Review question

What are the effects of treatments for fatigue in people living with amyotrophic lateral sclerosis (ALS) compared to no treatment or placebo?

Background

ALS, which is also known as motor neuron disease (MND), is a condition in which the nerves that control movement stop working. People experience problems moving their limbs, maintaining posture, swallowing, and breathing, which worsen over time and shorten life. The cause is unknown, and there is no cure. People living with ALS/MND often experience fatigue, which can cause distress and reduce quality of life. Fatigue can have many causes, including respiratory problems, medication, malnutrition, and depression. Our focus in this review was on treatments for fatigue that arises from the condition itself. Different treatments may improve symptoms of fatigue in ALS/MND. These include medicines, which may help people feel more awake, and other treatments, such as exercise. It is unclear whether any of these treatments are effective for improving fatigue in ALS/MND. We reviewed the available studies on the effects of treatments for fatigue in ALS/MND.

Study characteristics

The review included four small studies with a total of 86 participants. Each study investigated a different treatment. These were a drug treatment (modafinil) compared to placebo, breathing exercises compared to sham (inactive) breathing exercises, exercises with weights compared to usual care, and magnetic brain stimulation compared to sham rTMS.

Key results and quality of the evidence

We are very uncertain about the effects of modafinil, breathing exercises, exercises with weights, or magnetic brain stimulation on fatigue in people with ALS/MND, as the evidence was very low quality. It was often unclear whether studies were adequately designed and performed, as trial reports often lacked details. The results of these small studies were not precise. Three participants stopped taking modafinil because of side effects: headache in two, and chest tightness in one; participants also reported anxiety, nausea, dizziness, and sialorrhoea (inability to control oral secretions). We need more research on effective treatments for fatigue in ALS/MND.

The searches are up to date to September 2017.