Symptoms of MS
Fatigue
Two types of fatigue are recognised and both are common in MS, causing significant levels of disability and interfering with quality of life. One form is a continuous tiredness that prevents someone with MS from completing the easiest tasks. In the other the patient generally feels well at rest, but is overcome by a spontaneous feeling of tiredness after a few minutes of physical activity. This is called fatigability and it usually affects the legs and disappears after a short rest. It may be that someone affected in this way would be better with a motorised wheelchair rather than over-tiring themselves walking with sticks. Fatigability can also affect reading, with vision deteriorating after a while and returning following a short rest.
Much of fatigue is due to the difficulty in conducting nervous impulses through the areas of plaque formed in the central nervous system as part of MS. A relation between fatigue and depression, which is common in patients with MS, can be found. Some depressive symptoms may occur which overlap with what has commonly considered fatigue, such as decreased motivation and apathy, which can possibly be treated with antidepressants. Tiredness typically gets worse when someone gets hot due to exercise, warm weather, fever or a hot bath.
Coping with tiredness
Non-pharmacological treatments, including graded exercise training and energy management strategies may be helpful. Cold showers or baths can help some people and air-conditioning is essential in warm climates. The most important aspect of coping with tiredness is to pace yourself properly.
Drug treatments
Different treatment options are available for patients suffering from fatigue. In any case if you experience unbearable fatigue you should discuss this subject with your treating physician.
Cause of MS fatigue
The cause of MS fatigue is not fully understood. MS fatigue can be divided into four catagories:
• normal fatigue
This occurs whether or not MS is present. Not all fatigue is due to MS.
• neuromuscular fatigue
This is caused by inefficient nerve conduction. Respite periods are the solution to this short-circuiting fatigue.
• depression
Depression in MS is common and is often accompanied by poor sleep, poor appetite, depressed mood and fatigue.
• lassitude
This is an overwhelming tiredness that comes on for no obvious reason. Because psychotropic drugs are helpful in fatigue, it is thought that lassitude may be due to a biochemical imbalance in the brain.3
As well as disrupting daily life, MS fatigue can also cause anxiety when MS symptoms recur during periods of fatigue. This is particularly so after exertion and especially when an activity or the environment causes a rise in body temperature. It should be noted that fatigue is not related to relapses and fatigue does not cause worsening of the disease or a permanent increase in disability.
It is also possible that the impact and experience of fatigue may be exacerbated by psychosocial factors such as sense of control (i.e. the inability to manipulate, control or change the environment to suit personal psychological needs may be a factor in MS fatigue).
Management of MS fatigue
When fatigue becomes a major problem for the person with MS, a thorough medical evaluation should be undertaken to eliminate other causes of fatigue. A possible cause of MS fatigue may be sleep disturbances, which then result in daytime fatigue.
If central nervous system disease (in this case MS) is the sole basis for the fatigue, then adjustments should be made to lifestyle, environment and occupation to accommodate the fatigue. It may be necessary to change your role or shift your priorities within the family and at work, in order to pace yourself to avoid fatigue. Techniques such as time management, pacing, energy conservation, work simplification and relaxation breaks are all strategies which can be employed to control fatigue.
Practical tips:
• Avoid hot baths, very warm temperatures, excessive exercise, eating large meals, smoking
• Plan your life so work requirements, social occasions and late nights are staggered
• Follow a sensible diet, and reduce weight if overweight
• Yoga can be very helpful, combining exercise with meditation
• Keep physically fit, with a balanced programme of exercises that should be tailored to your capabilities. You should not be exhausted by these exercises and they should be followed by adequate rest periods.
Few drugs have been effective in combating MS fatigue. Management of depression (and associated fatigue) should include antidepressant medication and counselling.
Stress management and counselling should not be ignored in the control of fatigue. Psychosocial factors and quality of life concerns impact upon the ability of people with MS to cope with their lives and may be a factor in the cause of fatigue as well as a determinant of the degree to which it interferes with daily living.
In managing fatigue in MS it is also important to educate families and friends and, as well, health care professionals and employers, as to the existence of this aspect of MS. Fatigue is very much a symptom of MS but one that can be managed if understood and accommodated for.
References
1 Sheean GL, Murray NM et al. An open-labelled clinical and electrophysiological study of 3,4 diaminopyridine in the treatment of fatigue in multiple sclerosis. Brain 1998;121(5):967-975.
2 Brañas P, Jordan R et al. Treatments for fatigue in multiple sclerosis: a rapid and systematic review. Health Technology Assessment 2000;4(27):1-61.
3 Schwid SR, Covington M et al. Fatigue in multiple sclerosis: Current understanding and future directions. Journal of Rehabilitation Research and Development 2002;39(2):211-224.
Text is based on information of www.msif.org
