How To Maximise Energy
- Sleep. Poor sleep can make fatigue worse. Establishing a bedtime routine, avoiding caffeine and winding down before bedtime can improve sleep quality.
- Heat. Many people find that heat makes their MS worse and can make them feel more fatigued, especially during the summer months. There are several tips for keeping cool on our website, including having regular cold drinks and tepid showers.
- Nutrition. A poor diet and nutrition can make fatigue worse. Sugary snacks might give an initial boost, blood sugar levels quickly drop again leaving energy levels low. A balanced diet can help reduce fatigue and improve energy levels, but preparing food can be tiring work. There are a number of suggestions in Living with fatigue for reducing the impact of fatigue when preparing and eating meals.
- Relaxation techniques. Relaxation can help with fatigue as it promotes good sleep patterns, increases benefit from rest periods during the day and can be used to manage stressful situations.
- Exercise. In the past, people with multiple sclerosis were advised to avoid exertion but now it is known that muscles that are not used regularly become weakened and require more energy to do tasks, making fatigue worse. Exercise can be something energetic or something more leisurely.
Amantadine Modafinil And Methylphenidate For Fatigue In Ms
- The Lancet Neurology
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Relieving Fatigue Through Cooling
Research has shown that nerves with damaged myelin are sensitive to changes in temperature. A rise in temperature may cause nerve conduction to be less efficient, whereas a reduction in temperature may allow more signals to be transmitted across a damaged nerve.
The idea of cooling people with MS to alleviate symptoms has been researched and practiced for many years, but practical methods of cooling an individual had not been perfected until the 1990s. At this time, MSAA and NASA joined forces to develop and test a cool suit.
Cooling someone too quickly such as taking cold baths or sitting close to the air conditioner can cause shivering and vasoconstriction. This reaction does not help to alleviate MS symptoms. By slowly cooling down the body, an individual with MS may experience improvement in areas of physical performance, cognitive processing, and motor function. Cooling also significantly reduces fatigue, helping a person with MS perform his or her daily activities.
Controlled cooling is now achieved through passive cooling garments. These are portable and allow the wearer to enjoy symptom relief indoors or out. Passive cooling garments, such as a vest and wraps for the neck, wrists, or ankles, use ice or gel packs to give people with MS immediate and simple relief from heat and certain MS symptoms. Some passive garments are dampened and chilled before use.
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Amantadine In Clinical Trials For Ms
A Phase 2 clinical trial to study the safety and efficacy of ADS-5102 to treat MS patients with fatigue showed it was well-tolerated. Patients improved their walking speed in a timed 25-foot walking test, which measures the time it takes for patients to walk a distance of 25 feet.
A Phase 3 ongoing clinical trial is testing the effects of commonly used medications to treat fatigue in MS. It enrolled 140 participants who were randomly divided into four groups and treated with either ADS-5102, modafinil, methylphenidate, or a placebo.
A Phase 3 clinical trial is currently recruiting MS patients with fatigue for a multicenter placebo-controlled trial in states across the U.S. A total of 540 patients are expected to enroll and will be randomly assigned to receive either a placebo, 137 mg of ADS-5102, or 274 mg of ADS-5102 once daily at bedtime for 12 weeks. Fatigue will be assessed at the beginning and end of the trial using a timed 25-foot walking test.
An open-label extension study of the above trial is also planned in Colorado, Connecticut, Georgia, New York, and Washington. Patients will receive ADS-5102 once per day at bedtime for 52 weeks. Safety and tolerability are the primary goal measures, but patients will also be asked to complete a timed 25-foot walking test at four, 12, 24, and 52 weeks of the study to evaluate the efficacy of treatment.
Fatigue In Patients With Multiple Sclerosis
Primary Versus Secondary Fatigue
Clinically, fatigue has been divided into primary fatigue, a part of the MS disease process and secondary fatigue, in which fatigue is a complication of MS .
Figure. Primary and secondary causes of MS fatigue.
Nonpharmacologic Treatment
Nonpharmacologic approaches to MS-related fatigue include energy-conservation techniques, exercise, attention to sleep hygiene, and napping. Energy-conservation techniques are often prescribed through consultation with occupational therapy. Most, but not all, studies suggest moderate graded aerobic exercise has benefit in MS-related fatigue.11 The Cochrane systematic review of exercise in MS showed at least a modest benefit in MS fatigue, in contrast to many of the medications used to treat MS fatigue.12 Sleep hygiene may be helpful to maximize sleep efficiency and thereby avoid chronic sleep deprivation. Many patients with MS use complementary and alternative medicine for MS-related fatigue, but the efficacy of supplements and most other CAM therapies is not proven. Prokarin, a proprietary blend of histamine and caffeine applied via skin patch, in a small double-blind pilot study of 22 patients improved fatigue symptoms compared to placebo as measured by the Modified Fatigue Impact Scale .13 Low-dose naltrexone had a positive effect on quality-of-life measures in a single-center pilot study.14 Data for other CAM therapies are nonexistent.
