Tuesday, September 02, 2014

Sunday, February 21, 2010 B.E., Community Member, asks

Q: Why is no one talking about the use of Ritalin and other ADHD meds for MS related cognitive fatigue?

I have been dealing with MS since 4/94.  I suffer fron both physical as well as cognitive fatigue.  I am currently taking Ritalin 20 mgs @ 6A, 1030A & 3P.  This burns off the fog that would normally creep in from my MS.  I can only take the white pills of generic Ritalin (Methyln) as the ones with coloring do on have the same effect.  I have several food allergies that I attribute this to.

 

I am been taking this since they pulled Cylert off the market 4/05.  I started Cylert back in 7/96 with the same results.  Before I started either of these, 2+2 did not make 4.  It would make 3, 5 or even 22 where I could get 2 and 2 together but not actually do anything.  I could not take part in a 3 way conversation as by the time I came up with a response to a statement someone said, they would already be on a different subject. 

 

I am under the care of Dr. Andrew Goodman & Nurse Martha Lightfoot of the Rochester, NY MS Care Center for the past 15 years.  He has been a tremendous help to me to allow me to try new things or areas that other folks would not look to try.  Before I started with Dr. Goodman & Nurse Martha Lightfoot, please note, I was being seen by Dr. Aaron Miller who was the Chief Medical Officer of the NMSS.  His nurse, Nurse Linda Morgante did a little research and had found a study done in Texas looking at Cylert for MS Fatigue.  It took me 2 years of trying to convince Dr. Miller to let me try this.  I have had tremendous success with these meds. 

 

I am wondering why no one is looking at Ritalin for MS cognitive fatigue.  It is sometimes listed on the national site but quickly gets taken off when someone points this out to them.

 

A few links to reputable sites that also talk to the effects of Ritalin on MS cognitive fatigue are as follows:

 

Take, for example, the NMSS Momentum Winter 2007 issue that has a small section in an article on page 70 that states: 
 
My doctor prescribed a drug most often used for Alzheimer's patients, but when it gave me amazing night terrors, she suggested Ritalin, which has enabled me, like people with Attention Deficit Disorder, to focus on the bank statement, dinner, or our holiday newsletter for a few hours. Books, even my growing pile of New Yorkers, now have to wait for vacations, when there are no ringing telephones, burning cookies, or children's homework questions to distract me. 
 
www.nationalmssociety.org/download.aspx?id=9 
 
Also, the Mellon Center at the Cleveland Clinic specifically states on the symptom management page: 
 
Pediatric Multiple Sclerosis (MS) - Symptom Management Cognitive problems Some patients with MS find that they have cog 
nitive problems. This may range from the nuisance of not being able to remember names or ‘where you put things' to more severe problems with organizing your day or being able to function at work or at home. This may occur independently of depression and tends to be more common after years of MS. While there are no specific treatment for this, there are a number of things that can be done to combat this. 
 
At the Mellen center we would evaluate the cognitive problem, and consider testing such as neuropsychological measurement to fully evaluate the cognitive problem. We would review the medications that the patients is on to make sure that they are not causing some component of the cognitive problem. We will often suggest that people write things down, and try to simplify their day to day activities. It is a good idea to have one place to put things and try to be consistent when putting things away. We will assess sleep, pain, and depression, all of which may negatively affecting the ability to focus and remember things. If necessary, we may consider trials of medications such as donepezil (Aricept), or memantine (Namenda) in memory disorder related to MS. Both of these medications have been shown to improve measures of cognition in small trials in MS. 
 
On occasion for trouble with inattention or distractability we might consider Ritalin, Adderal, Concerta; all of these medications need to be cl 
osely monitored for safety. 
 
Occasional patients have trouble controlling their emotions. They may begin crying or laughing suddenly and inappropriately. This is a problem with the reflexes of emotion, not necessarily related to the person's mood at the time. A low dose of a tricyclic antidepressant may be beneficial for this symptom (known as involuntary emotional expression disorder, or IEED). A recent medication (Neurodex) has been shown to be effective for this disorder but is not yet FDA approved. 
 
Patients in the pediatric age group not only have to deal with their MS disease course, but also with the issues of growth and maturity, schooling, and peer relationships. A careful analysis of how the child with MS is doing at home and at school is key to understanding any cognitive issues that might occur. 
 
http://cms.clevelandclinic.org/neuroscience/body.cfm?id=1796 
 
On staff at the Mellen Center for MS is Deborah Miller, Ph.D. She is also the Committee Chair for the NMSS Editorial Advisory Board, I am wondering if they posted this information on Ritalin, Adderal, Concerta without studying and testing the medication results on their external website for anyone to view. 
 
Here is an NMSS white paper mentioning Ritalin for cognitive fatigue 
http://main.nationalmssociety.org/docs/HOM/Expert_Fatigue.pdf 
 
Canada MS Society Fatigue Brochure - Page 38 talks about Ritalin for fatigue 
www.mssociety.ca/en/pdf/livingWell.pdf 

 

Any questions or comment, please don't hesitate to reach out to talk / type.

 

Ben E.

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Answers (2)
Lisa Emrich, Health Guide
2/22/10 9:07pm

Ben,

 

Thank you for sharing this information.  Perhaps you could create a Sharepost and encourage more discussion of the topic.

 

Also, be sure to check out our post on Fatigue Management.  I made a point to mention Ritalin.  :)

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MoannaLisa, Community Member
6/ 7/11 1:20am

I was diagnosed with Fibromyalgia and ADHD five years ago along with a lot of other things.  As it turns out, I have MS.  When I was on Ritalin for the ADHD, my symptoms of forgetfulness, exhaustion, depression, and a lot of the mobility issues we have, completely improved.  I was no longer indecisive, and was able to communicate "betterly."  I stopped taking it due to the fact that I no longer am employed or in school.  But, now all of my symptoms have come back and are worse than ever.  Seeing your posted question has encouraged me to pose this question to my doctor and most likely resume taking Ritalin.  Thank you very much for it. 

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By B.E., Community Member— Last Modified: 04/01/14, First Published: 02/21/10