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Symptom: Primary (neurologic)


  • Overwhelming lassitude or tiredness at any time of day
  • Not correlated with activity level or quality and quantity of sleep
  • Often exacerbated by heat

Symptom: Secondary


  • Mood disorders-depression, anxiety
  • Stress
  • Commorbidities-acute (infection, injury) and chronic (diabetes, thyroid disorders)
  • Poor diet
  • Sleep disorders
  • Nocturia
  • Pain and spasticity
  • Decreased physical activity-muscle weakness and deconditioning
  • Environmental factors-temperature
  • Medication side effects

Psychosocial implications

  • Inability to carry out activities at home and at work (a major factor in early departure from the workforce and changes in family roles)
  • Fatigue of this magnitude affects mood and quality of life
  • Invisible symptom that is easily misinterpreted by others as laziness or disinterest


  • Address secondary contributing factors first
  • Physical therapy-energy conservation; moderate aerobic exercise; mobility aids
  • Occupational therapy-work simplification/energy conservation; nap schedule; use of assistive devices at home/work; cooling strategies/devices
  • Cognitive behavioral therapy-emerging evidence for decreased fatigue; is only sustained during treatment (van den Akker et al, 2016; van den Akker et al., 2017)
  • Medications for primary fatigue-amantadine, modafinil, armodafinil

Resources for clinicians

Resources for patients


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