Abstract
Elevated body temperature was recently reported for the first time in patients with relapsing–remitting multiple sclerosis (RRMS) relative to healthy controls. In addition, warmer body temperature was associated with worse fatigue. These findings are highly novel, may indicate a novel pathophysiology for MS fatigue, and therefore warrant replication in a geographically separate sample. Here, we investigated body temperature and its association to fatigue in an Italian sample of 44 RRMS patients and 44 age- and sex-matched healthy controls. Consistent with our original report, we found elevated body temperature in the RRMS sample compared to healthy controls. Warmer body temperature was associated with worse fatigue, thereby supporting the notion of endogenous temperature elevations in patients with RRMS as a novel pathophysiological factor underlying fatigue. Our findings highlight a paradigm shift in our understanding of the effect of heat in RRMS, from exogenous (i.e., Uhthoff’s phenomenon) to endogenous. Although randomized controlled trials of cooling treatments (i.e., aspirin, cooling garments) to reduce fatigue in RRMS have been successful, consideration of endogenously elevated body temperature as the underlying target will enhance our development of novel treatments.
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This study was approved by the ethical review board of University Hospital San Raffaele, Milan. All participants provided written informed consent before enrollment.
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VM Leavitt, E DeMeo, and G Riccitelli report no disclosures. MA Rocca received speaker honoraria from Biogen Idec, Sereno Symposia International Foundation, and Novartis and receives research support from the Italian Ministry of Health and Foundazione Italiana Sclerosis Multipla. G Comi has received consulting fees for participating in advisory boards from Novartis, Teva Pharmaceutical Industries Ltd, Sanofi-Aventis, Merck Seronon, Bayer Schering Pharma, Actelion Pharmaceuticals Ltd, and GeNeuro, and lecture fees from Novartis, Teva Pharmaceutical Industries Ltd, Sanofi-Aventis, Merck Seronon, Biogen-Dompe, Bayer Schering Pharma, and Serono Symposia International Foundation. M Filippi is Editor-in-Chief of the Journal of Neurology; serves on scientific advisory boards for Teva Pharmaceutical Industries Ltd.; and has received funding for travel from Bayer Schering Pharma, Biogen Idec, Merck Seronon, and Teva Pharmaceutical Industries. JF Sumowski has received speaker honorarium from Biogen Idec.
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M. Filippi and J. F. Sumowski contributed equally to the manuscript.
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Leavitt, V.M., De Meo, E., Riccitelli, G. et al. Elevated body temperature is linked to fatigue in an Italian sample of relapsing–remitting multiple sclerosis patients. J Neurol 262, 2440–2442 (2015). https://doi.org/10.1007/s00415-015-7863-8
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DOI: https://doi.org/10.1007/s00415-015-7863-8