What Is Multiple Sclerosis
Multiple sclerosis is an inflammatory autoimmune disorder that affects the central nervous system, which consists of the brain and the spine. The CNS regulates all the bodily functions, processes sensory information and enables appropriate neuromuscular responses to them.
In multiple sclerosis, an abnormal immune system attacks healthy nerve cells, causing inflammation and lesions in the brain and spine. The immune system primarily attacks myelin, a fatty substance which insulates nerve fibers and helps in conduction of electrical signals.
Axons are long hair-like projections from nerve cells , which transmit signals between nerve cells. Damage to myelin and axons disrupts communication between nerve cells and leads to various neuromuscular disabilities, depending on the CNS region affected.
Multiple Sclerosis Types
The course of multiple sclerosis and its symptoms are unique to each individual. Multiple sclerosis is considered active if relapses occur, with evidence of lesions in MRI tests, over a specific period of time. MS is also characterized as worsening or non-worsening, depending on whether disabilities increase or remain stable after relapses.
Multiple sclerosis is categorized into the following four types, based on clinical characteristics, frequency of relapses and time taken for lesion development and disease progression.
Two subtypes that may be grouped under RRMS are:
Secondary progressive MS
Primary progressive MS
Side Effects Of Disease
Eligibility for some MS medications depends on whether you test positive for a common virus called the John Cunningham virus , which can cause serious side effects. Depending on which MS treatment youre on, you may need to undergo regular blood tests for JCV while taking it and switch to a different treatment if your JCV levels become too high.
Because DMTs suppress aspects of the immune system, many of these MS treatments can increase your risk of contracting infections and, in rare cases, developing certain types of cancer. Each MS treatment has specific side effects and different risk levels. Your doctor can help you understand the risks and benefits of each MS medication based on your medical history and individual condition.
Medications Used To Treat Ms
Medications used for the treatment of fatigue can be helpful but are usually not the magic answer to curing fatigue.
Neurologists sometimes prescribe drugs such as the following to MS patients who need to manage fatigue:
Talk to your healthcare provider about whether one of these medications would be useful for you. It’s also important to understand that there are different strategies for taking these medications. It’s not an all or nothing deal.
For instance, a person with MS may only take their Provigil if they know they are going to have a long, grueling day. Another person may rely on daily Ritalin to manage fatigue.
These medications also have side effects, such as cardiovascular ones, which may not be safe for you.
You May Like: Can Fatigue Cause Low White Blood Cell Count
Weighing Decisions About Stimulants
All medications carry the risk of side effects. Determining whether the possible risks are worth the potential benefits is a complex decision-making process that factors in many variables. Make your neurologist your partner, and work closely with them to weigh the risks and benefits of adding a stimulant to your MS treatment regimen.
To avoid dangerous drug interactions, make sure all your health care providers and your pharmacist are up to date on the medications you take including over-the-counter remedies and nutritional supplements for each health condition.
Work Closely With Your Ms Healthcare Providers
Make and keep regular appointments with your doctor to assess whether your disease is under the best control possible and youre receiving optimal MS treatment.
In many cases, when MS is well-controlled, it can help in terms of fatigue levels, says Devon Conway, MD, a neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Ohio.
Don’t Miss: Can Fatigue Be A Sign Of Cancer
How Is Fatigue Related To Multiple Sclerosis
Fatigue is the most common symptom of multiple sclerosis . It occurs in 75 percent to 95 percent of patients with MS. Fatigue can occur at all stages of the disease. The symptom is not related to the severity or to the duration of MS. At times, fatigue interferes with function and is an important symptom to manage. There are a variety of ways to combat fatigue in MS.
How Is Ms Fatigue Different From Normal Fatigue
Fatigue in MS is different in many ways from the tiredness people may experience as the result of a long day at work or a late night out. Fatigue is also different from sleepiness, although staying in bed may be the only thing that seems to help at times. According to the National Multiple Sclerosis Society, people with MS commonly experience fatigue that persists daily, even after plenty of sleep, and worsens as the day goes on.
When fatigue affects people with MS in these ways, it may also be referred to as lassitude. MS fatigue is typically more severe than normal fatigue, and may interfere with work, school, and tasks of daily life. In fact, MS fatigue is a primary reason people with MS have to reduce work hours or stop working altogether.
