POST STROKE FATIGUE IN A SAMPLE OF EGYPTIAN PATIENTS WITH ISCHEMIC STROKE

Abstract

SUMMARY AND CONCLUSION F atigue is one of the most prominent negative outcomes experienced by stroke survivors with wide prevalence rate varying between 16% and 74% and this variation related to many factors such as the used definition of fatigue, characteristics of patient sample and the time point post-stroke. The onset of PSF varies from typically occurring early during the acute hospital stay, 7 to 10 days in majority of affected patients and 3 to 6 months in a considerable percentage of affected patients. However, its symptoms may persist for longer times and may reach several years, despite marked improvements in patients’ neurological and physical impairments. Fatigue is one of the major contributor to the burden of disease after stroke and there is no long history of investigations into PSF and the understanding of the mechanisms behind it still limited as most of existing studies were observational and cross-sectional. That renders the bulk of current information is at the level of association, not causation. PSF is a complex symptom with variable factors that are potentially associated with the development of PSF including demographic factors, pre-stroke fatigue, vascular burden, lesion location, stroke type, neural activity and metabolism, inflammatory markers, comorbidities, medications, pain, physical disability, depression, anxiety and nutrition. Stroke patients who suffer fatigue have lower quality of life than those without fatigue even after adjusting for age, disability, and depression. This is important as the quality of life is the closest thing we have to a central and universally important health outcome measures. Our study had studied PSF in a sample of 50 Egyptian patients with ischemic stroke with inclusion and exclusion criterion aiming to eliminate factors that cause fatigue in different medical and neurological conditions, not to stroke disease itself like those with already pre-stroke fatigue, those having pre-stroke depression, those having major disabilities etc. Those patients was studied for prevalence of PSF among them using FSS, associated risk factors and its effect on the patients’ quality of life. The patients were followed up to the previous at 1 and 3 months of the onset of symptoms. We had found high prevalence rate of PSF among our sample which was 96%. There was highly significant association with stroke severity at time of admission (P-value 0.000) and also high significant correlation with post-stroke anxiety and depression (P-value 0.000). Regarding the lesion location, our study had revealed significant association between lesion in the posterior circulation territory and PSF (P-value 0.023). However, there was no significant association with the rest of possible determinants in our study which may be partly due to small size of our sample, methodology and time-point follow up. There was high significant association between PSF and the patients’ post-stroke health related quality of life (P-value 0.000).