What is your treatment approach for multiple sclerosis related fatigue?

I generally recommend optimizing any non-pharmacologic interventions first. Exercise, making sure there is no sleep issue, treating comorbid depression. A recent trial suggests a lack of benefit for amantadine, methylphenidate, and modafinil. I find that in general, they don’t make much of an impact like the study suggests. I do have individual patients that have responded very well to some of the above treatments so I will still utilize them at times for certain patients.

Nourbakhsh et al., PMID...

Half of my patients respond to Amantadine 100 mg BID 5 days a week. If they don't respond in a month I stop it. I agree with exercise, light weights, stretching, walking when possible,a range of vitamins and supplements-alpha lipoic acid, E, D, and B-complex, yoga, and pilates-when possible. I simply try to get them active.