Pharmacologic Treatment
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Do Drugs Really Help Fatigue
Thereâs conflicting evidence about which drugs, if any, ease MS-related fatigue. Some studies show that amantadine may have a moderate effect for some people. Other research found that modafinil or methylphenidate could improve wakefulness in people with excessive daytime sleepiness .
Some people with MS say drugs donât get rid of their fatigue. But medicine can keep them awake and make their tiredness easier to handle.
Even if a drug helps you, it may not work as well over time. Tell your doctor if that happens. You may need to take a âdrug holiday.â That means youâll quit for a weekend or a few weeks. Your doctor will let you know when you can start your treatment back up again.
Ms Fatigue Vs Feeling Fatigued
Life can get busy, so its natural to sometimes feel run down or exhausted. This can come from stress at home or at work, a poor diet and a lack of exercise, or even just a rough nights sleep.
The difference between feeling fatigued and MS fatigue is that MS fatigue doesnt go away with rest. MS fatigue can be chronic, ongoing and can make it harder to engage in work, life and daily tasks.
Were here to give you the information, support and services to help you manage MS fatigue and any other symptoms you may be experiencing.
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No Benefit Of 3 Commonly Used Medications In Ms Fatigue
May 29, 2020
A new placebo-controlled trial has shown no benefit over placebo of three different drugs commonly used to treat fatigue in patients with multiple sclerosis .
The TRIUMPHANT study found no difference between the effects of amantadine, modafinil, methylphenidate, and placebo in the Modified Fatigue Impact Scale in a study involving 141 patients with multiple sclerosis.
There was also no difference between any of the drugs and placebo in any of the pre-planned subgroups which included different Expanded Disability Status Scale scores, depressive scores, use of disease-modifying therapy, or type of MS .
The research was presented on AAN.com as part of the 2020 American Academy of Neurology Science Highlights.
“These three drugs are used very commonly used for MS fatigue by neurologists, psychiatrists, and primary care doctors, but they don’t seem to be any better than placebo. They were all associated with increased side effects compared with placebo even with short-term use,” lead investigator Bardia Nourbakhsh, MD, Johns Hopkins University School of Medicine, Baltimore, told Medscape Medical News.
However, in a post-hoc analysis there was an improvement in fatigue severity with two of the drugs methylphenidate and modafinil in patients with excessive daytime sleepiness.
He said the trial was adequately powered and the question has been answered.
All three drugs were associated with an increase in adverse effects versus placebo.
Trial Finds No Measurable Effect In Ms Fatigue For Three Agents
Methylphenidate, modafinil, amantadine show similar results as placebo
Modafinil, methylphenidate, and amantadine were not superior to placebo in improving multiple sclerosis fatigue and resulted in more frequent adverse events, the TRIUMPHANT-MS trial found.
Our results support the notion that most of the benefits that have been reported in the clinical use of medications for multiple sclerosis fatigue are attributable to the placebo effect, reported Bardia Nourbakhsh, MD, of Johns Hopkins University in Baltimore, and coauthors in Lancet Neurology.
The results of this study do not support an indiscriminate use of amantadine, modafinil, or methylphenidate for the treatment of fatigue in multiple sclerosis, they wrote.
The trial enrolled 141 MS patients with Modified Fatigue Impact Scale score of more than 33 at two academic MS centers from October 2017 to February 2019. Participants received oral amantadine , modafinil , methylphenidate , or placebo, each given for up to 6 weeks. All patients were scheduled to receive all four study medications in one of four different sequences with 2-week washout periods between agents.
Mean MFIS score was 51.3 at baseline. At the maximal tolerated doses, estimated mean values of MFIS scores were 40.6 for placebo, 39.0 for modafinil, 38.6 for methylphenidate, and 41.3 for amantadine .
At the time of screening, 79% of participants were taking a disease-modifying therapy. Mean EDSS was 3.0.
Cat ID: 36
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Amantadine Modafinil And Methylphenidate For Ms
For one of the most prevalent symptoms of MS, fatigue, methylphenidate, modafinil, and amantadine are commonly prescribed. Substantial evidence supporting their efficacy is lacking, however. In the randomized crossover TRIUMPHANT-MS trial, none of the 3 agents was superior to placebo in improving MS-related fatigue, but they did cause more adverse events.
