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MS – Fatigue Management — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Fatigue ManagementSCE Neurology

A 39-year-old with relapsing–remitting MS requests modafinil for 6 weeks of worsening fatigue. There are no new focal neurological signs, but nocturia has increased, baclofen was recently up-titrated, sleep is unrefreshing and mood has fallen. What is the most appropriate next step?

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Correct answer: D — Assess sleep, nocturia, mood, recent medicines, infection, anaemia and thyroid function before attribution

NICE cautions against assuming that fatigue is caused by MS. Because this patient has several credible contributors, assessment should cover sleep disorder, bladder disturbance, a sedating medicine change and depression, alongside infection, anaemia and thyroid dysfunction. Only after reversible factors are addressed should MS-specific fatigue strategies or a drug trial be selected. Fatigue without objective new neurological findings does not by itself establish a relapse or justify corticosteroids.

Reference: NICE NG220: Multiple sclerosis in adults — recommendations. https://www.nice.org.uk/guidance/ng220/chapter/Recommendations