Fatigue due to multiple sclerosis

Up to 75% of patients with multiple sclerosis (MS) have fatigue—the causes are complex and management is difficult.

Seek contributing factors (eg nocturia, pain or spasms, mood disorders or anxiety, sleep disorders [restless legs syndrome is more common in people with MS]). Exclude hypothyroidism, anaemia and concomitant conditions (eg infection).

Drugs have low efficacy for fatigue in MS, but amantadine and modafinil are sometimes used.

Chronic or relapsing fatigue may reflect disease activity—refer the patient for expert advice. In some patients, immunotherapy can improve fatigue by reducing inflammation in the brain.