The Biological Substrates of Poststroke Fatigue: a Qualitative Meta-Analysis for the Pathogenesis and Treatment of Poststroke Fatigue
Abstract
Stroke is the leading cause of physical disability worldwide and represents a black hole that drains the global health economy. Pathological post-stroke fatigue (PSF) is one of the most common sequelae, affecting up to 85% of stroke patients. Intractable PSF is the worst or one of the worst stroke symptoms in 40% of stroke survivors due to the overwhelming perceptual shortage of energy for physical and mental activities. The pathogenesis of PSF is blurred by a vast array of comorbidities inherent to this group of patients, which can precipitate fatigue regardless of the cerebrovascular injury. Fatigue is a subjective experience that may elude the quantification of uniform metrics. Quantitative meta-analysis on PSF studies is enigmatic due to the inconsistent study designs, methodology of fatigue assessment, and heterogeneity of patient characteristics.
This thematic meta-analysis scrutinizes the evidence for factors involved in PSF pathogenesis and constructs a clinical framework to approach PSF. Moreover, a treatment paradigm is proposed based on the compound evidence-weighted extractions of data from prospective studies on PSF. Moreover, proactive testing for autonomic reflexes and postural hypotension is of paramount importance, and judicious selection and titration of antihypertensives may correct subclinical orthostatism that manifests seamlessly as morbidly chronic fatigue. PSF may hinder rehabilitation and impact morbidity and mortality. Embracing the proposed…
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