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Treatment of Fatigue in Multiple Sclerosis

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Updated June 10, 2014

Although almost all of us with MS suffer from fatigue, but in many cases there are things our doctors can do to help. If fatigue is interfering with your daily life, it is important to talk to your doctor about it. It is crucial that you give your doctor all the details necessary to evaluate and treat your fatigue. Ideally you can keep a "fatigue log" to give her that notes the following: levels of fatigue, times of day when it occurs, what you were doing, times you took your medications, and anything you did that relieved your fatigue.

Diagnosing and Evaluating Fatigue

Determine Causes: While people with MS experience what is referred to as "MS lassitude," which is caused by the disease itself, there are many other causes and contributors to fatigue. Some of these other causes even include the very drugs to slow MS or help MS symptoms. Other things which can contribute to fatigue are sleep disturbances, depression, exertion and infections.

Determine Severity: Your doctor will need to assess the level of your fatigue. If your fatigue has come on suddenly or has gotten much worse, she may suspect a relapse and follow her protocol for evaluating and treating relapses, including sending you for an MRI scan. Otherwise, a diagnosis of MS fatigue means having fatigue symptoms for at least 50% of the time, lasting for more than 6 weeks. She will probably also ask you to rate how severe it is and how much it is interfering with your life, so that she can decide how aggressive to be in terms of medications and dosages.

The approach to treating fatigue has many components:

Medications for Fatigue

Currently, the most-commonly prescribed medications for MS-related fatigue are Provigil (modafinil) and Symmetrel (amantidine). Read the full articles: Provigil as Treatment for Fatigue in MS and Symmetrel as Treatment for Fatigue in MS

Occasionally other drugs might be prescribed, including:

  • Ritalin (methylphenidate), a central nervous system stimulant, which is most often prescribed for attention-deficit hyperactivity disorder (ADHD).
  • Cylert (pemoline), a central nervous system stimulant. It has side effects which require careful monitoring.

Adjust Medications that Can Cause Fatigue

These fall into two classes: medications that have fatigue as a side effect, and medications that contribute to fatigue indirectly by making it hard to sleep.

Drugs with Fatigue as a Side Effect: Some of the culprits in this group of drugs include the disease modifying therapies which are made from beta-interferon (Avonex, Betaseron and Rebif), as well as Tysabri and Novantrone. It is important to report if you notice a pattern to your fatigue in relation to your medications (for example, it is worse the day after an injection or infusion). Your doctor will probably not switch your disease modifying therapy, but may prescribe one of the drugs used to treat MS fatigue and tell you to take it on an as-needed basis. She may also suggest changing the times when you take your medication (if possible) to ensure that your worst fatigue occurs when you have the opportunity to rest (for example, take your Avonex injection on Friday night, so that you can rest the next day).

Fatigue is also a side effect of some medications taken for MS symptoms such as spasticity (including baclofen, Valium and Zanaflex) or pain (including Klonopin and Neurontin). Others include medications for high blood pressure, allergy medications and anti-anxiety drugs. Depending on which drug your doctor suspects is the problem, she may switch you to another medication or have you alter the times when you take your meds (for example, time them so your largest dose is at night, if that is appropriate).

Drugs that Cause Insomnia: Corticosteroids like Solu-Medrol often cause sleep disturbances and anxiety. Since these are taken short-term, your doctor may prescribe a sleeping aid or anti-anxiety drug to help you get rest during your treatment.

Ironically, most of the drugs that are prescribed to treat MS-fatigue can also cause insomnia. The first thing your doctor will try in this case will probably be to adjust the times when you take these drugs, so that your largest dose is early in the day. She may also adjust the amount of medicine you are taking.

Investigate and Treat Other Causes

Sleep disturbances are common in people with MS, and the resulting lack of sleep at night leads to sleepiness during the day. Insomnia can be caused by spasms, depression, anxiety, pain, and/or the frequent need to urinate at night (nocturia). All of these can be effectively treated.

Exertion causes fatigue in people with MS when they constantly need to compensate for symptoms like spasticity or muscle weakness, which may make it harder to walk, maintain balance or complete household tasks. In this case, your doctor may prescribe physical therapy to help build your muscles, improve balance or move more efficiently. She may also refer you to an occupational therapist, who can help you adjust your actions to use less energy, as well as make adjustments in your home to make it easier to perform self-care and household tasks.

Depression often causes people to feel overwhelmingly tired. In some people, the fatigue itself causes depression. In the case of depression, your doctor may start with an anti-fatigue drug to see if that helps both the fatigue and depression. If you are still depressed, she will probably refer you to a psychiatrist so that you can get help with your depression, including anti-depressant medications. Again, some of the medications used to treat depression can also cause fatigue, so you must make sure that your psychiatrist is aware of your fatigue, as well as other MS symptoms.

Infections, such as colds, flu or urinary tract infections can cause fatigue. If your doctor suspects that you may have a urinary tract infection, she will test your urine and prescribe an antibiotic. In the case of a cold or flu, you will probably be told to rest until you are better, then come back if you are still experiencing fatigue.

Source:

Turkington, Carol. The A to Z of Multiple Sclerosis. New York: Checkmark Books. 2005.

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