Clinical trials indicate efficacy for multiple nonpharmacologic treatments in alleviating physical and mental fatigue associated with MS. These include neuromodulation (transcranial direct current stimulation, functional electric stimulation, and pulsed magnetic field therapy), exercise, and cold therapy (not heat). The results of clinical trials of pharmacologic treatments are less clear. ALCAR, amantadine, dalfampridine, and modafinil have demonstrated efficacy in some trials but not others. Methylphenidate and botulinum toxin injections have not demonstrated efficacy in clinical trials.

References:
Zielińska-Nowak E et al. J Clin Med. 2020;9:3592.