Fatigue in multiple sclerosis (MS) is defined as mental or physical exhaustion that prevents a person from performingĀ everyday activities. It is one of the most common symptoms in MS, affectingĀ more than 80 percent of patients, and a major cause of under-employment, early retirement, and a reducedĀ quality of life.
MS-related fatigue could be āprimary,ā also called lassitude, which is a direct result of myelin damage. This fatigue is unique to MS and different from thatĀ experienced by non-MS patients. It is sudden, more severe, aggravated by heat or humidity, and unaffected by restful sleep.
āSecondaryā MS-related fatigue is an indirect result of suchĀ MS symptoms as depression, stress, recent relapses, the side effects of medication, and sleeps disorders.
Various causes can be behind sleep disorders in MS, such as nocturia (frequent urination at night), nighttime muscle spasms, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea (OSA).
The underlying causes of MS-related fatigue are not properly understood. The criteria to distinguish primary and secondary MS-related fatigue are still lacking.
Managing fatigue in multiple sclerosis
Experts recommend several fatigue management strategies that include evaluating and treating any secondary causes (such as drug side effects, depression, sleep disorders, etc.), followed by drug therapy, exercise, and self-management (diet changes, taking naps, relaxing exercises, a cool shower, etc.).
There is limited information about the effects of disease-modifying therapies (DMTs) on MS-related fatigue. Some studies suggest interferon-Ī² (brand names, Avonex,Ā Betaferon,Ā PlegridyĀ or Rebif)Ā and glatiramer acetate (brand names, Copaxone or Glatopa) as effective DMTs to reduce fatigue. No such effect has been observed with teriflunomide, dimethyl fumarate, or alumtuzumab.
A published trial showed that alfacalcidol (a vitamin D analog) reduced fatigue. Carnitine (involved in energy metabolism)Ā was also shown to improve fatigue in another study.
The FDA-approved therapy 4-aminopyridine (fampridine; brand name, Ampyra) is used to treat MS-related walking ability, and has been shown to improve fatigue inĀ studies such as this one.
Other effective strategies include rehabilitation (exercise, self-management, mindfulness training) and cognitive behavioral therapy (CBT).
Fatigue can also be significantly easedĀ by treating underlying sleep disorders, like usingĀ continuous positive air pressure (CPAP) for sleep apnea, drug therapy orĀ CBT for insomnia, and medications for restless leg syndrome or otherĀ and nighttime limb movements.
A 2016Ā studyĀ gave an overview of both the challenges in treating fatigue in MS patients, and the various approaches shown to be effective. Its authors suggestedĀ “a comprehensive approach, including self-management strategies, rehabilitation, CBT, and the treatment of underlying sleep disorders and potentially other comorbidities.”
The researchers also recommendedĀ anĀ algorithm (a practical set of instructions), which they called theĀ Berlin Treatment Algorithm, that clinicians might use to identify the causes of fatigue in MS patients and to arrive at appropriate and individually tailored treatments.
Multiple Sclerosis News TodayĀ is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
