Fatigue Is Often The Most Debilitating Ms Symptom
You see, despite being such a common aspect of life with MS, we really don’t know much about this symptom. Fatigue is often considered by many people living with MS to be one of the most debilitating symptoms they deal with on a regular basis. Even with all the physical and cognitive disabilities that MS has left me with, I would say that fatigue is what holds me back the most in my day to day life. Because of this, I am pretty dependent on the medications used to help manage fatigue, which is what I want to talk about today.
Common Multiple Sclerosis Drugs
Your doctor has choices to make within each class of MS medicines. Finding the right treatment for you may involve some trial and error. Here are 10 drugs commonly prescribed for MS:
is a muscle relaxant. It improves muscle movement and relieves , muscle tightness, and cramping from spasticity . It is available as a tablet and an infusion system that delivers the drug into the spinal canal.
Dalfampridine improves walking or gait difficulties. It is the only drug with FDA approval for this MS symptom. It comes as a tablet you take twice daily.
Dexamethasone is corticosteroid for managing relapses. Typically, doctors use the IV form for several days. A slow taper using an oral corticosteroideither dexamethasone or prednisonemay be necessary afterwards.
Dimethyl fumurate is a disease-modifying agent. It is a capsule you take twice a day. Taking it with food will decrease the side effect of .
Fingolimod is a disease-modifying agent. It comes as a once-daily capsule. Fingolimod is effective for reducing the relapse rate in patients with Relapsing-Remitting MS. Because it can cause an abnormally , you will take the first dose in a setting where a doctor can monitor your heart for six hours.
Glatiramer acetate is a synthetic protein that acts as a disease-modifying agent. It is a once-daily injection that goes under the skin . You will learn to give yourself these injections.
Teriflunomide is a disease-modifying agent. It comes as a tablet you usually take once daily.
Fuel Your Body With High
Theres no specific diet for MS, but the NMSS recommends following a healthy diet thats low in fat and high in fiber. According to the NMSS, the foods you choose to eat affect your energy levels.
Consuming simple carbohydrates such as sugary foods and highly refined foods such as white bread, white rice, or pasta can cause blood sugar levels to spike and crash. The crash can exacerbate preexisting fatigue in persons with MS, explains Barbara Giesser, MD, neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint Johns Health Center in Santa Monica, California.
How can you avoid this? Regularly choosing high-quality foods can help, says Dr. Giesser. Good options include:
- Protein-packed options, like beans, nuts, and lean animal proteins
- Fiber-rich foods, like oatmeal, brown rice, and high-fiber breakfast cereals
- Fresh fruit and leafy green vegetables
- Fat-free or low-fat yogurt
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Importance Of Observational And Comparative Effectiveness Studies
Advances in neuroimaging and paraclinical data have important implications for research in MS, as these data can further delineate disease status. One observational cohort study compared MRI imaging data in 78 MS patients grouped by higher efficacy or lower efficacy DMTs. Patients on higher efficacy DMTs were found to have slower rates of subcortical atrophy, specifically in the thalamus and putamen . Other recent studies have demonstrated a more robust impact on decreasing neurofilament light chain levels and lessening the rate of ganglion cell inner plexiform layer loss on optical coherence tomography with natalizumab compared to interferons and/or glatiramer acetate .
Two pivotal clinical trials currently taking place aiming to answer this question regarding treatment paradigms are the TREAT-MS trial and the DELIVER-MS trial. The primary endpoint in TREAT-MS is time to sustained disability progression, while the primary endpoint in DELIVER-MS is normalized whole brain volume loss. Table Table11 provides an overview of the study design and outcomes for TREAT-MS and DELIVER-MS clinical trials.
Complementary And Alternative Therapies For Ms
Some people with MS find that complementary therapies help them feel better.
Many complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are.
Many people think that complementary treatments have no harmful effects. But people can occasionally experience problems, and it’s not a good idea to use them as an alternative to medicines prescribed by your doctor.
If you’re considering using an alternative treatment alongside your prescribed medicines, it’s important to let your doctor know your plans.
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A Little More Strength To Carry The Weight
In my experience, it’s not like you take a pill and, just like that, no more fatigue until the pill wears off. When I take my medication, the fatigue is still there, but it becomes easier to work through it kind of like how cold medication doesn’t eliminate a cold, but it may help reduce the symptoms of one. If you think of fatigue like the weight of a huge boulder on your back that you have to walk around with, I would say that these medications don’t really remove the weight of the boulder but instead give you a little more strength to carry it. The heaviness in my body caused by my fatigue is always there, but these medications make it a little less difficult to not be crushed by it. At least that how it feels to me.
