Poor Coordination Or Incoordination
Poor coordination in MS results from cerebellar involvement and can be one of the most disabling symptoms of MS. It often co-exists with tremor, and balance difficulties. Errors in rate, range, direction, and force of movement are characteristic in these cases, making the simplest of daily activities like walking, pouring liquids, eating, and personal hygiene very difficult.
ManagementWalking aids, home safety assessment with focus on bathroom, kitchen and stairs.
Key Healthcare Professionals: Neurologist, occupational and physical therapists.
How Can I Manage My Fatigue
There are different ways in which you can manage your fatigue to reduce its impact on daily life and you can continue to do the activities you love.
We run regular online Fatigue Management Programmes. These used to take place at the Centre but have moved online due to the current pandemic. Running for 6 weeks they give practical advice on how you can manage your fatigue and still have the energy for the things you love doing.
We also have short tips on managing fatigue below.
If you feel you would benefit from our help and advice, or you have any questions regarding your fatigue, or the energy levels of someone you care for, please contact on.
Clinical Aspects Of Ms
In clinical practice, the first step is to investigate whether there is an underlying cause or trigger for the fatigue, which needs to be treated before starting any specific treatment for it. Causes and triggers of fatigue may be related to MS, such as pain, night spasms and urine dysfunction, which can lead to sleep disturbances and increased tiredness, or being unrelated to MS, as it is described in Table .
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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 Due To Disrupted Sleep
MS causes a variety of symptoms that disrupt sleep. Muscle spasms, pain, bladder problems and breathing difficulties can all affect sleeping patterns.
Usual treatment
The solution to this type of fatigue lies with identifying why the sleep is being disrupted and treating the underlying problem. Your GP or neurologist can help with this.
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Tip : Regulate Your Sleep
Sleep problems are often behind the fatigue that people with MS experience.
Whether you have trouble falling asleep, staying asleep, or getting the amount and type of sleep you need to awaken feeling refreshed, the result is the same: You feel tired.
To help prevent these problems, its important to regulate your sleep. This might involve identifying and treating other MS symptoms that cause sleep problems for example, urinary dysfunction.
If all else fails, you can talk with your doctor about using sleep medications for a short period of time.
Fatigue: Applying Cognitive Behavioural And Energy Effectiveness Techniques To Lifestyle
This 6-week group-based manualised fatigue management programme combines cognitive behavioural and energy effectiveness approaches. The aim of the programme is to help people normalise their fatigue experiences, learn helpful ways of thinking about fatigue and use their available energy more effectively. It is delivered in groups of 612 people by two health professionals with experience of MS-fatigue, of facilitating group-work and an awareness of cognitive behavioural principles. Further detail can be found elsewhere.
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Fatigue Due To Poor Nutrition
Poor diet and dehydration can contribute to fatigue, as the body does not have the neccesary nutrients to provide energy.
Usual treatment
Foods that combat fatigue include complex carbohydrates and foods rich in potassium, iron and vitamins B and C. You should also maintain an adequate intake of liquids. A dietician can provide specialist advice on nutritional needs. This is particularly important if you also have bowel problems.
Krupp’s Fatigue Severity Scale
Many studies of MS-related fatigue have used the Fatigue Severity Scale to identify fatigued patients. Initially designed to identify common features of fatigue in both MS and lupus patients, the Fatigue Severity Scale assesses the impact of fatigue on multiple outcomes, with a physical focus. Each of 9 responses is provided on a 7-point Likert scale. Prior studies have shown acceptable internal consistency and stability over time, and sensitivity to change afforded by clinical improvement. The Fatigue Severity Scale has been shown to differentiate between subgroups of patients with MS, chronic fatigue syndrome, and primary depression. Moreover, the scores correlate with other scales commonly used in MS, including the Modified Fatigue Impact Scale and Fatigue Descriptive Scale.
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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.
Medical Panel Prescribes Fatigue Journaling And Symptom Management To Fight Ms Fatigue
- Fatigue is common in a variety of chronic conditions, including multiple sclerosis .
- People with MS can practice self-management strategies to help conquer fatigue, including creating a fatigue journal, addressing sleep issues, and dealing with underlying symptoms like depression.
