As yet there is no cure for MS but there are facets of the disease which have recognised treatments and which can be very effective.

Exacerbations

The standard treatment for significant acute exacerbations is the use of steroids, which exert powerful anti-inflammatory effects. Steroids reduce inflammation at the site of new demyelination, allowing return to normal function to occur more rapidly and reducing the duration of the exacerbation. The current favoured steroid regimen is methyl-prednisolone given intravenously in high doses for 3-5 days with, perhaps, subsequent tapering lower oral doses of prednisone for 1-2 weeks. The use of steroids are not thought to have any effect on the long-term course of the disease.

Altering the course of the disease

A number of new drugs have recently been approved for use in MS which have some effect on the frequency and severity of exacerbations and the number of lesions as seen on MRI, though the effect on progression of disability remains unclear.

v      General Disease Modifying Therapies

Ø       Glatiramer acetate (Copaxone®)

Ø       Interferon beta-1a (Avonex®)

Ø       Interferon beta-1a (Rebif®)

Ø       Interferon beta-1b (Betaseron® or Betaferon®)

Ø       Mitoxantrone (Novantrone®)

Ø       Natalizumab (Tysabri®)

v      Acute Exacerbations

Ø       Dexamethasone (Decadron®)

Ø       Methylprednisolone (Depo-Medrol®)

Ø       Prednisone (Deltasone®)

The US National MS Society website and the Canadian MS Society website includes a useful comparison between the disease modifying drugs for MS.

Symptom Specific Treatment

For many of the symptoms that occur in MS, effective treatments are available.  It is important, however, that careful diagnosis and repeated symptom evaluation is undertaken together with a competent physician (GP, neurologist or other specialists such as urologists, gynaecologists etc).  

v     Spasticity

Ø      Baclofen (Lioresal®)

Ø      Clonazepam (Klonopin® or Rivotril ®)

Ø      Dantrolene (Dantrium®)

Ø      Diazepam (Valium®)

Ø      Gabapentin (Neurontin®)

Ø      Tizanidine (Zanaflex®)

v     Tremor

Ø      Clonazepam (Klonopin® or Rivotril ®)

Ø      Isoniazid (Laniazid®)

v     Fatigue

Ø      Amantadine

Ø      Fluoxetine (Prozac®)

Ø      Modafinil (Provigil®)

Ø      Pemoline (Cylert®)

v     Bladder Dysfunction

Ø      Ciprofloxacin (Cipro®)

Ø      Desmopressin (DDAVP Nasal Spray®)

Ø      Imipramine (Tofranil®)

Ø      Methenamine (Hiprex, Mandelamine®)

Ø      Nitrofurantoin (Macrodantin®)

Ø      Oxybutynin (Ditropan®)

Ø      Oxybutynin: extended release formula (Ditropan XL®)

Ø      Phenazopyridine (Pyridium®)

Ø      Propantheline bromide (Pro-Banthine®)

Ø      Sulfamethoxazole (Bactrim® or Septra®)

Ø      Tolterodine (Detrol®)

v     Bowel Dysfunction

Ø      Bisacodyl (Dulcolax®)

Ø      Docusate (Colace®)

Ø      Docusate mini enema (Therevac Plus®)

Ø      Glycerin (Sani-Supp supository ®)

Ø      Magnesium hydroxide (Phillips’ Milk of Magnesia®)

Ø      Mineral oil

Ø      Psyllium hydrophilic mucilloid1 (Metamucil®)

Ø      Sodium phosphate (Fleet Enema®)

v     Sexual Dysfunction

Ø      Alprostadil (Prostin VR®)

Ø      Alprostadil (MUSE®)

Ø      Papaverine

Ø      Sildenafil (Viagra®)

v     Pain

Ø      Amitriptyline (Elavil®)

Ø      Carbamazepine (Tegretol®)

Ø      Clonazepam (Klonopin® or Rivotril ®)

Ø      Gabapentin (Neurontin®)

Ø      Imipramine (Tofranil®)

Ø      Nortriptyline (Pamelor® or Aventyl ®)

Ø      Phenytoin (Dilantin®

v     Cognitive, Psychiatric and Psychological Dysfunction

Ø      Bupropion (Wellbutrin®)

Ø      Fluoxetine (Prozac®)

Ø      Paroxetine (Paxil®)

Ø      Sertraline (Zoloft®)

Ø      Venlafaxine (Effexor®)

v     Vertigo & Dizziness

Ø      Meclizine (Antivert ® or Bonamine ®)

v     Temperature Sensitivity & Paroxysmal itching

Ø      Hydroxyzine (Atarax®)

v     Nausea; Vomiting

Ø      Meclizine (Antivert ® or Bonamine ®)

Rehabilitation and Management

While it may not be possible to improve all lost function, all people with MS should try to optimise their physical, mental and social condition. After an exacerbation there may be the need for restorative rehabilitation.  During remission periods people with MS should participate in a maintenance therapy programme to achieve and sustain their optimum physical condition. This may involve physiotherapy, stretching, coordination exercises, speech and swallowing instruction.  It may also include medication, good nutrition and counselling.  There may be the need for lifestyle changes (both social and occupational).