Treatments for Symptoms of Multiple Sclerosis

How do doctors treat the symptoms of MS?

MS causes a variety of symptoms that can interfere with daily activities but which can usually be treated or managed to reduce their impact. Many of these issues are best treated by neurologists who have advanced training in the treatment of MS and who can prescribe specific medications to treat the problems.

Vision Problems

Eye and vision problems are common in people with MS but rarely result in permanent blindness. Inflammation of the optic nerve or damage to the myelin that covers the optic nerve and other nerve fibers can cause a number of symptoms, including blurring or graying of vision, blindness in one eye, loss of normal color vision, depth perception, or a dark spot in the center of the visual field (scotoma).

Uncontrolled horizontal or vertical eye movements (nystagmus) and "jumping vision" (opsoclonus) are common to MS, and can be either mild or severe enough to impair vision.

Double vision (diplopia) occurs when the two eyes are not perfectly aligned. This occurs commonly in MS when a pair of muscles that control a specific eye movement aren't coordinated due to weakness in one or both muscles. Double vision may increase with fatigue or as the result of spending too much time reading or on the computer. Periodically resting the eyes may be helpful.

Weak Muscles, Stiff Muscles, Painful Muscle Spasms and Weak Reflexes

Muscle weakness is common in MS, along with muscle spasticity. Spasticity refers to muscles that are stiff or that go into spasms without any warning. Spasticity in MS can be as mild as a feeling of tightness in the muscles or so severe that it causes painful, uncontrolled spasms. It can also cause pain or tightness in and around the joints. It also frequently affects walking, reducing the normal flexibility or “bounce” involved in taking steps.

Tremor

People with MS sometimes develop tremor, or uncontrollable shaking, often triggered by movement. Tremor can be very disabling. Assistive devices and weights attached to limbs are sometimes helpful for people with tremor. Deep brain stimulation& and drugs such as clonazepam also may be useful.

Problems with walking and balance

Many people with MS experience difficulty walking. In fact, studies indicate that half of those with relapsing-remitting MS will need some kind of help walking within 15 years of their diagnosis if they remain untreated. The most common walking problem in people with MS experience is ataxia—unsteady, uncoordinated movements—due to damage with the areas of the brain that coordinate movement of muscles. People with severe ataxia generally benefit from the use of a cane, walker, or other assistive device. Physical therapy can also reduce walking problems in many cases.

In 2010, the FDA approved the drug dalfampridine to improve walking in patients with MS. It is the first drug approved for this use. Clinical trials showed that patients treated with dalfampridine had faster walking speeds than those treated with a placebo pill.

Fatigue

Fatigue is a common symptom of MS and may be both physical (for example, tiredness in the legs) and psychological (due to depression). Probably the most important measures people with MS can take to counter physical fatigue are to avoid excessive activity and to stay out of the heat, which often aggravates MS symptoms. On the other hand, daily physical activity programs of mild to moderate intensity can significantly reduce fatigue. An antidepressant such as fluoxetine may be prescribed if the fatigue is caused by depression. Other drugs that may reduce fatigue in some individuals include amantadine and modafinil.

Fatigue may be reduced if the person receives occupational therapy to simplify tasks and/or physical therapy to learn how to walk in a way that saves physical energy or that takes advantage of an assistive device. Some people benefit from stress management programs, relaxation training, membership in an MS support group, or individual psychotherapy. Treating sleep problems and MS symptoms that interfere with sleep (such as spastic muscles) may also help.

Pain

People with MS may experience several types of pain during the course of the disease.

Trigeminal neuralgia is a sharp, stabbing, facial pain caused by MS affecting the trigeminal nerve as it exits the brainstem on its way to the jaw and cheek. It can be treated with anticonvulsant or antispasmodic drugs, alcohol injections, or surgery.

People with MS occasionally develop central pain, a syndrome caused by damage to the brain and/or spinal cord. Drugs such as gabapentin and nortryptiline sometimes help to reduce central pain.

Burning, tingling, and prickling (commonly called "pins and needles") are sensations that happen in the absence of any stimulation. The medical term for them is dysesthesias" They are often chronic and hard to treat.

Chronic back or other musculoskeletal pain may be caused by walking problems or by using assistive aids incorrectly. Treatments may include heat, massage, ultrasound treatments, and physical therapy to correct faulty posture and strengthen and stretch muscles.

Problems with Bladder Control and Constipation

The most common bladder control problems encountered by people with MS are urinary frequency, urgency, or the loss of bladder control. The same spasticity that causes spasms in legs can also affect the bladder. A small number of individuals will have the opposite problem—retaining large amounts of urine. Urologists can help with treatment of bladder-related problems. A number of medical treatments are available. Constipation is also common and can be treated with a high-fiber diet, laxatives, and other measures.

Sexual Issues

People with MS sometimes experience sexual problems. Sexual arousal begins in the central nervous system, as the brain sends messages to the sex organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response—including arousal and orgasm—can be directly affected. Sexual problems may also stem from MS symptoms such as fatigue, cramped or spastic muscles, and psychological factors related to lowered self-esteem or depression. Some of these problems can be corrected with medications. Psychological counseling also may be helpful.

Depression

Studies indicate that clinical depression is more frequent among people with MS than it is in the general population or in persons with many other chronic, disabling conditions. MS may cause depression as part of the disease process, since it damages myelin and nerve fibers inside the brain. If the plaques are in parts of the brain that are involved in emotional expression and control, a variety of behavioral changes can result, including depression. Depression can intensify symptoms of fatigue, pain, and sexual dysfunction. It is most often treated with selective serotonin reuptake inhibitor (SSRI) antidepressant medications, which are less likely than other antidepressant medications to cause fatigue.

Inappropriate Laughing or Crying

MS is sometimes associated with a condition called pseudobulbar affect that causes inappropriate and involuntary expressions of laughter, crying, or anger. These expressions are often unrelated to mood; for example, the person may cry when they are actually very happy, or laugh when they are not especially happy. In 2010 the FDA approved the first treatment specifically for pseudobulbar affect, a combination of the drugs dextromethorphan and quinidine. The condition can also be treated with other drugs such as amitriptyline or citalopram.

Cognitive Changes

Half -to three-quarters of people with MS experience cognitive impairment, which is a phrase doctors use to describe a decline in the ability to think quickly and clearly and to remember easily. These cognitive changes may appear at the same time as the physical symptoms or they may develop gradually over time. Some individuals with MS may feel as if they are thinking more slowly, are easily distracted, have trouble remembering, or are losing their way with words. The right word may often seem to be on the tip of their tongue.

Some experts believe that it is more likely to be cognitive decline, rather than physical impairment, that causes people with MS to eventually withdraw from the workforce. A number of neuropsychological tests have been developed to evaluate the cognitive status of individuals with MS. Based on the outcomes of these tests, a neuropsychologist can determine the extent of strengths and weaknesses in different cognitive areas. Drugs such as donepezil, which is usually used for Alzheimer’s disease, may be helpful in some cases.

Complementary and Alternative Therapies

Many people with MS use some form of complementary or alternative medicine. These therapies come from many disciplines, cultures, and traditions and encompass techniques as different as acupuncture, aromatherapy, ayurvedic medicine, touch and energy therapies, physical movement disciplines such as yoga and tai chi, herbal supplements, and biofeedback.

Because of the risk of interactions between alternative and more conventional therapies, people with MS should discuss all the therapies they are using with their doctor, especially herbal supplements. Although herbal supplements are considered "natural," they have biologically-active ingredients that could have harmful effects on their own or interact harmfully with other medications.