.

https://doi.org/10.1002/mus.880181210

PMid:7477063 PMCid:PMC2733338

Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet. 2004;363(9413):978-88.

https://doi.org/10.1016/S0140-6736(04)15794-2

Morgante F, Dattola V, Crupi D, Russo M, Rizzo V, Ghilardi MF, et al. Is central fatigue in multiple sclerosis a disorder of movement preparation? J Neurol. 2011;258(2):263-72.

https://doi.org/10.1007/s00415-010-5742-x

PMid:20859746

Hesse S, Moeller F, Petroff D, Lobsien D, Luthardt J, Regenthal R, et al. Altered serotonin transporter availability in patients with multiple sclerosis. Eur J Nucl Med Mol Imaging. 2014;41(5):827-35.

https://doi.org/10.1007/s00259-013-2636-z

PMid:24562640

Iriarte J, Subira ML, Castro P. Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors. Mult Scler 2000;6:124-30.

https://doi.org/10.1191/135245800678827572

PMid:10773859

Heesen C, Nawrath L, Reich C, Bauer N, Schulz KH, Gold SM. Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour? J Neurol Neurosurg Psychiatry. 2006;77(1):34-9.

https://doi.org/10.1136/jnnp.2005.065805

PMid:16361589 PMCid:PMC2117393

Newland P, Starkweather A, Sorenson M. Central fatigue in multiple sclerosis: a review of the literature. J Spinal Cord Med. 2016;39(4):386-99.

https://doi.org/10.1080/10790268.2016.1168587

PMid:27146427 PMCid:PMC5102292

Pellicano C, Gallo A, Li X, et al. Relationship of cortical atrophy to fatigue in patients with multiple sclerosis. Arch Neurol. 2010;67(4):447-53.

https://doi.org/10.1001/archneurol.2010.48

PMid:20385911

Derache N, Grassiot B, Mézenge F, Emmanuelle Dugué A, Desgranges B, Constans J-M, et al. Fatigue is associated with metabolic and density alterations of cortical and deep gray matter in Relapsing-Remitting-Multiple Sclerosis patients at the earlier stage of the disease: A PET/MR study. Mult Scler Relat Disord. 2013;2(4):362-9.

https://doi.org/10.1016/j.msard.2013.03.005

PMid:25877847

Sepulcre J, Masdeu JC, Goñi J, Arrondo G, Vélez de Mendizábal N, Bejarano B, et al. Fatigue in multiple sclerosis is associated with the disruption of frontal and parietal pathways. Mult Scler. 2009 Mar;15(3):377-44.

https://doi.org/10.1177/1352458508098373

PMid:18987107

Riccitelli G, Rocca MA, Forn C, Colombo B, Comi G, Filippi M. Voxelwise Assessment of the Regional Distribution of Damage in the Brains of Patients with Multiple Sclerosis and Fatigue. Am J Neuroradiol. 2011;32(5):874-9.

https://doi.org/10.3174/ajnr.A2412

PMid:21393405

Colombo B, Martinelli Boneschi F, Rossi P, Rovaris M, Maderna L, Filippi M, et al. MRI and motor evoked potential findings in nondisabled multiple sclerosis patients with and without symptoms of fatigue. J Neurol. 2000;247(7):506-9.

https://doi.org/10.1007/s004150070148

PMid:10993490

Wilting J, Rolfsnes HO, Zimmermann H, Behrens M, Fleischer V, Zipp F, et al. Structural correlates for fatigue in early relapsing remitting multiple sclerosis. Eur Radiol. 2015;26:515.

https://doi.org/10.1007/s00330-015-3857-2

PMid:26026721

Engström M, Flensner G, Landtblom A-M, Anna-Christina EK, Karlsson T. Thalamo-striato-cortical determinants to fatigue in multiple sclerosis. Brain Behav. 2013;3(6):715-28.

https://doi.org/10.1002/brb3.181

PMid:24363974 PMCid:PMC3868176

Rocca MA, Meani A, Riccitelli GC, Colombo B, Rodegher M, Falini A, et al. Abnormal adaptation over time of motor network recruitment in multiple sclerosis patients with fatigue. Mult Scler. 2016 Aug;22(9):1144-53.

https://doi.org/10.1177/1352458515614407

PMid:26493126

Bonzano L, Pardini M, Roccatagliata L, Mancardi GL, Bove M. How people with multiple sclerosis cope with a sustained finger motor task: A behavioural and fMRI study. Behav Brain Res. 2017;325, Part A:63-71.

https://doi.org/10.1016/j.bbr.2017.02.008

PMid:28188814

Tartaglia M, Narayanan S, Francis SJ, et al. The relationship between diffuse axonal damage and fatigue in multiple sclerosis. Arch Neurol. 2004;61(2):201-7.

https://doi.org/10.1001/archneur.61.2.201

PMid:14967766

Téllez N, Alonso J, Río J, Tintoré M, Nos C, Montalban X, et al. The basal ganglia: a substrate for fatigue in multiple sclerosis. Neuroradiol. 2008;50(1):17-23.

