From the Research
Multiple sclerosis symptoms can indeed worsen as the day progresses, a phenomenon known as fatigue-related symptom worsening or "MS fatigue". This is different from normal tiredness and affects about 80% of MS patients. As body temperature rises throughout the day due to activity and environmental factors, nerve conduction in demyelinated pathways becomes less efficient, temporarily worsening symptoms like weakness, coordination problems, vision changes, and cognitive difficulties.
Key Points to Consider
- This pattern is often predictable, with symptoms typically being milder in the morning and worsening by afternoon or evening.
- Management strategies include planning important activities for morning hours when energy is highest, taking scheduled rest breaks, using cooling techniques (such as cooling vests or cold drinks), and medications like amantadine (100mg once or twice daily), modafinil (200mg daily), or methylphenidate (10-60mg daily in divided doses) for severe cases.
- Additionally, energy conservation techniques, physical therapy, and maintaining a consistent sleep schedule can help minimize this daily symptom fluctuation.
- This pattern differs from disease progression, which refers to long-term worsening over months or years rather than daily fluctuations. According to a study published in 2008 1, worsening of symptoms is associated with lower physical activity levels in individuals with multiple sclerosis. However, the most recent and highest quality study on the topic of multiple sclerosis treatment was published in 2024 2, which provides a comprehensive review of immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis, but does not specifically address the daily fluctuation of symptoms. Another study published in 2021 3 provides an overview of the diagnosis and treatment of multiple sclerosis, but also does not address the daily fluctuation of symptoms.
Treatment Options
- The study published in 2024 2 found that natalizumab, cladribine, and alemtuzumab are effective in reducing relapses and slowing disability progression in patients with relapsing-remitting multiple sclerosis.
- The study published in 2018 4 reviews the mechanisms of action, clinical trial results, and side effects of newer drugs used for multiple sclerosis, including fingolimod, teriflunomide, and dimethyl fumarate.
- The study published in 2015 5 compares the effectiveness of fingolimod versus interferon beta/glatiramer acetate after natalizumab suspension in multiple sclerosis, and found that fingolimod is associated with a lower risk of relapse. However, these studies do not provide direct evidence for the daily fluctuation of symptoms in multiple sclerosis patients.
Daily Symptom Fluctuation
- A study published in 2008 1 found that worsening of symptoms is associated with lower physical activity levels in individuals with multiple sclerosis, which may be related to the daily fluctuation of symptoms.
- The daily fluctuation of symptoms in multiple sclerosis patients is a common phenomenon, and management strategies such as planning important activities for morning hours, taking scheduled rest breaks, and using cooling techniques can help minimize this daily symptom fluctuation. In conclusion, while the daily fluctuation of symptoms in multiple sclerosis patients is a common phenomenon, the most recent and highest quality studies on the topic of multiple sclerosis treatment do not specifically address this issue. However, management strategies such as planning important activities for morning hours, taking scheduled rest breaks, and using cooling techniques can help minimize this daily symptom fluctuation.