Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 6420 msfocusmagazine.org MS symptoms may interfere with sleep, in- cluding muscle spasms, bladder issues, and pain. Depression and anxiety may result in difficulty getting to sleep or staying asleep. Studies have shown that a only small percentage of adults in the U.S. get the amount of exercise needed. Add in some of the challenges posed by MS and it’s no surprise that many people with MS are deconditioned. For those with MS, regular exercise has been shown to improve energy levels and mood. The good news is that the exercise does not have to be anything fancy. The best exercise for a person with MS is the one they have access to andwill stickwith. In thewords of the ancient Greek philosopher, Nike, “Just do it!” Mood disturbances, such as depression, are more common in people with MS and mayalso disrupt sleep and affect energylevels. Many people with depression experience a symptom called anhedonia. This Greek word means you have a lack of desire to do things that you would normally enjoy. This could be eating, having sex, going out of the house, etc. So, how do we sort out fatigue from anhedonia (realizing you may have both)? If your spouse wants to go to the movies and you just cannot muster the energy to get off the couch, even though you really want to see this movie, you are likely dealing with fatigue. If this awesome movie and that great, hot popcorn just seem kind of “Meh!” you may be dealing with anhedonia from depression. Also important to know, many of the medications used for managing MS may be associated with fatigue or drowsiness. Medications used for spasticity (baclofen, tizanidine, and clonazepam) may all cause fatigue. Anticholinergic medications (oxybutynin, tolteridine, etc.) used to treat overactive bladder symptoms may cause tiredness or drowsiness. Medications used for pain management and depression may also be associated with a drop in energy levels. The decision to treat various MS symptoms with a medication always includes a discussion of the risks and benefits. Finally, interferon beta injections (Betaseron, Rebif, Avonex, Plegridy, and Extavia) can be associated with post-injection flu-like side effects including fatigue and worsened depression. These drugs have been around a while and we have learned how to minimize these issues. Finally, when thinking about fatigue, don’t forget that just because a person has MS, it does not mean they can’t have other health problems. Non-MS medications, low thyroid function, hormonal issues, and cardio- pulmonary disease can also contribute to fatigue. I strongly encourage people with MS to have a primary care provider and keep up with routine health screening. There is a dangerous tendency to blame all symptoms in a person with MS on their MS,sometimesignoringotherhealthproblems. Identifying Causes of Fatigue The underlying cause of primary MS fatigue, especially lassitude, remains unclear. Efforts to identify brain MRI abnormalities that correlatewith fatigue have not provided an absolute answer. Some research suggests that problems with the immune system itself may result in an overabundance of inflammatory chemical messengers, called cytokines, that cause fatigue. Nerve fiber fatigue, on the other hand, is a bit better understood. Electrical information Symptom Management