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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What Are Some Medical Treatments For Ms
In general, if possible, it is good to avoid using medications. People with MS often take several medications. Limiting the number of medicines is good medical practice. It is also important in reducing costs. However, if fatigue continues to interfere with activities, medications may be useful. These medications may include:
Last reviewed by a Cleveland Clinic medical professional on 01/28/2019.
Speech And Swallowing Difficulties
A speech and language therapist can help you find ways to overcome problems with speech and swallowing.
For example, they can offer advice about foods that are easy to swallow and recommend exercises to strengthen the muscles used in speech and swallowing.
If swallowing problems become very severe, some people need to be fed using a tube, which is fitted into the stomach through the skin.
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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.
Extreme Fatigue Activity Tracking
MS fatigue is one of the diseases most distressing symptoms.
The greatest news is that employing energy-saving techniques and making lifestyle changes can relieve fatigue. Changes in your way of life might assist to alleviate symptoms. It can also help to prevent flare-ups and the worsening of symptoms. Your coping skills and attitude toward your illness can also aid in the management of MS.
Stress can exacerbate MS symptoms and make you feel even more tired. Exercise strengthens walking muscles. In persons with MS, it also reduces tiredness, enhances mood, and improves the quality of life. Each week, an MS exercise regimen includes 150 minutes of activity. Walking or swimming are examples of activities that get your heart beating.
Work out at your own speed and on your own terms. Stretch for at least 10 minutes every day to loosen up your muscles.
CareClinics activity tracker allows you to identify any acts that caused, increased, or eased your symptoms. You can hold yourself accountable for achieving your goals.
The platform includes tools such as reminders, reports, and trackers to help you keep track of your resolutions. You can enter the sorts of workouts you plan to conduct in the activity screen of the Check-in section.
The platform also allows to track calorie intake. If your doctor has advised particular physical therapy or exercises, here is a fantastic spot to keep track of them and remind yourself to stick to a schedule.
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What Does It Mean For A Fatigue Medication To Work
Now do keep in mind, this is all based on my own experience with these medications. I am 100% sure that not everyone will totally agree with everything I have to say because we are all different. I’ve said it a million times before and I’ll say it at least a million more times what works for one doesn’t work for all. If it did, we probably wouldn’t have such a large assortment of medications to choose from. As well, if you are thinking about starting one of these medications for the first time , I think it’s important to start one with the right expectations. Ask yourself, what does it mean for a fatigue medication to “work”?
How Amantadine Works
Amantadine acts directly on the central nervous system and helps stimulate the production of dopamine, a neurotransmitting chemical similar to adrenaline. Dopamine affects a structures in the brain collectively known as the basal ganglia, which help regulate movement, emotional response, and the ability to experience pleasure and pain.
The mechanism of action in terms of how it specifically improves MS fatigue is still not entirely understood.
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What Is Metformin
So, now to the matter in hand. Metformin belongs to a class of drugs called biguanides, used in the treatment of type II diabetes because it changes the way in which the body stores and releases glucose by mimicking the natural processes involved in fasting. This is the key concept behind this study would OPCs reactivate and make more myelin in a fasted state?
In this rat model, mature animals were fed metformin in their drinking water for 3 months, and then given an injection that caused focal demyelination essentially causing rat MS. The metformin was then continued and the responses observed. In those rats given the treatment, there was significantly more remyelination than in those that were exposed to the MS injection without being given metformin. They effectively demonstrated that metformin could reverse the ageing effect on OPCs and induce remyelination.
Interestingly, the team found almost identical results in terms of remyelination when the rats were put through a regimen of alternate day fasting meaning that they were severely calorie restricted every other day for 6 months.
What Does It Mean
The design of the study reduced the likelihood that participants could guess which drug they were currently taking in studies which compare a single fatigue drug with placebo, side effects can allow participants to recognise when they are taking the active treatment, and this can influence the results. The study was carried out at two study centres, with a relatively small group of people, and participants took each treatment for six weeks. Results might differ in other places, with longer-term use of medicines or a larger study.
Overall, the results of this study suggest that none of the medications is more effective than placebo at reducing fatigue levels. However, there was some indication that modafinil and methylphenidate could be beneficial if daytime sleepiness is a significant contributor to fatigue levels.
The researchers concluded that the lack of effect on fatigue levels compared to placebo, and the increased risk of side effects, do not support the routine use of amantadine, modafinil or methylphenidate for treating fatigue in MS.
