Fatigue severity correlates poorly with neurologic disability and with the burden of disease as measured by cranial MRI scans. Patients often experience increased fatigue at the time of clinical relapse, and fatigue is therefore presumed to be related to cytokine mediators of inflammation. It is important to identify depression as an underlying cause, and a trial of an antidepressant should be considered. An aerobic fitness program has been shown to reduce fatigue substantially, but benefits were achieved only after several months. An occupational therapist can help the patient to manage activity and conserve energy.
Drug therapy is partially effective in some patients.
Amantadine 100 mg qam or bid, or pemoline 18.75 to 37.5 mg bid is sometimes useful. Medications should be used on a trial basis and should be discontinued if the benefits are not significant within a 2-week period.