The goal of the TRIUMPHANT-MS trial was to compare the efficacy of twice-daily oral methylphenidate, modafinil, and amantadine against each other and placebo. Eligible patients had MS-related fatigue with a Modified Fatigue Impact Scale of > 33. Their Expanded Disability Status Scale score at the time of screening was between 0.0 and 7.0. Participants were allocated to one of four treatment sequences: 1) amantadine, placebo, modafinil, methylphenidate 2) placebo, methylphenidate, amantadine, modafinil 3) modafinil, amantadine, methylphenidate, placebo and 4) methylphenidate, modafinil, placebo, amantadine. Each medication was titrated over 4 weeks to the participants highest tolerated dose or the pre-defined highest dose. Each intervention was given up to 6 weeks, with a 2-week washout period between each treatment. The primary outcome measure was the MFIS score when the highest tolerated dose was used . A total of 141 patients of 18 years and older were enrolled and randomized. Data from 136 participants were included in the intent-to-treat analysis of the primary outcome.
What Was The Research About
Multiple sclerosis, or MS, is an illness that affects the central nervous system. Fatigue is a common and disabling symptom of MS.
In this study, the research team wanted to learn how well three commonly used medicines work to help patients with MS feel less fatigued and improve quality of life. The medicines were amantadine, methylphenidate, and modafinil. The team compared these medicines with a placebo. A placebo is a pill with no active ingredients. Using a placebo helps researchers learn if results are due to a medicine or chance.
Patients took each of the medicines and the placebo in a specific order over seven to eight months.
The research team also looked at whether patients took the medicines as prescribed and if they had adverse events. An adverse event is when a medicine causes harm an example is an allergic reaction.
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What Causes Fatigue In Patients With Multiple Sclerosis
The exact cause of MS-related fatigue is still unknown. There are several theories on the subject:
- One theory is that fatigue is related to the general activation of the immune system. Chemical messengers are called cytokines these levels are higher in patients with MS and may be higher still in patients with fatigue. One way of describing this is that you may feel like you have a virus all of the time.
- Another theory is that people with MS may have to use more parts of their brain to do the same task as someone without MS in essence, they are working harder.
- Another theory is that fatigue is related to reduced electrical transmission of signals in the brain.
Whatever the theory, we know that fatigue from MS is a very real part of the disease.
The Chalder Fatigue Scale
One of the most well-known fatigue scales, the Chalder Fatigue Scale was created for chronic fatigue syndrome patients. This 14-item instrument quantifies fatigue intensity in terms of physical and mental domains. Each item is quantified by a numeric value on a Likert scale, and a sum score is calculated. Higher totals indicate more fatigue. Advantages of this instrument include its ease of use and brevity: it can usually be completed within 23 minutes. Although it has demonstrated good internal consistency in patients with chronic fatigue syndrome, MS-Specific assessments of validity and consistency for this instrument are lacking. Nonetheless, some investigators still regard The Fatigue Scale as a valuable instrument for clinical studies.
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What Are Symptoms Of Fatigue
There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.
The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.
A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.
Finding Help And Taking Help That’s Offered
People might say to you ‘If theres anything you need…’ or ‘If there’s anything I can do…’, but it is not always easy to ask for help, even when it is offered.
It can be useful to prepare a list of tasks that youd like help with. That way, if someone does offer to help, you can easily tell them how they could help.
If you find it hard to take, or ask for help, our fatigue management course could help you!
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Actions For This Page
- Multiple sclerosis is a disease of the central nervous system that can affect the brain, spinal cord and optic nerves.
- Common symptoms include fatigue, bladder and bowel problems, sexual problems, pain, cognitive and mood changes such as depression, muscular changes and visual changes.
- See your doctor for investigation and diagnosis of symptoms, since some symptoms can be caused by other illnesses.
- Whilst there is not yet a cure for MS, researchers are making promising progress and discoveries about the treatment and management of MS every day.
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What Were The Results
The three medicines didnt help patients feel less fatigued or sleepy or improve quality of life better than the placebo.
The percentage of patients who stopped taking each medicine was 6 percent for amantadine, 5 percent for methylphenidate, 8 percent for modafinil, and 3 percent for placebo.
Compared with placebo, more patients who took the medicines reported adverse events. The percentage of patients who reported at least one adverse event was 39 percent for amantadine, 40 percent for methylphenidate and for modafinil, and 31 percent for placebo.
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Sexual Function And Ms
Sexual dysfunction is common in MS. It can be directly related to MS from brain or spinal cord lesions, or more indirectly related due to other MS symptoms such as depression and fatigue, or from wider relationship and social issues stemming from MS.
Although a difficult area to talk to your health professional about, it is an important area to maintain your quality of life and self-confidence. There are many avenues of help available from physical to psychological and your GP, MS nurse or neurologist can point you in the right direction for the most appropriate assessment and assistance.
Organise Your Living And Work Spaces
You might find there are practical changes that can be made to the places you work and live. Maybe re-organising desks or cupboards, or adjusting the temperature or lighting to suit you better.
Sometimes, the simplest of changes can make the workplace or home more energy efficient for you.
An occupational therapist can help you assess the spaces you use at work and at home – and may suggest adaptations or equipment that could help. For more information about the support that occupational therapists can offer, and how to find one, download or order our leaflet Occupational therapy and MS.
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