An estimated 80 percent of people living with multiple sclerosis experience fatigue, which can interfere with work, school, and tasks of daily life. However, there are several lifestyle strategies for tackling this symptom. Experts from across the MS care spectrum shared advice on this topic during the International Progressive MS Alliances Nov. 9 webinar, Fatigue in Progressive MS.
Usually, fatigue is described as this overwhelming feeling of tiredness or exhaustion its not specific to MS, and may occur in other chronic conditions as well, said Dr. Jaume Sastre-Garriga, a neurologist at The Multiple Sclerosis Centre of Catalonia, in Barcelona, Spain, during the event. It can be one of the most common and also disabling symptoms in multiple sclerosis.
Dr. Sastre-Garriga noted that people with MS may face a stigma due to the fatigue that they experience. In fact, others might consider them to be lazy when they are truly feeling fatigue due to their MS. Being fatigued by MS is not being lazy. Fatigue is a symptom that needs to be tackled in the best way we can, he said.
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Experts Recommend Both Physical Activity And Cognitive Behavioral Therapy
byKate Kneisel, Contributing Writer, MedPage Today December 6, 2021
Fatigue is one of the most common symptoms of multiple sclerosis , affecting as many as 80% to 90% of patients, and is considered the most troublesome MS symptom by 40% of patients. Characterized as a feeling of extreme mental or physical exhaustion, MS-related fatigue is noted for its detrimental effects on quality of life, daily activities, and work, independent of disease-related physical disability and depression.
Studies have suggested that significant fatigue may occur during the 5- to 10-year prodromal period now generally thought to precede an MS diagnosis, and may be misdiagnosed as chronic fatigue. Of 300 patients with relapsing-remitting MS in a survey study, 52% had experienced fatigue before their MS diagnosis.
“Lassitude or ‘MS fatigue’ is different from other types of fatigue in that it comes on easily and suddenly, often is more severe than normal fatigue, and is more likely to interfere with daily responsibilities. It generally occurs on a daily basis, with no explanation or trigger, and tends to worsen as the day progresses,” Julie Fiol, RN, MSCN, of the National MS Society, told MedPage Today.
“We identified a fatigue network of interconnected areas of the brain — generally the same as that observed in traumatic brain injury, Gulf War illness, and MS,” DeLuca said. “If we have a biomarker associated with self-reported fatigue, that is a major finding.”
Disclosures
Multifaceted Approach To Fatigue Management
Fatigue management strategies were often used in combination, underlining the need for a multifaceted approach towards fatigue management for example, the person below describes how they have modified their expectations and values and how this has enabled them to use fatigue management tools such as delegation and pacing:Working full time means I only have the weekend to clean top to bottom. Before I attended the programme it had to be done all in one go, now I delegate some of the cleaning to others in the house or spread the cleaning over two days.
Respondents comments illustrated the links between attitudes/expectations, behaviours and emotions:The course made me realise I didn’t have to feel guilty for not being able to do everything I used to do. I’ve learnt to say no. I’ve slowed down and am able to lie down in the afternoon and relax.
Fatigue management was described as an ongoing process that would not be achieved overnight and a process that could be revisited:Now that things have settled down I am going to revisit the whole programme over the coming months and start to work in more of the techniques.
For some a significant aspect of the FACETS programme was the confirmation that MS-fatigue is different from normal tiredness and a major symptom of MS. People described increased awareness about the causes of fatigue and possible strategies for reducing its impact:I was surprised to find that exercise reduced my fatigue and also environmental changes .
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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.
Tip : Manage Your Medications
If youre taking medications for other symptoms, check their side effects to make sure they arent adding to your fatigue.
Talk to your doctor about each medication you take and work together to determine whether you can stop taking those that can cause fatigue.
In terms of medication to help ease fatigue, your doctor can help you decide whats right for you.
While some medications can help with fatigue management, the Cleveland Clinic advises against using medications to treat tiredness.
This is because you may already be taking other medications for your MS, and its best to limit the number of drugs you take when possible.
However, everyones MS symptoms are different. If you try the tips in this article and nothing works, there are medication options to help reduce fatigue.
They include amantadine and modafinil , two drugs used off-label.
Theyre still being studied as a treatment for MS fatigue, which means your insurance may not cover them for this purpose. For more information about these drugs, talk to your doctor.
OFF-LABEL DRUG USE
Off-label drug use means a drug thats FDA approved for one purpose is used for a different purpose that it hasnt yet been approved to treat.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients.
