The Influence of Cognitive Behavioral Therapy on Fatigue, Cognition and Inflammatory Biomarkers in Multiple Sclerosis Patients

This study was done to to examine the influence of using a computer-based cognitive behavioral therapy on primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS. This study was conducted in the time period between December 2020 till May 2021.

1. Subjects Selection:

Forty MS patients were selected from Neurology Department Faculty of Medicine, Cairo University out-patient clinic , Multiple Sclerosis Research Unit, Cairo University and from Faculty of Physical Therapy ,Cairo University out-patient clinic. The patients were diagnosed and referred from a neurologist. All the patients were referred from a neurologist as a clinically definite MS according to Mcdonald criteria. The diagnosis was confirmed by MRI. The patients were assigned into two equal groups (Conventional physical therapy program)(G1) & ( Computer-based cognitive behavioral therapy)(G2).

• Inclusion criteria:

• All types and representations of MS patients were included in this study. - The age of the patients ranged from 20-45 years. - All the patients subjected to a standard neurological examination before participating in the study( sensory, motor, coordination , balance, gait and fundus examination).

• All the patients were free from any other neurological problems.

• Multiple sclerosis patients were subdivided into two equal groups (Conventional physical therapy program)(G1) & ( Computer-based cognitive behavioral therapy)(G2).

• All included patients for both groups complained from fatigue for more than three months with total score of FSS ≥ 36.

• All included patients complained of a cognitive decline for more than three months ( including attention, concentration or memory problems according to the RehaCom scores)

• All the patients were ambulatory with mild to moderate disability according to the expanded disability status scale (EDSS) ≤ 5(Ambulatory without aid or rest for 200 meters).

• Serum levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were elevated in all recruited patients for both groups.

• All the patients were medically stable with absent or mild hemiparetic, ataxic, sensory or motor manifestations.

• The main complain for all patients in both groups is the sense of fatigue and varying degrees of cognitive dysfunction.

• All recruited MS Patients kept on their medications as glucocorticoids, amantadine , betaferon , hypnotics and modafinil throughout the study.

• All patients were educated .

• Exclusion criteria:

The patients were excluded when they met one of the following criteria:

• Severe visual, verbal or acoustic impairments that may interfere with cognition testing,
• Serious chronic illness that could interfere with or modify assessment or treatment outcomes.
• Low leukocyte count & elevated ESR as this interfere with cytokine levels.
• Secondary causes of fatigue including severe depression ( beck depression inventory (BDI ≥ 21) and sleep disturbance ( Epworth sleepiness scale (ESS ≥ 12)
• Inability to complete questionnaires study outcome measure as in severe cognitive impairment and illiteracy.
• Magnetic resonance imaging (MRI) of the brain showed plaques within the cingulate gyrus, insula , temporo-basal cortical areas or diffuse patchy frontal lesions as they usually complain from cognitive impairment independent of fatigue.

2. Instrumentations & Procedures :