MS and the Fatigue Factor
by Pamela Martin
I am often reminded of the time I set out for what was to be a short walk.� Struggling with an armload of groceries, I was in a hurry to get home.� Unfortunately, I came upon construction debris in the road, and was forced to take a detour around the mess.
As fate would have it, the path I chose was deceptively circuitous.� As one road led way to another, I discovered that I was going in circles.� My legs grew weary and the load heavier as I continued through the winding course.� By the time I stumbled home, I was completely and deathly exhausted.� In short, I used much more energy navigating through the twisting and zigzagging course than if I�d been able to use the more direct approach.
My experience is illustrative of the process at work in MS.� Myelin-damaged roadblocks force the communication mechanisms of the brain to take less effective, and roundabout routes.� This inefficient detour can result in a burdensome fatigue for the person with MS, both physically and mentally.
When asked about MS-specific fatigue, many sufferers anecdotally describe it as "bone-tired" or a "wearing a suit of armor" feeling.� It differs from normal fatigue in that there is generally no easy correlation between the amount of energy expended and the severity of the weariness.� You would expect someone who just scaled Mt. Olympus to feel extremely exhausted.� You would not expect that same level of exhaustion from someone who merely cooked a simple dinner.� Yet, the problem is not simply an amplification of normal fatigue.� There are many more nuances involved in this symptom.
MS fatigue is often variable, sometimes unrelenting, and generally appears regardless of the amount of sleep the patient gets.� Some patients find that although they regularly get a full night�s sleep, they awaken in the morning unrefreshed.� Many require a scheduled nap in the afternoon when the fatigue is at its worst levels.� For me, I have found no connection between the total rest I get, and the way I feel at any given moment.� There have been times where I have gotten plenty of sleep the night before, but spent the next day in a zombie-like stupor, where even the simplest task requires a superhuman effort.� On the other hand, there have been times where I made it through an unusually busy day, yet felt no ill effects for several days.
Not only does MS fatigue drain a patient physically, but it can also cause mental distress.� Remember the child�s game of trying to pat your head and rub your stomach at the same time?� It was hard to concentrate on both tasks at the same time, so ultimately, you ended up not doing either chore very well.� Many people with MS can relate to that feeling of being mentally overwhelmed.� Often, the dysfunctional nervous system is working overtime, processing the enormous sensory data that we experience daily.� Because the process is disrupted and inefficient, it may be difficult to hold a conversation and listen to background music at the same time.� Or someone may find it impossible to drive at night because the array of lights and sounds are disconcerting.� Similarly, I was once struck dumb and unable to answer a store clerk who simply asked me for my telephone number.� Because my senses were already overloaded from the shopping experience, my brain simply shut down when faced with a simple question.� At that moment I was just mentally worn out.
What Causes MS-related Fatigue?
Although scientists have no definitive answer, a couple of likely theories are presented regarding the cause of MS fatigue.
Location, Location, Location. One theory holds that fatigue is related to the loss of myelin--the protective coating of the nerve fiber.� The locations where the myelin loss occurs are responsible for the severity and type of fatigue.� In this scenario, it is the cerebral abnormalities themselves that contribute to fatigue.� The random placement of myelin lesions or loss could account for the variety of ways people with MS experience the symptoms of fatigue.
Interestingly, a 1999 study found fatigue severity did not correlate with myelin scarring or deterioration as observed on MRI. (1) Correspondingly, a 1998 study suggested that the differences in fatigue levels could not be solely explained by the degree of disease activity or disability. (2)� There is certainly a great need for more study in this area.
Poor Body Functioning. It has also been speculated that the general deterioration of overall functioning as a result of having MS may simply exhaust the body�s storehouse of energy.� Muscle weakness and decreased nerve conduction are the obvious culprits.� But some researchers have noted that altered metabolism and inadequate respiration are other energy-depleters.� Again, further investigation is needed in this area.���
Above all, patients must consult with their physician or other health care professional to determine the value of treatments available for MS fatigue.� The prescription drug, Neurontin�, which is used to control tremors and spasms, has been reported by some users to relieve fatigue as well (although the reasons for this are not totally understood).� In addition, amantadine (Symmetrel�) and pemoline (Cylert�) have been helpful to a small number of MS patients.� Unfortunately, others have found them to be complete failures at remitting fatigue, and have caused unwanted side effects.
Cephalon, Inc. recently reported positive findings from a new clinical study on the effectiveness of Provigil�.� Generally used for the treatment of narcolepsy, this medication was statistically successful in reducing fatigue in a study of MS patients.
Because these medications are of limited effectiveness, and can be accompanied by unwelcome side effects, many patients combat fatigue in other ways.� Patients learn how to simplify and manage their daily tasks more effectively, so as to save energy.� Physical therapy can teach some how to obtain benefits from using assistive devices to prolong energy.� In addition, avoiding heat, taking scheduled naps, limiting overexertion, managing stress, and monitoring the effects of medication are other steps taken to combat fatigue.
(1) Fatigue In Multiple Sclerosis: cross sectional correlation with brain MRI findings in 71 Patients,� Bakshi R; Miletich RS; Henschel K; Shaikh ZA; Janardhan V; Wasay M; Stengel LM; Ekes R; Kinkel PR, Neurology 1999 Sep 22; 53(5):1151-3
(2) Fatigue in Multiple Sclerosis: interrelations between fatigue complaints, cerebral MRI abnormalities and neurological disability,� Van der Werf SP; Jongen PJ; Lycklama a Nijeholt GJ; Barkhof F; Hommes OR; Bleijenberg G, J Neurol Sci 1998 Oct 8; 160(2):164-70
© 2000 Pamela Martin
Pamela Martin was diagnosed with MS in 1993 while working on her Master's degree in HR management.