This study investigates the effect of high-dose thiamine (vitamin B1) on symptoms of fatigue in patients with multiple sclerosis (MS). Fatigue is one of the most common and distressing symptoms of MS for which there is currently no effective treatment. The hypothesis of the study is that fatigue is related to mild intracellular thiamine dysfunction, even when blood levels are in the normal range.
15 patients with MS-related fatigue received 600-1500 mg thiamine orally daily or 100 mg/mL parenterally weekly. Fatigue was assessed using the Fatigue Severity Scale (FSS). After 20 days, 14 out of 15 patients showed a significant improvement in fatigue symptoms, with an average reduction in FSS score of 41%. Improvements occurred within a few days of starting therapy, regardless of the form of administration. No serious side effects were reported.
Conclusion: High-dose thiamine could be an effective and safe treatment option for MS patients with fatigue. Further placebo-controlled studies are needed to confirm the underlying mechanisms and long-term efficacy.
Background:
Fatigue is one of the most common and distressing symptoms of multiple sclerosis (MS), affecting around 75% of patients. Despite its significant impact on quality of life, there is as yet no effective treatment. The pathophysiology of MS-related fatigue is poorly understood, but previous studies suggest that mitochondrial dysfunction and disruption of cellular energy metabolism may play a role.
Vitamin B1 (thiamine) is crucial for glucose metabolism and mitochondrial energy production. This study hypothesizes that MS-related fatigue is associated with mild intracellular thiamine dysfunction, even when blood levels are in the normal range. The administration of high-dose thiamine could compensate for this dysfunction and alleviate fatigue.
Methodology:
– Participants: 15 MS patients diagnosed with fatigue (9 women, 6 men, average age 47.2 years).
– Duration of treatment: 20 days.
– Dosage:
– 600-1500 mg thiamine orally daily (adjusted according to body weight).
– Alternatively 100 mg/mL parenterally once a week.
– Fatigue measurement: Before and after treatment with the Fatigue Severity Scale (FSS).
– Additional clinical parameters: Determination of blood thiamine and thiamine pyrophosphate (TPP).
Results:
1. Reduction of fatigue:
– The average FSS value fell significantly from 45.4 to 26.9 (p < 0.0001).
– 14 out of 15 patients reported a subjectively noticeable improvement in their energy and resilience.
2. Fast onset of action:
– When administered parenterally, improvements were observed within a few hours.
– With oral administration, the first effects occurred after 2-3 days.
3. Improvement of other symptoms:
– Patients reported a reduction in sleep disorders, depression, anxiety, muscle weakness and tachycardia.
– Neurological deficits, such as motor impairments, showed no significant change.
4. Thiamine and TPP levels:
– Blood thiamine levels increased significantly after high-dose therapy, but without direct correlation with the improvements in fatigue.
– This indicates a possible intracellular transport disorder or a structural enzymatic dysfunction.
5. Side effects and safety:
– No serious side effects occurred during the entire study.
– The treatment was well tolerated by all patients.
Discussion:
– The results support the hypothesis that MS-related fatigue could be linked to a dysfunction of intracellular thiamine transport.
– High-dose thiamine could overcome this disorder by increasing the thiamine concentrations in the cells via diffusion.
– Similar results were observed in earlier studies on fatigue in other inflammatory diseases, such as ulcerative colitis.
– The effect of thiamine could be explained by its role in mitochondrial function, energy metabolism and the reduction of oxidative stress.
Conclusion:
This pilot study provides initial evidence that high-dose thiamine could be a promising treatment option for MS patients with fatigue. The therapy showed a rapid, significant and sustained improvement in symptoms, without side effects. Further placebo-controlled studies are needed to confirm long-term efficacy and determine optimal dosing strategies.