MULTIPLE SCLEROSIS-FATIGUE MANAGEMENT

SUMMARY

1. Subjective lack of mental & physical capacity to perform usual duties; 78-87% of MS patients experience fatigue.

2. Self-absorbing and all-consuming phenomenon! Worse with heat and after meals, a rise of ≥ 0.5^oC results in heat-related fatigue (Uhthoff's phenomenon).

3. Assessment scales: fatigue-severity scale, fatigue-descriptive scale, fatigue-impact scale.

4. DDx for fatigue: low-level of fitness (secondary fatigue), poor sleep hygiene, hypothyroidism, sedative medications such as Baclofen.

5. Non-pharmacologic management most effective: energy-conservation techniques, pacing, patient/family education, adaptive equipment, work-simplification, home modifications, aerobic exercise, sleep hygiene, lifestyle modifications.

6. Pharmacologic management: amantadine, modafinil, fampridine.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].