Ask the Doc: Q & A with Edward Kasarskis, MD, PhD 

Dr. Kasarskis

Edward Kasarskis, MD, PhD is Director of the University of Kentucky ALS Multidisciplinary Clinic at Cardinal Hill Rehabilitation Hospital in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Q: Can fatigue make ALS worse?

Dr. Kasarskis: That’s actually a more complicated question than it may seem, depending on what you mean by the word “fatigue.” Do you mean the inability to sustain a muscular contraction the feeling that you can’t physically do what you used to be able to do? Or perhaps you’re referring to malaise, that “blah” feeling?

People with ALS have weakened muscles without any reserve capacity. That means the muscles are less effective, which is recognized as fatigue. You may find you hit a wall a lot sooner than you have experienced before. Typically, when you generate force in a muscle, you increase its strength by stimulating the nerve cells in the spinal cord (the spinal motor neurons) to fire more rapidly or by stimulating more nerve cells to fire. This natural process is hindered in ALS because you have fewer neurons, and therefore you will have trouble generating the force you want or need. Muscles will get physically tired sooner. Basically, we all have a physical limit and with ALS you reach your limit sooner than before you developed the disease.

You need to pace yourself and acknowledge your limits. Save your energy for what you most need or want to do. And don' hesitate to use tools to extend your abilities. Roofers use power air hammers, not hand hammers, to maximize their ability to do a job. Like them, you can use tools that will help you be more successful in performing tasks. Talk with an Occupational Therapist or a Physical Therapist about what options are available to minimize our fatigue and extend your capabilities.

Each issue we feature a leading neurologist specializing in ALS responding to a question. If you would like to submit questions for a future Q & A, please send your questions to Amber Walters. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.