Nourbakhsh B, Revirajan N, Morris B, et al.Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial.Lancet Neurol. 2021 Jan 20:38-48.Full article
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What Does Ms Fatigue Feel Like
MS fatigue is one of the most unpleasant symptoms of the disease. Fatigue can be a major symptom of active inflammatory illness, or it can be a secondary sign of other medical disorders, heat, drugs, stress, depression, and sleep issues. MS fatigue may be terrible, and it can interfere with job and family life, mental and physical health, and social and recreational activities for some people. The greatest news is that adding energy-saving techniques, making lifestyle changes and using medications prescribed can relieve fatigue. Its crucial to rule out other reasons for the exhaustion that arent connected to MS, such as anemia or thyroid problems.
Why am I so Tired all the Time?
Many contributing factors change with an MS diagnosis and fatigue cannot direct to a particular cause. Some of the common reasons are the following:
A Diagnostic Approach To Fatigue
An open ended question, followed by a series of more focused inquiries will often prove to be a productive approach. This should be followed by screening for other confounding conditions such as sleep disorders or depression. A systematic approach to the assessment and treatment of fatigue in patients with MS is summarized in .
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Muscle Spasms And Stiffness
Muscle spasms and stiffness can be improved with physiotherapy.
Techniques like stretching exercises can help if your movement is restricted.
If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles.
This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.
These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which of these would be best for you with your specialist MS nurse or GP.
If these medicines are not effective, you may be offered a 4-week trial of nabiximols . This is a cannabis-based medicine sprayed into the mouth. Read about medical cannabis.
Exercise Can Boost Energy
Certain types of easy exercise, such as gardening and yoga , have been shown to boost energy levels, reduce stress, improve joint range of motion, help manage spasticity, and increase strength. Because of its natural buoyancy, water allows many men and women with MS to perform exercises they cannot do outside of the pool. Water exercise helps increase flexibility, strengthen the upper and lower extremities and trunk, improve ambulatory skills, increase coordination and balance, and condition the overall body to raise endurance levels and lessen fatigue.
For more information on the benefits of aquatic therapy and aquatic exercise for individuals with MS, please see the Health and Wellness column from the Summer/Fall 2012 issue of The Motivator. This may be found on MSAAs website at mymsaa.org/publications/motivator/summer-fall12/health
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Medications For Ms Relapses
While many relapses go away on their own, more severe relapses require treatment.
Inflammation causes MS relapses, and its typically treated with corticosteroids. These drugs can reduce inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:
If corticosteroids dont work, your doctor may prescribe corticotropin .
Corticotropin is an injection, and its also known as ACTH gel. It works by prompting the adrenal cortex to secrete the hormones cortisol, corticosterone, and aldosterone. The secretion of these hormones helps to reduce inflammation.
Lifestyle Changes To Cope With Ms Fatigue
If you’re suffering from MS-related fatigue, it’s important to see your doctor first to pinpoint the causes of your fatigue. Fatigue is often related to MS symptoms and medical conditions that need treatment. However, there are also a few simple lifestyle changes that can help you cope with fatigue.
Embrace the nap. Used appropriately, napping can help give you a real energy boost. The ideal nap lasts 10-30 minutes. It should be a time for quiet rest. Even if you don’t fall asleep, the rest will still help recharge you. You can nap up to three times a day. Talk to your doctor or occupational therapist about the best nap schedules for you napping shouldn’t get in the way of a good night’s sleep.
Keep cool. Hot temperatures can make fatigue worse. Talk to your doctor or occupational therapist about ways to beat the heat. Having a cool drink, staying in the shade, taking breaks when you get overheated, and using air conditioning can all help you stay cool and refreshed.
Exercise. Does the thought of exercise make you feel exhausted? Believe it or not, exercise can actually help you feel less tired and give you more energy. Check with your physiotherapist to find the exercise that’s right for you, and inform your doctor before starting any new exercise program.
Prioritize. We only have so much energy. Don’t waste time and energy on things that aren’t really important to you. Focus on the things that matter, and schedule them for times when you have the most energy.
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Find Out More About Managing Fatigue
Fatigue is believed to be the most common symptom in MS and it can often have a major impact on people’s lives. The causes of fatigue in MS are not well understood and it is thought to be a combination of factors. It can be caused by the MS itself, through ‘short-circuiting’ nerves and it can be caused partly by other factors, including heat, inadequate diet, poor fitness and stress. As there are several causes of fatigue, there are also a number of ways that it can be managed and its impact reduced. Most management techniques revolve around ensuring the best levels of energy are available and then using the energy in the most efficient way.