https://doi.org/10.1007/s00234-007-0304-3

PMid:17955232

Roelcke U, Kappos L, Lechner-Scott J, Brunnschweiler H, Huber S, Ammann W, et al. Reduced glucose metabolism in the frontal cortex and basal ganglia of multiple sclerosis patients with fatigue: a 18F-fluorodeoxyglucose positron emission tomography study. Neurol. 1997Jun;48(6):1566-71.

https://doi.org/10.1212/WNL.48.6.1566

PMid:9191767

Leocani L, Colombo B, Magnani G, Martinelli-Boneschi F, Cursi M, Rossi P, et al. Fatigue in Multiple Sclerosis Is Associated with Abnormal Cortical Activation to Voluntary Movement-EEG Evidence. NeuroImage. 2001;13(6):1186-92.

https://doi.org/10.1006/nimg.2001.0759

PMid:11352624

Chaudhuri A, Behan PO. Fatigue and basal ganglia. J Neurol Sci. 2000;179(1):34-42.

https://doi.org/10.1016/S0022-510X(00)00411-1

Homayouni Moghadam F, Vakili Zarch B, Shafiei M. Double edged effect of gum-resin of ferula assa-foetida on lifespan of neurons. Iran J Basic Med Sci. 2013;16(4):668-71.

Tayeboon GS, Tavakoli F, Hassani S, Khanavi M, Sabzevari O, Ostad SN. Effects of Cymbopogon citratus and Ferula assa-foetida extracts on glutamate-induced neurotoxicity. In Vitro Cell Dev Biol Anim. 2013;49(9):706-15.

https://doi.org/10.1007/s11626-013-9656-7

PMid:23949776

Homayouni Moghadam F, Dehghan M, Zarepur E, Dehlavi R, Ghaseminia F, Ehsani S, et al. Oleo gum resin of Ferula assa-foetida L. ameliorates peripheral neuropathy in mice. J Ethnopharmacol. 2014;154(1):183-9.

https://doi.org/10.1016/j.jep.2014.03.069

PMid:24709312

Cheng CY SS, Tang NY, Ho TY, Chiang SY, Hsieh CL,. Ferulic acid provides neuroprotection against oxidative stress-related apoptosis after cerebral ischemia/reperfusion injury by inhibiting ICAM-1 mRNA expression in rats. Brain Res. 2008 May;13(1209):136-50.

https://doi.org/10.1016/j.brainres.2008.02.090

PMid:18400211

Ahmadvand H, Amiri H, Dehghani Elmi Z, Bagheri SH. Chemical Composition and Antioxidant Properties of Ferula-assa-foetida Leaves Essential Oil. I J Pharmacol Therap. 2013;12:52-7.

Vauzour D, Vafeiadou K, Rodriguez-Mateos A, Rendeiro C, Spencer JPE. The neuroprotective potential of flavonoids: a multiplicity of effects. Genes Nutr. 2008;3(3):115-26.

https://doi.org/10.1007/s12263-008-0091-4

PMid:18937002 PMCid:PMC2593006

Iranshahy M, Iranshahi M. Traditional uses, phytochemistry and pharmacology of asafoetida (Ferula assa-foetida oleo-gum-resin)-A review. J Ethnopharmacol. 2011;134(1):1-10.

https://doi.org/10.1016/j.jep.2010.11.067

PMid:21130854

Huang CY, Kuo WW, Shibu MA et al. Citrus medica var. sarcodactylis (Foshou) activates fibroblast growth factor-2 signaling to induce migration of RSC96 Schwann cells. Am J Chin Med. 2014;42(2):443-52.

https://doi.org/10.1142/S0192415X14500293

PMid:24707873

Menichini F, Tundis R, Loizzo MR et al. Citrus medica L. cv Diamante (Rutaceae) peel extract improves glycaemic status of Zucker diabetic fatty (ZDF) rats and protects against oxidative stress. J Enz Inhib Med Chemist. 2016;31(6):1270-6.

https://doi.org/10.3109/14756366.2015.1115400

PMid:26643200

Sadati SN, Ardekani MRS, Ebadi N et al. Review of Scientific Evidence of Medicinal Convoy Plants in Traditional Persian Medicine. Pharmacogn Rev. 2016 Jan-Jun;10(19):33-8.

https://doi.org/10.4103/0973-7847.176546

PMid:27041871 PMCid:PMC4791985

Oprean R, Tamas M, Roman L. Comparison of GC-MS and TLC techniques for asarone isomers determination. J Pharm Biomed Anal. 1998 Oct;18(1-2):227-34.

https://doi.org/10.1016/S0731-7085(98)00161-7

Liu J, Li C, Xing G et al. Beta-asarone attenuates neuronal apoptosis induced by Beta amyloid in rat hippocampus. Yakugaku Zasshi. 2010 May;130(5):737-46.

