People with multiple sclerosis (MS) who often feel extreme fatigue as one side effect of the disease should take steps to conserve their energy more often, say doctors who evaluated the effect that fatigue has on quality of life in MS patients.1
How effective is energy conservation, when used as a part of a strategy by MS patients? That was a question that Virgil Mathiowetz, MD, of the University of Minnesota and a team of researchers wanted to answer.
Energy Conservation and Quality of Life
They evaluated the impact of a 6-week energy conservation course, taught by occupational therapists, on MS-related fatigue and quality of life. Each of the 169 patients who took part was randomly assigned to take the course immediately, or postpone starting it, and then was switched over.
Patients in the course met in small groups of 7-10 individuals for 2 hours per week where they discovered whether they are performing daily duties, such as employment, household chores, and leisure activities in an energy-efficient manner. If not, they were taught ways to conserve their energy.
Mathiowetz explained that steps to conserve energy are similar to managing a budget. Just like people can save money so that they don't spend more than they bring in, they can conserve energy so that more of it isn't used up before it can be replenished in the body.
Positive Benefits Found
Mathiowetz found that people in the immediate intervention group experienced a significant reduction in fatigue while taking the course, and continued to improve after the course ended. That compares to patients who delayed starting the course. They saw only slight improvement in fatigue during that period. But fatigue levels significantly improved once those patients began taking part in the therapy, the researchers discovered.
Those patients who learned how to more efficiently manage their energy also saw greater improvements in their quality of life, said Mathiowetz.
He said this is the third in a series of studies that achieved these positive results. In nearly all cases, there is a slow, but ongoing benefit over time, he says, because it takes time for people to fully implement these new strategies and maximize them.
A Significant Disability
As many as 40 percent of MS patients have described fatigue as their most disabling symptom, experts note, even more so than weakness, spasticity, motor problems, or bowel or bladder problems. "In addition to nonpharmacologic measures, such as exercise and energy conservation strategies, several pharmacologic agents have been evaluated for their ability to reduce MS-related fatigue, including amantadine, central nervous system stimulants (pemoline), and the novel wake-promoting agent modafinil," wrote one expert in a review paper on the topic.2
A 1995 clinical study found that amantadine is effective at treating MS-related fatigue, but that pemoline was not.3
Other medical experts have termed modafinil as "promising" for this indication.4
1. 129th Annual Meeting of the American Neurological Association. 2004 Oct 3-6. Toronto, Ontario, Canada.
2. Bakshi R. Fatigue associated with multiple sclerosis: diagnosis, impact and management. Mult Scler 2003 Jun;9(3):219-27.
3. Krupp LB, Coyle PK, Doscher C et al. Fatigue therapy in multiple sclerosis: results of a doble-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology 1995 Nov;45(11):1956-61.
4. Tellez N, Montalban X. Modafinil and fatigue in multiple sclerosis [Translated from Spanish]. Neurologia 2004 Oct;19(8):434-7.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
