Perspectives in MS
Perspectives in MS

Fatigue and MS: Part 1 - Introduction

I am tired. I work hard during the day and still do overnight shifts at the hospital on occasion. When I finally get home after a hard day’s work, I have two small children who mistake me for a trampoline. When I finally put them to bed, I often help clean up the house. And when I finally have a moment to sit still, I try to read the latest articles or work on something I am writing. My youngest child still thinks it’s a good idea to get up before sunrise, and my cat frequently decides 3am would be a good time to show me how loud she can purr. So I repeat, I am tired. And so are most people I know.

Although I treat patients with a wide age range and a great variety in their lifestyles, many of them have, like me, tiring jobs and young children. One of my patients recently complained of severe fatigue; this was not surprising, since she works as a nanny taking care of a 1-year-old girl, and twin 2-year-old boys. I have several other patients whose jobs require them to work overnight, so like me, they have erratic sleep schedules. Of course these people are tired. In many of my patients, I am not sure if their fatigue comes from their lifestyle, directly from their MS, from medications they are taking, or a combination of these factors. 

Yet, fatigue in patients with MS seems to go significantly above and beyond the normal tiredness that goes along with the stresses of every day life. Not only do MS patients have more fatigue overall, their fatigue seems to have a different quality about it, sometimes termed MS lassitude. MS patients often describe fatigue as an overwhelming force in their lives that occurs no matter how much sleep they get. Routinely I hear patients say that they are too tired to go outside or they are unable to make it throughout the day without a nap. Unlike people without MS, heat and humidity can significantly worsen the fatigue of patients with MS. All of these symptoms can occur even when patients have little or no objective physical disability or depression. 

Although it was not a properly done scientific study, a survey of nearly 200 patients at an MS meeting in the U.K. in 1998 found that amongst these responders, fatigue was both the most common and most bothersome symptom. The results of this survey are below.

SymptomSymptom rated as one of worst (% of patients)Patients currently experiencing symptom (%)
Bladder/bowel problems5066
Balance problems4473
Muscle weakness4469
Visual problems20-
Muscle stiffness1764
Muscle spasms1451


Wow. This shows the amazing extent to which fatigue interferes with the lives of MS patients, and how the standard neurological exam—of asking people whether they feel a pinprick or measuring how fast they walk 25 feet—is often wholly inadequate to measure what matters for patients. In my next postings, I will discuss treatments for fatigue is MS patients.

I am available via e-mail at and will try to answer all questions.

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About the Author

Dr. Howard is a neurologist & psychiatrist, and an expert in multiple sclerosis.

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