Fatigue is one of the most common and disabling symptoms of multiple sclerosis.

Fatigue affects as many as 80% of people with multiple sclerosis (MS) and can significantly affect a person’s quality of life. However, some lifestyle changes, healthful habits, and medications can help people manage MS fatigue.

In this article, we discuss the symptoms, causes, and treatment of MS fatigue.

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People who have fatigue feel overwhelmingly tired, typically with no obvious cause. They may find it difficult to perform everyday tasks, perform at work, or socialize. A person with MS may experience both physical and mental fatigue.

People with MS may also experience episodes of lassitude, a type of fatigue that is characteristic of MS. Lassitude differs from other kinds of fatigue because it tends to:

  • occur daily
  • develop early in the morning, even after a restful night
  • worsen throughout the day
  • be aggravated by heat and humidity
  • interfere with everyday activities and responsibilities
  • be unrelated to physical ailments or depression levels

Doctors use the Modified Fatigue Impact Scale (MFIS) to assess a patient’s fatigue symptoms. The MFIS is a 21 item questionnaire that covers physical, cognitive, and psychosocial health.

An MFIS questionnaire typically takes 5-10 minutes to complete and contains statements including:

  • I have been less alert.
  • My muscles have felt week.
  • I have had trouble concentrating.
  • I have had difficulty making decisions.

Patients then describe how these statements have reflected their experience in the prior 4 weeks. They do so using a scale.

  • 0: never
  • 1: rarely
  • 2: sometimes
  • 3: often
  • 4: almost always

The MFIS is a shortened version of a Fatigue Impact Scale first introduced in 1994 and remains an effective method of assessing fatigue.

Doctors can use a questionnaire to get a better understanding of a person’s overall fatigue levels. They can also separate results into physical, cognitive, and psychosocial categories. This allows doctors to assess the ways in which fatigue is affecting a patient and plan treatment accordingly.

The MFIS is also available in a shorter 5-item version.

MS fatigue can negatively affect a person’s quality of life.

Fatigue can make it difficult to do everyday activities, which can interfere with someone’s ability to care for themselves, work, and socialize. Fatigue is a major reason some people with MS choose to stop working or to reduce working hours.

MS fatigue may also cause symptoms that lead to mobility issues.

Many of the medications that people take to manage MS fatigue can also cause side effects, such as:

There are primary and secondary causes of MS fatigue.

Primary fatigue

MS causes damage and scarring of nerves in the brain and spinal cord. Primary MS fatigue is fatigue resulting from this damage. However, the exact ways in which this translates to fatigue are not well known.

According to a 2019 review, one possible reason for fatigue could be MS lesions affecting the parts of the brain that control motivation and motor planning. Others suggest that the way the body adapts to MS damage, and the increased effort required, could also play a role in fatigue.

More research is required to determine the specific ways in which MS scarring leads to fatigue.

Secondary fatigue

Certain conditions related to MS may cause fatigue. When a person experiences fatigue because of these factors they have secondary fatigue.

Reasons for secondary fatigue can include:

  • disrupted sleep due to muscle spasms or bladder poblems
  • depression
  • stress
  • low energy levels due to inactivity

Some people with MS may find that using their muscles for repetitive movements, such as walking longer distances, causes their muscles to tire quickly. The resulting exhaustion is a type of fatigue called short circuit fatigue. This usually resolves with rest.

People with MS fatigue should talk with their doctor to identify the triggers of fatigue and develop a treatment plan.

Treatment plans are all different, but most involve a combination of:

  • undergoing occupational therapy
  • engaging in exercise
  • establishing a consistent sleep schedule
  • learning to manage energy levels
  • establishing healthful eating habits
  • staying hydrated by drinking 6 to 8 cups of water daily

MS fatigue medications

The Food and Drug Administration has not approved any medications specifically for MS fatigue. However, doctors may prescribe certain medications off-label for MS fatigue. They include:

  • Prozac (fluoxetine), a selective serotonin reuptake inhibitor that alters brain chemicals
  • Symmetrel (amantadine), an antiviral medication that may alter dopamine levels
  • Provigil or Alertec (modafinil), an agent that promotes wakefulness
  • Ritalin (methylphenidate), which stimulates the central nervous system

In addition, disease-modifying therapies (DMTs) may help reduce MS symptom frequency, delay disease progression, and limit new disease activity. DMTs work by changing the way a person’s immune system functions. This can reduce inflammation from MS.

The U.S. Food and Drug Administration has approved several DMTs for use.

For people experiencing a severe flare-up of symptoms, doctors may recommend short-term treatment with high-dose corticosteroids.

Other MS symptoms may contribute to fatigue, especially depression and sleep disruption. As a result, a doctor may prescribe medication to treat specific symptoms. Examples include:

  • botulin toxin (Botox) for bladder and muscular problems
  • duloxetine (Cymbalta), venlafaxine (Effexor), paroxetine (Paxil), or sertraline (Zoloft) for depression
  • clonazepam (Klonopin) for tremors and muscle issues
  • enemas, mineral oil, or milk of magnesia for bowel dysfunction
  • tizanidine (Zanaflex), dantrolene sodium (Dantrium), or baclofen (Gablofen) for muscle issues
  • oxybutynin (Ditropan), darifenacin (Enablex), or prazosin (Minipress) for bladder problems

Alongside taking medication, people may find that developing a good support network and sharing the experience of MS fatigue can help improve their emotional well-being.

There is no cure for MS fatigue. It is usually unpredictable and can worsen or improve for a time.

It is important to treat MS early. Long-term DMT treatment may slow the progression of MS. This can reduce symptoms and potentially delay other complications.

Taking DMTs in the long term may also slow the conversion of relapsing-remitting MS to secondary-progressive MS, a form of MS that causes symptoms to worsen steadily.

Fatigue is one of the most common, pervasive, and early symptoms of MS.

Several lifestyle habits, medications, management strategies, and other therapies may reduce symptom severity and frequency. Treating MS symptoms early can generally improve a person’s long-term quality of life.

Anyone who experiences unexplained fatigue that interferes with everyday life or does not improve with rest should talk with a doctor.

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