Multiple Sclerosis (MS) Fatigue: What One Needs to Know

Introduction

A majority of people with multiple sclerosis live with fatigue. Fatigue may be the most common symptom in people with limited activity. It can interfere with daily activities. Although the cause of MS fatigue remains unknown, there are effective ways to manage it.

What Are the Types of Multiple Sclerosis Fatigue?

If you live with MS, you may experience different kinds of fatigue. For example, muscle spasms or bladder issues may keep you up at night. You may find that daily tasks such as getting dressed and preparing meals take more effort. Depression can also cause fatigue.

The types of multiple sclerosis fatigue are:

• Primary MS fatigue: Demyelination and nerve damage in the central nervous system cause primary fatigue.

• Secondary fatigue: Causes include depression or anxiety associated with MS.

• Physical fatigue: When efforts are applied more than required during movement.

What Causes MS Fatigue?

Several factors can contribute to fatigue in multiple sclerosis. Primary fatigue results from demyelination and nerve damage in the central nervous system, disrupting efficient signal transmission and increasing energy demand. Depression and sleep disturbances can cause secondary fatigue.

MS fatigue also affects mental health. Depression at some point is experienced in half of the individuals with MS, and MS fatigue symptoms can be worsened due to this depression. The burden of MS fatigue can be increased due to other MS symptoms, including weak legs, weak muscles, and spasticity. Certain medications can also lead to side effects such as fatigue.

What Are the Primary and Secondary Mechanisms of Fatigue in MS?

The primary mechanisms of fatigue in MS involve the immune system or sequelae from central nervous system damage. Specific causes are proinflammatory cytokines, endocrine influences, axonal loss, and altered patterns of cerebral activation. Fatigue in MS can also arise from associated conditions or the accumulation of disease burden. Specific causes to consider include sleep disorders, depression, disability status, MS subtype, and iatrogenicity.

What Are the Symptoms of MS Fatigue?

Fatigue in multiple sclerosis is of two types.

• The first type is related to feeling tired, which becomes worse in the afternoon or even after activity. Individuals experiencing this type of fatigue are unable to do many tasks without getting tired.

• Muscular fatigue is the second form of fatigue, characterized by increased weakness following repeated activity. This form of fatigue usually occurs during walking.

What Does MS Fatigue Feel Like?

Not all individuals experience the same intensity of MS fatigue, and it is tough to explain how one feels. Most individuals experience extreme tiredness, low energy, and muscular fatigue. Some individuals with MS might feel weighed down and like every movement is difficult or clumsy. Others might feel it as extreme jet lag or a hangover-type feeling that will not go away or improve with rest. Mental fatigue may be described as brain fog or difficulty thinking clearly.

The characteristics of MS fatigue are:

• Daily or frequent occurrence.

• Symptoms worsen as the day progresses.

• Intensification with heat and humidity.

• Sudden onset without much activity involved.

• Interference with daily tasks, even those that may not require much energy.

Individuals might also feel fatigued in the morning, even after a good night’s sleep. Rest typically does not improve MS fatigue.

What Are the Impacts of Chronic Fatigue on Quality of Life?

Chronic fatigue can negatively impact various aspects of life, including mood, self-advocacy, relationships, work, and personal interests. Pain may also be an overlapping symptom with fatigue. These challenges may also impact mental health. Therefore, managing the progression of MS is crucial for better outcomes. The healthcare team should be informed and spoken to about ways to cope with fatigue directly and maintain the quality of life.

How to Manage MS Fatigue?

Managing MS and fatigue involves a multifaceted approach. Lifestyle changes, such as incorporating regular rest periods, drinking sufficient fluids, and practicing stress management, can be beneficial. In some cases, symptoms can be alleviated through medication or physical therapy. Individuals with MS should work closely with healthcare providers to develop a personalized treatment plan.

What Are the Therapies to Decrease MS-Related Fatigue?

Different therapies, including rehabilitation, can help you plan to prevent and reduce the effects of MS-related fatigue. They can teach you energy-saving strategies and help you avoid activities that trigger your fatigue.

To address the fatigue, one can try any of the following:

• Tasks can be simplified at work and home, and energy can be conserved through occupational therapy.

• Energy-saving walking techniques (with or without assistive devices) can be learned and practiced, along with other daily tasks, through physical therapy.

• Regular exercise can also be developed through physical therapy to prevent deconditioning (muscle loss occurs when you are less active).

• Sleep regulation might involve treating other MS symptoms that interfere with sleep (e.g., spasticity, urinary dysfunction, etc.).

• Psychological interventions, such as stress management, relaxation training, membership in a support group, cognitive behavioral therapy, or psychotherapy

• Heat management strategies are used to prevent overheating and maintain a cool environment.

What Are the Medications and Nutrition Required for MS Fatigue?

No medications are made explicitly for MS fatigue. Experts agree on the following tips for a healthy diet:

• Have meals at home. It is always better to have home-cooked food.

• Consume a variety of colorful, fresh fruits and vegetables daily to stay hydrated.

• Whole grains should be chosen over refined grains to maintain good health.

• Avoiding processed foods and added sugars as much as possible is better.

Conclusion

The treatment of MS-related fatigue is challenging. Knowledge of treatable etiologies and a systematic approach can facilitate prompt diagnosis and management, offering the best chance to identify treatable causes and impacts for the profoundly active patient.

Key Takeaways:

• One of the common and disabling symptoms of multiple sclerosis is fatigue, which often affects daily functioning and quality of life.

• Multiple sclerosis is multifactorial, involving nerve damage, immune system activity, sleep problems, and medication side effects.

Managing fatigue typically requires a combination of lifestyle modifications, energy-conserving strategies, and personalized medical interventions. If you or someone you know has multiple sclerosis and wants help and support, consult our neurologist at iCliniq.