So, your doctor can prescribe a drug however they think is best for your care.
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Limitations Of The Evidence
There were several important limitations that affect the overall quality of evidence. First, only two studies used fatigue as a primary outcome measure,, and of these studies, only one recruited participants with clinically significant levels of fatigue . Therefore, there is limited evidence of the effect of interventions specifically designed to manage fatigue in people with clinically significant levels of fatigue.
In addition, seven different fatigue outcome measures were used in this review, limiting the ability to directly compare results between studies. Although a meta-analysis of exercise interventions demonstrated that the selection of fatigue outcome measures did not moderate the effect of interventions, there is a need for core fatigue outcome measures to enable pooling of statistical data for meta-analysis and comparison of effects between studies. In addition, MCID has been determined only for the FIS. Therefore, the MCID of the MFIS and FSS should be determined to establish the clinical significance of changes in fatigue severity and impact.
A Different Kind Of Tired
Before learning how to beat fatigue, its useful to understand the types of fatigue you may face when you have MS.
Researchers have started to identify a number of distinct characteristics specifically associated with MS. They define it as quite different from garden-variety tiredness:
- Onset: It can begin suddenly.
- Frequency: It often occurs every day.
- Time of day: It can occur in the morning, despite having slept the night before.
- Progression: It commonly worsens throughout the day.
- Sensitivity to heat: Heat and humidity may aggravate it.
- Severity: It tends to be more severe than other types of fatigue.
- Effect on activities: Its more likely than regular fatigue to disrupt your ability to perform everyday tasks.
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Behavioral And Educational Interventions
Several published reviews and studies have examined the effectiveness of various types of behavioral and/or educational interventions for management of fatigue in pwMS, which included group fatigue management programs, energy conservation programs, and psychotherapies . A meta-analysis investigated overall effectiveness of different types of educational programs on reducing the impact or severity of self-reported fatigue in pwMS . The authors included eight RCTs, involving 662 pwMS. Educational interventions included a fatigue management program, energy conservation programs, mindfulness interventions, and CBT. The authors found significant global improvement with a large pooled treatment ES for the educational interventions of 0.54 .
Limitations Of The Review
There were many other studies that investigated the effectiveness of fatigue management interventions in people with progressive MS however, these studies were excluded because the results for people with progressive MS could not be specifically identified. In addition, the overall quality of evidence in this review is limited by the inclusion of quasi-experimental studies, which are less methodologically rigorous and introduce risk of selection bias. Furthermore, due to the inclusion of quasi-experimental studies and the heterogeneity in outcome measures and interventions used between studies, it was not feasible to conduct a meta-analysis, and results were generated by narrative synthesis.
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Strengths And Limitations Of This Study
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This study was nested within a large pragmatic multicentre randomised controlled trial undertaken in the UK.
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It provides valuable insights into experiences of a complex group-based fatigue management intervention designed for people with multiple sclerosis .
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Resource constraints meant that we were limited to a postal semistructured questionnaire rather than conducting interviews or focus groups. However, this might have reduced the likelihood of demand characteristics.
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Eighty-two per cent of the 72 participants who attended 4 or more sessions of the Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle programme completed the Fatigue Management Strategies Questionnaire .
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The FMSQ was administered 4months following the FACETS programme so we do not have information about participants use of fatigue management strategies in the longer term.
Get Help For Depression
If you are feeling down and hopeless, or if things that used to be enjoyable dont interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.
Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.
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How Is Ms Fatigue Different To Ordinary Fatigue
MS fatigue is more than the tiredness that everybody feels after exertion or missing a good nights sleep. This type of tiredness can still affect you, but MS fatigue goes beyond that.
MS fatigue can be physical and mental it saps energy in an instant and can stop you from completing tasks. MS fatigue can be very debilitating and, unlike ordinary fatigue, it can take a long time to recover from.
MS fatigue is often overwhelming. It can happen at any time without warning or without any apparent reason. Some people say they experience MS fatigue after gentle activities such as writing or reading and they immediately need to rest.
Others say that MS fatigue happens after physical exertion, such as taking the dog for a walk or doing the shopping. For others, MS fatigue can happen after cognitive exertion such as working on the computer and completing mentally-demanding tasks. You may also experience MS fatigue when you wake up, in some cases every day, even after a good nights sleep.
