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Fatigue
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How are patients with Multiple Sclerosis affected by fatigue?
Fatigue is one of the more common symptoms of MS, occurring in up to 80% of people. Patients with MS rank fatigue as one of the symptoms that most impairs their quality of life. In MS, fatigue is a chronic condition that can be accompanied by neurological exacerbations (relapse/flare ups) or no change in the neurological symptoms.

What makes Multiple Sclerosis fatigue different?
Several different kinds of fatigue occur in patients with Multiple Sclerosis. Possible contributing factors are:

• Relapse/Flare up of MS symptoms due to inflammation in the central nervous system
• Medication (many medications carry fatigue as a side effect)
• Sleep disturbances (e.g., bladder dysfunction and nocturnal spasms)
• Depression
• Concurrent illness (e.g., infection)
• Level of activity
• Heat
• Lifestyle patterns (e.g., diet, exercise/deconditioning)
• Psychosocial issues
• Pain (e.g., spasms, tingling)
• Effortful movement (e.g., tremors, balance or changes in walking)

In addition to the other sources of fatigue, researchers have identified another kind of fatigue. This so called "MS fatigue" is different from fatigue experienced by persons without MS.

MS Fatigue:

• Generally occurs on a daily basis
• May occur early in the morning, even after a restful night’s sleep
• Tends to worsen as the day progresses
• Can be aggravated by heat and humidity
• Left untreated, will continue to worsen over time
• Is generally more severe than non-MS fatigue
• Is more likely to interfere with daily responsibilities

MS-related fatigue does not appear to be linked to the degree of physical impairment from MS or depression. The exact cause of fatigue in MS is unkown. Since there are many factors that can affect MS-related fatigue, the origin of fatigue should be determined so that appropriate treatment can be administered.

How is fatigue in MS patients treated?
Fatigue should be evaluated by a physician so that all other conditions such as depression, thyroid disease, anemia and side effects of medications can be ruled out. A complete evaluation will help identify the factors contributing to fatigue and an individual treatment plan can be developed.

Tips for dealing with fatigue include:
• Occupational therapy to simplify tasks at work and home.
• Physical therapy to develop an exercise program, tips for energy saving walking techniques and performing other daily tasks.
• Psychological interventions such as therapy, relaxation training, stress management or membership in a support group.
• Sleep regulation, which might involve treating other MS symptoms that may interfere with sleep (e.g. urinary problems, pain, and spasticity) and using sleep medications as needed on a short-term basis.
• Heat management which may include strategies to avoid overheating and keeping cool.
• Medications such as amantadine hydrochloride and modafinil (Provigil®) may be prescribed. Other medications may also be considered. While these medications are not approved specifically by the US Food and Drug Administration (FDA) for the treatment of MS related fatigue, each has shown some benefit in clinical trials.

Additional tips to practice
• Pace yourself – Try to break down an activity into smaller tasks and rest when needed.
• Plan Ahead – Prioritize activities in all areas of your life.
• Eat Right – Don’t skip meals and eat a balanced, healthy diet. Drink plenty of fluids and avoid large amounts of caffeine.
• Take advantage of services such as having prescriptions or groceries delivered and hiring someone to assist with house cleaning.
• Use labor saving devices such as reachers, handgrips and long shoe horns
• Exercise – Light to moderate exercise can be very beneficial for people with MS. Swimming in cool water and yoga are suggested activities
• Get plenty of rest.
• Medications – Take your medications as prescribed by your doctor.
• Communicate with your healthcare provider.