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MS fatigue — SCE Neurology MCQ

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HardMSMS fatigueSCE Neurology

A person with stable multiple sclerosis has disabling fatigue. Infection, anaemia, thyroid disease, sleep disorder, medication sedation and depression have been addressed, and there is no clinical relapse. What is the preferred next management approach?

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Correct answer: A — Energy-management and supervised-exercise programme for MS fatigue

The best answer is “Energy-management and supervised-exercise programme for MS fatigue”. After secondary causes are addressed, NICE supports collaborative fatigue management, including pacing or energy conservation and aerobic, resistance or balance exercise matched to ability. “Disease-modifying therapy escalation for persistent fatigue symptoms” is less appropriate because fatigue alone without inflammatory activity does not demonstrate DMT failure “Repeated high-dose methylprednisolone for fatigue without relapse” is less appropriate because steroids expose the patient to harm without a defined relapse “Prolonged bed rest to reduce neurological energy demand” is less appropriate because deconditioning can worsen fatigue and participation “Annual MRI surveillance as the principal fatigue intervention” is less appropriate because surveillance imaging does not itself treat fatigue or functional goals

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