I just joined multiplesclerosis.net and was looking around. This is a well written and chock full of interesting information. I was curious though, as to why there was no mention of using ADHD stimulants like Ritalin, Adderall, Concerta or Vyvanse for the treatment of MS related cognitive fatigue. I have been living with this very disabling symptom since my diagnosis in April '94.
I have been dx since 4/94 with RRMS. I have rather significant cognitive fatigue issues from my MS.... 2+2 do not = 4. It took me 2 years to convince my neurologist to let me try Cylert for this. 18.75 mg tablets used for ADHD for many many years. It was like night and day. The fog burned off and life was real time again as opposed to being 2-3 steps behind on everything.
When it got pulled off the market in '04, I shifted over to Ritalin. 20 mg 3x per day...6a, 1030a & 3p. The Ritalin lasts about 6-7 hours so by the time the first dose was wearing off, the next dose was working. About 1 1/2 years ago, I tried Adderall 2x per day on advice of my current neurologist. I take this at 630a & 11a. This lasts most of the day without issue.
I do not know what I would do without this medication. I could not keep track of my life, take part in a 3 way conversation or put together a coherent argument on something. For more info, do a Google search on Ritalin or Adderall and ms cognitive fatigue. You find some postings from different sources as well as many that I have put up asking why this has not been studied further. They are doing 2x studies, one with Vyvanse and another with a new medication labeled C105 for MS cognitive fatigue. They are both being run out of the University of Buffalo.
Besides my personal experiences, here is a link to a paper written by the folks at the University of Buffalo entitled "Lisdexamfetamine dimesylate (Vyvanse) improves processing speed and memory in cognitively impaired MS patients: a phase II study" from 2012.
The first paragraph reads as follows:
Multiple sclerosis (MS) causes cognitive impairment including slowed processing speed and problems with learning and memory. Stimulants are attractive candidates for improving mental speed but carry risk of addiction and other adverse behavioral effects. Lisdexamfetamine dimesylate (LDX) is a d-amphetamine prodrug currently approved for attention deficit (hyperactivity) disorder with the potential to be better tolerated due to its prolonged clinical effect. This phase II placebo-controlled, double-blind study aimed to assess the safety and efficacy of LDX in cognitively impaired MS patients.
Here's an interesting presentation on MS related cognitive fatigue from 2014 MS Society in Alberta, Canada. Take a look at page 23 of this document. It talks about how amphetamines that are used to treat ADHD (Ritalin, Vyvanse, Adderall, Concerta) seem to work / are effective for treating MS related cognitive fatigue.
Here's a 2012 study taking about ADHD stims for cognitive fatigue.
Here's a National Multiple Sclerosis Society paper, while it is for physical fatigue, talks about how Ritalin can be used for treatment of MS Fatigue.
Please feel free to look into this pathway for treatment of MS related Cog Fog. There is quite a bit of information out there that many doctors and patients just do not know about. If anyone has ANY questions or comments on this, please don't hesitate to let me know. I will be more than happy to share what I know as well as other sources of information on this.
Thank you for reading this far. I do appreciate it. I hope it is useful to you. Have a great day.