Cog Fog - Questions and Answers

By benelisofon

3 min read

I just finished Devin's article all about his struggles with cog fog or technically known as MS related cognitive fatigue. This is a well written and very informative section. Thanked for sharing! 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 this very disabling symptom.

Used Cylert to manage my cognitive fatigue

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.

Switched to Ritalin and Adderall

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 the advice of my current neurologist. I take this at 630a & 11a. This lasts most of the day without issue.

Not sure what I would do without this medication

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.

Cognitive fatigue studies

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.

Vyvanse

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."

ADHD treatments for MS cognitive fatigue

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.

ADHD stims

Here's a 2012 study taking about ADHD stims for cognitive fatigue.

Ritalin for physical MS 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.

MS-related cog fog

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.

Ben E.

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DonnaFA Member
Hi Ben, We're glad to have you as part of the community and we very much appreciate you sharing your story and all the wonderful knowledge you have gathered along your journey. We're also very glad to hear that you enjoyed the article and maybe have added it to your arsenal! Thanks for taking the time to comment! -Warmly, Donna (MultipleSclerosis.net team)
ummshaya Member
Hello, I was diagnosed in Dec of '09. I have been off all meds since early 2011. In remission since then. The only major problem I've had is the cog fog, everything else I can manage no problem. My son has ADHD and has been taking vyvance for several years and it really helps him. So one day I took one (yes I know, not smart) to see how clearly he sees with it. Well within 40 minutes I was up making beds, doing laundry, cleaning bathrooms, and playing with the kids all at the same time! The fog was lifted and I felt like a champion! No joke. This is what I have needed for years now! That MS fog is so hard to beat, sometimes I don't even know why I get out of bed. I feel like a hopeless lump that cannot accomplish anything. Until now! The problem is that I can't get it prescribed for me, and I have moved to Kuwait where controlled drugs are not readily available. Anyway, vyvance yes cog fog no. Thanks Ash
1. b2468 Member
 That's fantastic that the Vyvanse worked so well. Are you still using this?
b2468 Member
There is also adderall, ritalin and a few other options for adhd meds. Are any available to you? Tell your son's Doctor about your experience and ar if they will prescribe this for you. Good luck!!
Therry Neilsen Moderator & Contributor
I'm coming to this article six years later. I've recently been following up on suggestions that I might be ADHD. My neurologist prescribed Adderall, and I've been trying to work out an effective dose. It's surprisingly comforting to learn that ADHD can present as part of the panoply of symptoms that make up one's individual version of MS. I have an appointment in September to be evaluated for ADHD by a neuropsychologist, and I want to go into the appointment well prepared, with detailed observational notes. It's a good thing my personal motto is " The unexamined life is. Not worth living. The only other observation I want to note is that I'm 76. I feel like I have about 15 years to finish all the projects I started and never finished. 
1. Alene L. Brennan, RYT Moderator & Contributor
 <inline-mention username="Therry Neilsen" user-id="4095618"/> I'm sorry to hear that dealing with these new symptoms. That said, I'm glad that you found this article here to offer some guidance and support. It's great to hear that you have an appointment on the calendar for an evaluation, although September certainly is a long ways off. Is here an opportunity to get on a cancelation list? Best Alene, moderator