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Multiple Sclerosis

Beyond Just Tired: Figuring Out MS-Related Fatigue

By Christine Haran

When people meet someone with multiple sclerosis (MS), they often expect to see signs of muscle weakness or poor balance and coordination. MS is an autoimmune disease that affects the brain and spinal cord and produces a wide range of symptoms that come and go over time, causing varying degrees of disability. But people living with the disease say that one of their most debilitating symptoms is not visible to others. It's fatigue.

Fatigue affects up to 87 percent of people with MS, and about 40 percent say it is their most disabling symptom—and one that interferes with their work and social lives. Although the cause of MS-related fatigue is not fully understood, a study recently published in the Archives of Neurology found that nerve cell dysfunction is associated with fatigue in MS. This was determined by measuring nerve cell damage or loss with magnetic resonance spectroscopy (MRI). The extra work the brain has to do to compensate for this brain injury, the study authors write, results in a feeling of fatigue.

Below, Heidi Crayton, MD, co-director of the Multiple Sclerosis Center at Georgetown University Hospital in Washington, DC, discusses how people with MS can cope with fatigue.

Do most people with MS experience fatigue?
The majority of people with MS, regardless of their degree of disability, report that fatigue is huge symptom. And their fatigue is certainly not simple tiredness. It's whole-body washout. People describe feeling completely wrung out like a rag. It can be a physical as well as a mental fatigue; people are just incapable of performing at the level that they're used to. Lassitude is probably the closest word in the English language that comes close to MS fatigue.

Is there a way that fatigue is measured in MS?
Yes, when we try to objectively measure fatigue in clinical trials, we use several scales. They measure how much fatigue affects people's activities of daily living, the typical duration of their fatigue, and if it impacts them psychologically, physically, cognitively.

I think fatigue probably interferes more with daily living and one's ability to have a job than physical disability does. A workplace can make accommodations for someone's physical disability, but it's very difficult to make accommodations for somebody's cognitive deficits, which are often the result of fatigue. The ability to multitask goes down. Memory declines, and without those skills, sometimes it's very difficult to maintain a job. Fatigue also contributes to the loss of relationships.

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