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Is there anything that I can do to help the fatigue? Sometimes it overwelms me.

Question Date: 9/20/2012


Thanks for the inquiry! Fatigue can be one of the most severe symptoms of Multiple Sclerosis and is very often the least well treated. First off, I would highly recommend that you be sure to have both your serum vitamin B12 and D levels checked. If either is low or even in the low normal range, supplementation can really help. We like to see serum vitamin B12 levels between 600 and 900 as patients function best in that range. For vitamin D we like to see the serum levels between 60-80, which is high optimal range, as levels in that range promote optimization of bone mass, reduce the risk of cancer, provide optimization of immunoregulation in MS patients, reduce depression and reduce the risk of MS-related relapses. In our facility we also offer our MS patients a "fatigue class" which is taught by one of our occupational therapists. MS patients who attend learn how to best manage their energy stores. Check with your health care provider, the Multiple Sclerosis Foundation or local National MS Society chapter to see if you have such a class in your area. Finally, a number of different medications can really help with treatment of MS-related fatigue. The anti-viral drug, Amantadine 100 mg, can often be helpful for mild MS-related fatigue. We recommend 1 capsule first thing in the morning and again in the mid-afternoon to help give our patients a "boost" in their energy. If the fatigue is more severe, we will try either Provigil/Nuvigil or a combination of long- and short-acting Methylphenidate. Both sets of drugs can be very effective in helping to treat Ms-related fatigue. Talk to your health care provider about which drug might be best for you. If you take either Provigil or Nuvigil, we recommend taking a "drug holiday", that is no Provigil or Nuvigil one day per week, as that helps preserve the drug's efficacy. I hope this helps!

Answer Date: 11/16/2012


Dr. Greg Zarelli


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