Things to Know When Managing MS Fatigue, with Luis Compres-Brugal, M.D.

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). Often described as an invisible symptom, MS fatigue can significantly impact daily life, even though it may not be outwardly apparent to others.

According to Luis Compres-Brugal, M.D., director of the neuroimmunology/multiple sclerosis program at Miami Neuroscience Institute, part of Baptist Health South Florida, MS-related fatigue can be divided into two main categories: motor (physical) fatigue and mental (cognitive) fatigue. Each type has different underlying causes and requires tailored management strategies.

Motor fatigue occurs when muscles become weak and exhausted after only a short period of physical activity, such as walking or standing. Patients may notice their limbs feeling heavier or weaker as they move, making everyday tasks more challenging. Certain medications can help improve walking speed and reduce muscle fatigue, offering relief to some individuals.

Mental fatigue, also known as cognitive fatigue or brain fog, is more complex. While the exact cause remains unclear, multiple factors contribute to it, including sleep disturbances, vitamin deficiencies, anemia and thyroid disorders. Poor sleep quality — due to conditions like sleep apnea or frequently waking during the night — can worsen fatigue. Compres-Brugal says identifying and addressing these underlying issues is crucial to managing cognitive fatigue. Mental exercises, such as puzzles and therapy, may also help, and in some cases, medications like amantadine or modafinil may be used as a last resort.

Because MS fatigue is multifaceted, treatment often requires a multidisciplinary approach. Compres-Brugal advises patients to work closely with their health care providers to create a personalized plan that considers all contributing factors. While there is no one-size-fits-all cure, fatigue can be effectively managed with the right strategies.

4 Things to Know When Managing MS Fatigue

• Fatigue is one of the most common and disabling MS symptoms, affecting both the body and the mind.
• Sleep disturbances, vitamin deficiencies, anemia and thyroid issues can worsen fatigue and should be addressed.
• Improving sleep hygiene, treating underlying conditions and engaging in mental exercises can help manage cognitive fatigue.
• MS fatigue management requires an individualized and multidisciplinary approach, so patients should discuss their symptoms openly with their health care providers.