Despite great advances in the diagnosis and treatment of multiple sclerosis (MS) within the prior two decades, the treatment and prevention of this degenerative autoimmune disorder remain challenging, as it affects around 2.8 million people worldwide who present with diverse constellations of symptoms. Furthermore, early changes in specific symptoms and functional ability within the first year after initial MS diagnosis have not been thoroughly investigated. One of the most prevalent symptoms described as the most impairing by many patients with MS is fatigue, defined as a feeling of disproportionate tiredness and overwhelming exhaustion, thus severely impacting quality of life. However, fatigue is often undertreated, and effective and feasible countermeasures remain scarce. The work in this dissertation had three Aims: i) to examine alertness, fatigue, mental health, sleep, and fitness to drive in patients with MS shortly after de-novo diagnosis and 1 year later, with comparisons to a matched healthy control group (Study 1); ii) to evaluate a novel light therapy-based intervention method using blue-enriched bright light (468 nm, 1,500 lux) applied via glasses in healthy participants during the early morning hours of night shift work and comparing these with placebo glasses (dim red light, 660 nm, 150 lux) to assess effects on sleepiness, alertness, and sustained attention (Study 2); and iii) assess the safety and efficacy of the same light therapy glasses applied in Study 2 in patients with MS with fatigue, compared with placebo glasses, directly after awakening in an attempt to reduce fatigue and improve quality of life (Study 3). Study 1, a prospective observational study, examined psychological, psychometric, and physiological data collected in a prospective pilot study over the course of 1 year, including 25 patients with MS and 25 healthy matched controls. Directly after diagnosis, alertness, fatigue, mental health, sleep, and fitness to drive were similar in patients with de-novo MS and matched healthy controls. Further, no deteriorations in the assessed components were observed 1 year after diagnosis. Study 2, an intervention study, included a placebo-controlled, randomized, crossover design, examining psychological and psychometric data from healthy participants using light therapy glasses. These experiments involved blue-enriched bright light therapy glasses and placebo glasses (dim red light) and were conducted during night shift work at a sleep laboratory. Usage of both light glasses from 5:00 a.m. to 5:30 a.m. slightly reduced sleepiness but yielded no significant effects on alertness directly after light exposure or on fatigue and sustained attention after the night shift. No side effects were reported, and the acceptance and feasibility of the glasses were good. Building on the findings of Study 2, Study 3 included the same study design adapted to patients with MS with fatigue, using the glasses directly after awakening in the morning. With a focus on analysing the efficacy and feasibility of the light glasses, we were able to provide evidence of the immediate and prolonged significant reductions in fatigue following blue-enriched light exposure (compared to dim red light) and of clinically significant reductions in fatigue levels after one intervention week. Side effects and their severity were mild, and acceptance levels and feasibility were high. Within the limitations of these studies, namely limited sample sizes, study settings, and generalizability, these findings contributed to the existing knowledge about the initial development of specific symptoms and functional ability within MS. They further provided evidence for a novel portable light therapy-based intervention method that can help treat a highly debilitating MS symptom, initiating ideas for further research, and extending current treatment options for patients with MS and fatigue.
Julia Ottersbach (Thu,) studied this question.