Viola Biberacher: fatigue in multiple sclerosis

Written by Lauren Pulling

We spoke to Viola Biberacher, Technical University of Munich (Munich, Germany), at this year’s ECTRIMS congress in London, UK (14–17 September 2016). Her group has been researching the driver of fatigue in multiple sclerosis (MS), which has a major impact on patients and their quality of life but as yet is not fully understood. Viola discusses her work and her thoughts on the correlation observed between fatigue and the inflammatory environment in the CNS in MS.
Could you tell us about your background and current research?

I’m a medical doctor practicing at the Technical University of Munich. I’m a resident in neurology and I also do research beside my normal work. My research field is mainly MRI in MS but we are also interested in how these MRI changes are associated with laboratory findings in cerebrospinal fluid (CSF).

You recently presented your research, ‘Chasing the driver of fatigue in multiple sclerosis: brain MRI versus CSF’ at ECTRIMS 2016 – please could you provide our readers with a brief overview of this?

We were interested in the driver of fatigue in MS patients. We performed a follow-up study where we analyzed different CSF parameters of disease onset and brain MRI scans during the first few years of the disease and compared these data with the development of fatigue. We found that disability and disease duration have a major impact on fatigue – we additionally found hints that the inflammatory milieu in the CSF at disease onset is also independently associated with the development of fatigue.

I think this area of research is especially interesting and relevant because all of us know the sensation of tiredness when we just have a cold, so why shouldn’t we be fatigued with ongoing inflammation in the brain?

How much of an impact does fatigue have on MS patients?

It really has a major impact because it affects the majority of MS patients and it can substantially limit quality of life. When I was working at the outpatient unit, fatigue was one of the most significant and disabling symptoms, especially in the early disease stages when patients are still able to walk normally but fatigue limits their activities.

The study you presented found some correlation between the inflammatory environment in the CNS and fatigue experience. Do you think there is a causal relationship here?

I think that there might be a causal relationship. There are also other studies investigating this but it is difficult to investigate the inflammation directly because the area under investigation is compartmentalized in the CNS and these are mostly local processes that cannot be measured in the peripheral blood.

What are the main challenges in determining the cause of fatigue in MS?

I think the main challenge is that everything is correlated, so I do not think there is one driver of fatigue but instead a picture of many contributing factors. I think perhaps we have just identified a new piece of the puzzle with our study because there are so many things that might drive fatigue and these might also vary during the disease course. Additionally, in later disease stages when patients are bound to a wheelchair, it is difficult to assess levels of fatigue.

What do you think the next steps will be for your group, and more generally in this field?

I think of course our study needs replication. We would like to do this in our own cohorts but we do not have the CSF samples from enough MS patients, so it will take some time before we can validate our own data. But maybe other researchers who listened to the talk will do that job for us and then it will be interesting to look in more detail at these alterations and perform additional functional analyses of the CSF cells.

I hope that maybe in 10 years’ time we will know more and have new opportunities to enable us to help our patients.