FATIGUE is the most common MS symptom—experienced by 75 to 95% of people with the disease. Approximately 50 to 60% of people with MS describe fatigue as one of their most troubling symptoms, regardless of their disease course or level of disability. The Social Security Administration recognizes fatigue as a significant cause of unemployment among people with MS.

Fatigue was recently defined by the Fatigue Management Panel of the Multiple Sclerosis Council on Clinical Practice Guidelines as:

A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities.

RECOMMENDATIONS

Based on clinical experience and careful review of the medical literature and research findings pertaining to MS-related fatigue, the Medical Advisory Board of the National MS Society makes the following recommendations:

• Because of the complexity of MS-related fatigue, the first step in effective treatment is to identify the cause(s) of the fatigue (e.g., any combination of factors, including co-existing medical illnesses, side effects of medications, depression, disrupted sleep, and fatigue caused by the MS itself.

• Once the source(s) of the fatigue have been identified, the treatment of MS-related fatigue is approached in a step-wise fashion in order to address all contributing factors.

The treatment of fatigue should include TWO major steps:

1. Management and elimination of any secondary causes of fatigue

• Treatment of any co-existing medical conditions (including depression) that are causing fatigue.

• Adjustment of any medications that may be producing excessive fatigue and/or sleepiness. Many common medications, including anticonvulsants, antihistamines, anti-hypertensives, sedatives, and certain antidepressants, have fatigue and/or sleepiness as a side effect.

• Management of any conditions or symptoms that interfere with sleep (e.g., sleep apnea, leg spasms, depression, MS symptoms such as bladder dysfunction, spasticity, or pain). Research indicates that 25 to 35% of people with MS experience disturbed sleep, which may contribute significantly to daytime fatigue.

• Management of any MS symptoms that may be producing additional fatigue. Symptoms such as weakness, spasticity, and ataxia may significantly increase the amount of exertion needed to carry out daily activities.

• Education about energy effectiveness strategies—defined as “the identification and development of activity modifications to reduce fatigue through a systematic analysis of daily work, home, and leisure activities. . . .” These strategies are frequently taught by a nurse or rehabilitation specialist (e.g., occupational and/or physical therapist).

• Appropriate rest to activity ratio

• Use of assistive devices to conserve energy (motorized scooters are particularly useful for ambulatory people who experience fatigue when walking)

• Environmental modifications to make activities more energy-efficient

• Cooling strategies to avoid the fatigue caused by elevations in core body temperature due to heat, exercise-related exertion, and fever

• Regular aerobic exercise, geared to the person’s ability, to promote cardiovascular health, strength, improved mood, and reduce fatigue

• Stress management techniques

2. Treatment of primary MS fatigue