Here is My Question:
My question is regarding fatigue. Besides good sleep habits, avoiding caffeine, and exercise, how often do you recommend medication such as methylphenidate? I know that these medications can also increase anxiety which is a problem for me. 

Answer:
This is a hard question to answer. Fatigue means so many different things to different individuals and has so many causes. 

Let’s assume there is no other medical cause for your fatigue (a big assumption since the list of causes is long) and we believe you have primary MS related fatigue. In this case first line treatment is amantadine 100 mg in the am and early afternoon. This rarely causes anxiety or insomnia. If this happens alter the dosing to 100 or 200 mg as a single dose in the morning. Some people require higher doses, but I rarely increase amantadine beyond 400 mg total dose in a day and monitor individuals closely if they are taking doses higher than 200 mg total per day. Common side effects of amantadine are mild nausea, nightmares or sleep disruption, peripheral edema (swelling of the legs) and livedo reticularis (an unusual mottling of the skin). At higher doses visual blurring may occur. People with kidney disease should reduce the daily dose of amantadine to prevent toxicity.

People who do not respond to amantadine, particularly if there is a component of excessive daytime sleepiness without a treatable cause or partially treated depression, often respond to the addition of modafinil or amphetamines. Those with anxiety or headache disorders must use amphetamines with caution and begin with low doses to avoid aggravating these conditions.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego

Here is My Question:
I was diagnosed with RRMS in 2001. Was recently taken off Copaxone because it seemed to have stopped helping. I have daily symptoms...never-ending. My question is about fatigue. Do most patients feel the extreme fatigue with activity? Simple things like washing a dish, brushing teeth, bending over or carrying groceries can wipe me out and even make me a little lightheaded. I notice I sleep more during the day, but I force myself to keep going. I've had all the cardiac tests which seem to be normal for my age (63). But I just can't seem to do much physical work anymore. I tried PT and water aerobics. The exercise makes things worse. I also have Graves, IBS, Gastritis, osteoarthritis and tendinitis. Also degenerative disc problems. Thanks so much. Appreciate any advice or suggestions.

Answer:
Your experience with fatigue is common among MS patients. Thankfully, we have lots of information on this site to help with the management of MS related fatigue. Just use the search feature to find the information. However, before you begin your search for answers remember the following: There is no single solution to fatigue; trying something like an exercise program, deciding that it is not helpful and discarding it is a mistake. Most of these strategies will require months of hard work and adjustments to find a successful solution. These solutions always require a combination of management strategies that include most of the following:

• An aerobic exercise program that gradually increases over time
• Adjustment or discontinuation of medications that may be worsening your fatigue 
• Judicious cooling
• Activity adjustments during the day
• Dietary modification as required
• Improved sleep hygiene as required
• Judicious use of medications prescribed by your MS doctor to treat fatigue and exertional weakness; these include amantadine, modafinil and 4 amino pyridine (Ampyra) to name a few
  

You should discuss the comprehensive management of your MS related fatigue with your MS team

Rip Kinkel