Combating Fatigue p125 Perhaps the most common of all MS symptoms is fatigue. It seems to go along with the MS territory, slowing patients down physically and psychologically; and proving especially problematic during the weeks and months after a flareup. What can be done to relieve this enervating and seemingly omnipresent condition? Pharmacologically speaking, the choices are limited. Perhaps the only medication doctors have had any success with so far is Symmetrel (Amantadine), a drug ordinarily prescribed for the reatment of Parkinson's Disease and Asian flue. The reasons why Symmetrel helps MSers are not understood, for though it appears to promote the release of the NeuroTransmitter Dopamine from the Basal Ganglia areas of the Brain. Theoretically this mechanism of action alone should not produce any particular ameiliorating effects on MS related fatigue. And yet it seems to do just that, and certainly few people will object. Although there are no assurances here, doctors have found that patients who take this medication often show a measurable if not dramatic lifting of their pep and energy level, and hence on their general outlook on life. As a bonus, Symmetrel often improves MS tremor, just as in Parkinson's Disease, and is sometimes given specifically for this purpose. Symmetrel's side effects are minor. Jitteriness and dryness of the Mouth are both common. Blurred Vision can occur and may pose a special difficulty for patients who are already suffering from Optic Neuritis or glaucoma. If any of these are a problem patients are advised to inform their doctor before taking the drug. Other side effects can include Constipation, Dizziness (especially when standing up suddenly), and a harmless but unsightly skin condition known as Livedo Reticularis. Which produces purplish blotches on the thights or forearms, and which occasionally remains after the medication has been discontinued. p126 Aside from Symmetrel there are few other medicinal choices in the battle against fatigue. Some doctors report limited success with Cylert (Pemoline), a Central Nervous Stimulant used to treat concentration and attention deficits in hyperactive children. AntiDepressants may be given, as Depression produces a Lassitude that is Emotional as well as Physical in origin. Vitamins such as those in Brewer's Yeast, Vitamin A, C, E, and the B complex are sometimes touted as energy producers, though these claims remain clinically unproven. Likewise, Manganese, Zinc, and Potassium Gluconate supplements, Vitamin B12 injections, and various megavitamin regimes are used. Coffee and caffeine drinks are also recommended for tiredness, but these substances do not "give" the body energy, as is commonly believed, they simply stimulate certain organs to produce more of it. Once this effort is expended, an energy deficit is produced, which is often equal and opposite to the energy surge formerly experienced - hence the afternoon "down" complained of by many heavy coffee and soda drinkers and, on a greater scale, by drug stimulant users. In this sense Caffeine and other drugs give with one hand and take back with the other. In all the chemical choices for tiredness and fatigue are limited. This means that if fatigue is to be confronted it must be done in other ways, specifically by the conservation of energy and by the pacing of one's activities. Treating Tremors p138 Tremors are common among MSers, though their range and intensity vary markedly. Some persons with Ataxia will present with wide excurstions of movement in the Arms and Hands, and will be unable to perform the most simple manual task such as buttoning a shirt or guiding a spoon to the Mouth. These tremors are not in the majority fortunately. More often a subtle oscillation of the head or trunk appears and disappears periodically, they often go unnoticed by others. p139 When shaking is slight, patients are able to compensate with simple tricks such as keeping their arms close to their bodies when making arm movements or using adaptive devices to accomplanish difficult manual tasks. In instances where Tremors are exacerbated by Emotional Agitation, the sedative effect of AntiHistamine drugs such as Atarax (Hydroxyzine) will relax the person and thus the shaking. In still other cases Inderal (Propranolol), a Blood Pressure and Angina medication, produces improvement and is most effective in Cerebellar Tremors that originate in the Basal Ganglia part of the Brain. As mentioned above, Symmetrel is sometimes prescribed for shaking and has the added effect in some patients of relieving exhaustion. When a Tremor is related to Spasticity, AntiSpasticity drugs such as Lioresal may slow it down enough to restore functionality to the affected parts. Finally, there is some evidence that Isoniazid, one of the three major drugs used for treating Tuberculosis, has a Tremor dampening effect, especially for a severe tremor. Since this drug tends to produce Liver toxicity in the large doses necessary for Tremor control, however, and since it is a relative newcomer to the MS pharmaceutical canon. Its use is controversial and should be considered only in extreme cases, and then only when accompanied by regular Liver Function Studies. Overall, pharmacologic treatment of MS Tremor is disappointing, and as yet no single drug achieves anything approaching total success. Physical Therapists often recommend exercises that concentrate on Stability, especialy of the Shoulder, Pelvis, Hips, and Trunk. An exercise known as patterning requires patients to repeat certain movements many times with resistance added by the PT as the movements become increasingly automatic. With repeated practice, these motion patterns become fixed in the body's muscular memory and, to some extent, reprogram and improve motor skills. Speech & Swallowing Disorders p140 The type of Speech and Swallowing Disorders developed by MSers depends on which area of the Brain is DeMyelinated, and in turn on which parts of the Tongue, Lips, Larynx, Vocal Cords, and Throat are affected. Speech may be slurred, unusually rapid, eccentric in rhythm, weak, or choppy. Swallowing reflexes may be impeded or delayed; sensations in the oral passageways may be severely diminished. In cases of Speech or Swallowing Disorders - both, happily, are relatively rare among MSers - there is little that can be done from pharmacologic standpoint, and the brunt of the work will involve management and rehabilitation. Speech language pathologists specialize in swallowing and speech problems, using such techniques as diet modification, special food preparation techniques, mouth and throat exercises, postural modification and muscle-retraining techniques, all of which at times can prove extremely effective. END