https://doi.org/10.1248/yakushi.130.737

PMid:20460873

Shin J-W, Cheong Y-J, Koo Y-M, Kim S, Noh C-K, Son Y-H, et al. α-Asarone Ameliorates Memory Deficit in Lipopolysaccharide-Treated Mice via Suppression of Pro-Inflammatory Cytokines and Microglial Activation. Biomolecule Ther. 2014;22(1):17-26.

https://doi.org/10.4062/biomolther.2013.102

PMid:24596617 PMCid:PMC3936426

Lim H-W, Kumar H, Kim B-W, More SV, Kim I-W, Park J-I, et al. β-Asarone (cis-2,4,5-trimethoxy-1-allyl phenyl), attenuates pro-inflammatory mediators by inhibiting NF-κB signaling and the JNK pathway in LPS activated BV-2 microglia cells. Food Chem Toxicol. 2014;72:265-72.

https://doi.org/10.1016/j.fct.2014.07.018

PMid:25066769

Çalişkan O, Aytekin Polat A. Phytochemical and antioxidant properties of selected fig (Ficus carica L.) accessions from the eastern Mediterranean region of Turkey. Scientia Horticulturae. 2011;128(4):473-8.

https://doi.org/10.1016/j.scienta.2011.02.023

Loizzo M R, Bonesi M, Pugliese A, Menichini F, Tundis R. Chemical composition and bioactivity of dried fruits and honey of Ficus carica cultivars Dottato, San Francesco and Citrullara. J Sci Food Agric. 2014;94:2179-86.

https://doi.org/10.1002/jsfa.6533

PMid:24338976

Ballard CG, Greig NH, Guillozet-Bongaarts AL, Enz A, Darvesh S. Cholinesterases: Roles in the Brain During Health and Disease. Alzheimer Res. 2005 Aug;2:307-18.

https://doi.org/10.2174/1567205054367838

PMid:15974896

Subash S, Essa MM, Al-Asmi A, Al-Adawi S, Vaishnav R. Chronic Dietary Supplementation of 4%; Figs on the Modification of Oxidative Stress in Alzheimer's Disease Transgenic Mouse Model. BioMed Research International. 2014;2014:8.

https://doi.org/10.1155/2014/546357

PMid:25050360 PMCid:PMC4090508

Bhanushali MM, Makhija DT, Joshi YM. Central nervous system activity of an aqueous acetonic extract of Ficus carica L. in mice. J Ayurveda Integr Med. 2014 Apr;5(2):89-96.

https://doi.org/10.4103/0975-9476.131734

PMid:24948859 PMCid:PMC4061596

Ali B, Mujeeb M, Aeri V, Mir SR, Faiyazuddin M, Shakeel F. Anti-inflammatory and antioxidant activity of Ficus carica Linn. leaves. Nat Prod Res. 2012;26(5):460-5.

https://doi.org/10.1080/14786419.2010.488236

PMid:21644169

Philip Lanskya E, Paavilainena HM, Pawlusb AD, Newman RA. Ficus spp. (fig): Ethnobotany and potential as anticancer and anti-inflammatory agents. J Ethnopharmacol. 2008;119(2):195-213.

https://doi.org/10.1016/j.jep.2008.06.025

PMid:18639620

Carey AN, Fisher DR, Joseph JA, Shukitt-Hale B. The ability of walnut extract and fatty acids to protect against the deleterious effects of oxidative stress and inflammation in hippocampal cells. Nutr Neurosci. 2013 Jan;16(1):13-20.

https://doi.org/10.1179/1476830512Y.0000000023

PMid:23321679

Hosseinzadeh H, Zarei H, Taghiabadi E. Antinociceptive, Anti-Inflammatory and Acute Toxicity Effects of Juglans Regia L. Leaves in Mice. Iran Red Crescent Med J. 2011;13(1):27-33.

Meeusen R, Watson P, Hasegawa H, et al. Central Fatigue, The Serotonin Hypothesis and Beyond. Sports Med. 2006;36(10):881-909.

https://doi.org/10.2165/00007256-200636100-00006

PMid:17004850

Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in Clinical Practice. 6th ed. Philadelphia: Butterworth Heinemann Elsevier; 2012.

Singh A, Naidu P, Gupta S, Kulkarni SK. Effect of natural and synthetic antioxidants in a mouse model of chronic fatigue syndrome. J Med Food. 2002;5:211-20.

https://doi.org/10.1089/109662002763003366

PMid:12639396

Generali JA, Cada DJ. Off-Label Drug Uses, Amantadine: Multiple Sclerosis-Related Fatigue. Hosp Pharm. 2014;49(8):710-2.

https://doi.org/10.1310/hpj4908-710

PMid:25477595 PMCid:PMC4252198

Calabrese M, Rinaldi F, Grossi P, Mattisi I, Bernardi V, Favaretto A, et al. Basal ganglia and frontal/parietal cortical atrophy is associated with fatigue in relapsing-remitting multiple sclerosis. Mult Scler. 2010;16(10):1220-8.

https://doi.org/10.1177/1352458510376405

PMid:20670981

DOI: http://dx.doi.org/10.31661/gmj.v8i0.1139

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