The effects of fatigue

Hello fellow MSers,

I am in a really deep spell of fatigue at the moment and I feel as if I have worked ten rounds as Mike Tyson’s sparring partner. In one of my many, many rests I started to wonder if this fatigue actually damaged the myelin sheaths as much as the relapses are supposed to? It certainly feels powerful enough for this to happen. I would be very greatful if anyone could tell me whether this harms us or not. Thanks to all, and here’s hoping for a better 2012.

Best Wishes,


There are several proposed causes of MS fatigue.

For a lot of people, every day fatigue is caused by the MS brain having to work extra hard to do things. (Sorry in advance for the rather silly analogy, but I couldn’t think of another way to explain!) If you can imagine the brain wanting to send a signal from A to B as getting a coach load of people from A to B. A normal brain would load all the people on the coach at A, head off at speed along the nice wide motorway and arrive at B without any hassle. But the lesions and axonal damage in MS means that the brain has to deal with lots of traffic jams and diversions. So getting the coach from A to B means taking longer, less well maintained routes, e.g. lots of meandering country lanes. But the coach can’t fit down the country lanes, so the MS brain also has to get areas involved that weren’t original designed to be involved - so instead of using a coach, it has to load the people onto lots of cars and bikes. In reality, this means that people with MS use far more of their brain to do things than people without MS. The normal brain uses up a massive amount of the body’s resources. The MS brain, with all that extra work, uses up far more - and it’s exhausting.

There are other causes of everyday fatigue too though. There are at least two parts of the brain that are responsible for monitoring fatigue. One is in the parietal lobe and kicks in when we are physically tired. The other is a team of areas in the frontal and limbic lobes. These kick in when we are mentally or just generally tired. Damage to either of these, or to the connections to and from them, could cause ongoing fatigue, even if there is no actual reason for the person to be fatigued.

Fatigue that hits just like a relapse is not the same as everyday fatigue. As far as I’m concerned, it is a relapse, even if nothing else is going on. That’s because it is probably a sign that the brain is under attack - that new lesions are forming. A lot of MS lesions are “clinically silent”, i.e. don’t cause observable symptoms. So if MS is causing new clinically silent lesions, we aren’t going to have new symptoms, but new roadblocks and diversions are being built so our fatigue gets much worse. When the body repairs the roadblocks a bit and the brain learns to deal with the remaining diversions, the fatigue improves again - back to the normal, everyday stuff.

Sorry, this is probably way more detail than you wanted! It is also my own explanation of various theories so there could be mistakes in there.

The simple answer to your question is that fatigue is a symptom of damage rather than a cause of damage. Rest, rest, rest, allow your body to try and repair what it can and your brain to work out new routes.

Everyday fatigue is bad. Relapse fatigue is truly terrible :frowning: You have my utmost sympathy.

I hope it gets better very soon!

Karen x

What a fab explanation of fatigue - having just had the truly terrible (along with the symptoms that went with it) and now being left with the bad I totally appreciate this traffic jam analogy and will use it at work to explain how I feel. Thank you, Karen (yet again)!


PS there are far too many people called Deb on here, maybe a reflection of our age, but the only friend from my childhood who has MS is also called Deb! ooh-er

Hi Deb,

Had noticed there were a few other Debs around and to minimise confusion used a distinctive pic, great having a moment know they have another name!!! And I have a close friend called Deb also and we constantly answer for each other when asked questions even when its her husband and I’m in their house…


Thank you for your reply Karen, and very well described. Right now I feel as bif my brain is attempting to get from A to B using a pennyfarthing! As you have advised, I will duly rest and await the outcome.



Hi Karen,

Can I ‘pinch’ a copy of your explanation of fatigue and print it out please?

In order to educate the ppl around me such as family, friends and possible employers in the future and well, basically hopefully make my life a damn site easier lol.

ty again Karen for ur wonderful explanation on fatigue issues,


Anna x

My grandson was diagnosed with relapsing remitting M.S. 5 years ago. He’s been on copaxone daily at first but now 3 times a week. It leaves terrible dents in his body so hopes to change to tablets. He suffers dreadfully from fatigue, to the extent that I actually to my eternal shame accused him of being either drunk or stoned.He’s having difficulty accessing help from the M.S. nurse, she seems to have far too many patients. We live in rural North Wales. How often should he see a specialist how often should he be offered an MRI scan . His sleep is disturbed as well, I don’t think he’s ever really rested after a nights sleep. Sometimes he sleep walks and talks is this M.S. related? I reallt don’t know how to help him and it@s truly terrible seeing him suffer like this. He works full time his employers are very understanding but his job needs to be done he can’t just take time off continually. Any help and advice will be gratefully accepted. Thankyou.