Recommended Reading: Strongtek Anti Fatigue Balance Board
How Can People Use The Results
Patients with MS and their doctors can use these results when considering ways to treat fatigue.
|How this project fits under PCORIs Research PrioritiesPCORI identified multiple sclerosis as an important research topic. People with MS, clinicians, and others wanted to learn how different treatment strategies, aimed at changing specific symptoms or the overall course of MS, affect patients symptoms and quality of life. To address this issue, PCORI launched an initiative in 2015 on Treatment of Multiple Sclerosis. The initiative funded this research project and others.
What Causes Ms Fatigue
Scientists currently dont fully understand the exact cause of MS-related fatigue. Some think that fatigue may be related to the constant activation of the immune system, sort of like having the flu virus at all times.
Others theorize that fatigue is related to the need for the brain to work harder in people with MS.
MRI scans have shown that people with MS fatigue use a larger area of the brain to perform tasks than people without fatigue. In response to nerve damage, the brain of a person with MS may be finding new routes for sending messages. This is thought to take more energy.
The feeling of fatigue may also be a result of the muscle weakness associated with MS.
Certain complications of MS can also induce fatigue. This may be referred to as a secondary cause. Complications of MS that may also cause fatigue symptoms include:
Fatigue can also be a side effect of certain medications, such as those used to treat spasticity, pain, and bladder dysfunction.
Don’t Miss: What Helps Rheumatoid Arthritis Fatigue
How To Treat It
If youre experiencing fatigue, make an appointment with your doctor to discuss possible treatment options. A doctor will likely want to run some tests to find out more about what may be causing your fatigue.
Based on the results of these tests, your doctor may prescribe medications or recommend counseling, physical therapy, and occupational therapy.
What Does It Feel Like
Not everyone experiences fatigue the same way, and the feeling can be difficult to explain to others. In general, there are two types of MS fatigue: a general feeling of extreme tiredness and muscular fatigue.
MS fatigue is different from regular tiredness. Some people with MS describe the fatigue as feeling like youre weighed down and like every movement is difficult or clumsy. Others may describe it as an extreme jet lag or a hangover that wont go away.
For others, fatigue is more mental. The brain goes fuzzy, and it becomes difficult to think clearly. Fatigue may affect the eyesight, as well as your ability to speak without slurring your words.
MS fatigue is also distinguished by the following characteristics:
- occurs on a daily basis
- often occurs in the morning even after a good night of sleep
- tends to worsen as the day progresses
- is aggravated by heat and humidity
- may come on suddenly
People with MS fatigue may need to recharge their batteries with frequent rest and a short daily nap, but its also possible to plan and schedule your daily activities to help conserve energy.
To conserve energy, try these tips:
While conserving energy is important, too much rest can be counterproductive. Exercising daily is essential for maintaining muscle strength and building endurance. Try these exercises and activities for MS.
There are several other lifestyle changes and remedies that can help you battle fatigue. These include:
Also Check: How Long Can Post Stroke Fatigue Last
Take Breaks And Pace Yourself
Pacing yourself and taking breaks during the day can help you stay healthy, says Wentink.
When Im drained and continue to push, I think Im putting myself at risk for getting sick, he says. When I feel fatigued, I take it as a sign that I need to step back and take a break.”
Symptoms tend to get worse when severe fatigue sets in, says Wentink. I try to slow down before that happens because I dont want to bring on a relapse, he adds.
Tips To Conserve Energy
Use Adaptive Aids.Reachers, dressing aids, and other adaptive equipment can significantly help conserve energy when dressing, bathing, and performing other household and personal activities. Many of these items may be obtained through MSAAs Equipment Distribution Program . Please visit mymsaa.org or call 532-7667 for more information.
Shop from Home.Rather than using valuable energy walking around stores, use catalogs or order items online. In addition to avoiding the crowds and exhaustion from walking through stores or malls, ordering clothes allows you to try them on at your leisure when your energy level is highest. Many grocery stores also offer online ordering with either free delivery or a minimal charge for delivery.
Take Fewer Steps.Try to take care of as many things as possible in one room to eliminate extra trips.
Consider Telecommuting.A great way to conserve energy is to reduce the amount of time spent traveling to and from work. Ask your employer about working part of the week from home.
Dont Get Overheated.This can cause fatigue. Wear your cooling vest or other cooling apparel and try to go outside either early in the morning or later in the evening, when temperatures are at their coolest.
The following medications, among others, are prescribed for depression. These have been found to help lessen fatigue in certain individuals. Antidepressants may need to be taken for several weeks before seeing an effect.
