Tomassini, Valentina, Pozzilli, Carlo, Onesti, Emanuela et al. · Journal of the neurological sciences · 2004 · DOI
This study compared two drugs used to treat fatigue: acetyl L-carnitine (ALCAR) and amantadine. Thirty-six people with multiple sclerosis who experienced fatigue took each drug for 3 months in turn, with a break between treatments. ALCAR was found to work better than amantadine at reducing fatigue severity, and fewer people stopped taking it due to side effects.
Although this study focuses on MS rather than ME/CFS, it is relevant because acetyl L-carnitine was previously shown to help fatigue in chronic fatigue syndrome patients. Understanding which fatigue-treatment options work better and with fewer side effects may inform approaches applicable to ME/CFS, where treatment options are currently limited.
This study does not establish whether ALCAR works for ME/CFS fatigue, as it enrolled only MS patients with different pathophysiology. The small sample size (36 participants, with 6 withdrawals) limits generalizability. It does not explain the biological mechanism by which ALCAR reduces fatigue or determine optimal dosing.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Tomassini, Valentina, Pozzilli, Carlo, Onesti, Emanuela, Pasqualetti, Patrizio, Marinelli, Fabiana, Pisani, Angela, et al. (2004). Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial.. Journal of the neurological sciences. https://doi.org/10.1016/j.jns.2003.11.005
BibTeX
@article{mecfsatlas-tomassini-2004-comparison-effects,
author = {Tomassini, Valentina and Pozzilli, Carlo and Onesti, Emanuela and Pasqualetti, Patrizio and Marinelli, Fabiana and Pisani, Angela and Fieschi, Cesare},
title = {Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial.},
journal = {Journal of the neurological sciences},
year = {2004},
doi = {10.1016/j.jns.2003.11.005},
note = {PubMed: 14759641},
url = {https://www.mecfsatlas.com/evidence/tomassini-2004-comparison-effects},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/tomassini-2004-comparison-effects
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