Don’t Miss: Breast Cancer Fatigue Before Diagnosis
Practice Mindful Movement Such As Yoga Or Tai Chi
Forms of exercise that include some form of meditation and mind-body connection, such as tai chi and yoga, may be helpful for MS fatigue, according to research published in BMC Neurology. And another review published in PLoS One in February 2017 found that tai chi may benefit quality of life among people with MS, but more research is needed to confirm this.
Yoga can be beneficial, as it incorporates mindfulness, stretching, and low-impact exercise, says Conway. There havent been a lot of studies about this, but in my personal experience, it can help, he says.
How Do Multiple Sclerosis Medications Work
Disease-modifying drugs modulate or suppress the immune system in different ways to slow down disease progression and limit disabilities.
Immunomodulators work by blocking the activity of specific cytokines which promote autoimmune reaction and inflammation in MS. Immunomodulators are used for treating relapsing forms of multiple sclerosis , to reduce the frequency of relapses and slow down accumulation of disabilities.
Immunomodulators prescribed for MS may be biologic preparations or synthetic formulations. Each drug works in a unique way to regulate immune activity. All the biologic medications are administered as injections or infusions, while synthetic drugs may be injections or oral formulations.
Following are the immunomodulatory drugs approved by FDA for multiple sclerosis:
- Biologic drugs
Dopamine agonists stimulate the release of dopamine, a chemical messenger in the brain. Dopamine plays an important role in regulating many functions such as pleasure, movement, pain processing and cognition.
Dopamine agonists are FDA-approved medications for Parkinsonâs disease, but used off-label to treat fatigue associated with MS. Dopamine agonist prescribed for MS is:
- Amantadine hydrochloride
Skeletal muscle relaxers
Skeletal muscle relaxers are prescribed to treat muscle stiffness caused my MS. Muscle relaxers used for MS include:
- Dantrolene sodium
Recommended Reading: Upper Back Pain Dizziness And Fatigue
What Drug Treatments Might Help With Ms Fatigue
Some people find that drug treatments help them manage their fatigue.
Although there are currently no drugs licensed in the UK specifically for MS fatigue, certain drugs licensed for other conditions are sometimes prescribed.
If you want to try a drug treatment for fatigue, the 2022 NICE Guideline for MS recommends any of the following that are suitable for you. A neurologist can discuss the potential benefits and risks, and check if its working for you:
Complementary And Alternative Therapies For Multiple Sclerosis
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.
You May Like: Can Lichen Planus Cause Fatigue
Tip : Conserve Your Energy
Energy conservation isnt just important for the environment. Its also a key principle for those with MS.
Whats your best time of day to get things done ?
If you notice that you feel less fatigue in the morning, take advantage of your extra energy to complete tasks such as shopping and cleaning. You can then conserve your energy later when you feel more fatigued, knowing youve already accomplished key tasks for the day.
People with MS may be especially sensitive to heat. As a result, they may experience more fatigue when they become overheated or are in a warmer environment. Try these techniques to cool down:
- Use air conditioning as needed, especially in the summer months.
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.
Don’t Miss: Treatment For Epstein Barr Chronic Fatigue
What Are Multiple Sclerosis Medications
Multiple sclerosis medications are prescribed to treat multiple sclerosis , an autoimmune disorder that affects the central nervous system . A large array of medications and therapies are used to manage multiple sclerosis, which can affect a wide spectrum of neurological functions and cause disabilities.
Multiple sclerosis medications are systemic medications taken orally or administered as injections or infusions. The targets of multiple sclerosis medications are to:
- Prevent or slow down progression of MS and related disabilities
- Reduce duration and frequency of relapses
- Treat acute relapses
- Relieve MS-related symptoms
The primary medications used to treat multiple sclerosis are known as disease-modifying drugs . DMDs modulate or suppress the immune system in different ways to alter the course of the disease and prevent or reduce relapses.
Disease-modifying drugs include both lab-manufactured biological protein formulations and synthetic drugs which work on the immune system. Several types of FDA-approved biologic medications such as interferons, the first type of medications to be approved for MS, and monoclonal antibodies are prescribed for treating multiple sclerosis.
Synthetic immunomodulatory drugs approved by FDA for treating MS include glatiramer, cladribine and teriflunomide. A new class of drugs known as sphingosine 1-phosphate receptor modulators, which include siponimod and ozanimod, are the latest to be approved by FDA to treat MS.
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.
Also Check: Foods To Help Adrenal Fatigue
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.