Multiple Sclerosis: Treatment

Although there is no known cure for MS, the following treatments are used, with limited efficacy:

Corticosteroids may be used to treat acute attacks. They have not been shown to affect the functional outcome of the exacerbation, but they do hasten any eventual recovery. A typical regimen would include intravenous methylprednisolone for five days, followed by a short course of prednisone taper. It is not clear whether oral prednisone can replace intravenous methylprednisolone, and a study of patients with optic neuritis suggests that oral treatment may be detrimental.^19,20

A relapsing–remitting diagnosis warrants the use of interferon or glatiramer acetate. Interferon is available as beta 1b and beta 1a. The drug choice depends on an individualized risk–benefit assessment for each patient. Interferon use is limited by its potential to create neutralizing antibodies, which are thought to decrease efficacy.

No therapy has been proven to affect the course of primary progressive disease although clinical trials are evaluating several immune suppressant medications.

Secondarily progressive disease can be treated with immunosuppressants, such as methotrexate, cyclosporine, azathioprine, cyclophosphamide, interferon, and steroids. Long–term use of immunosuppressants may be limited by the increased risks of infections or malignancy.

Mitoxantrone is approved by the U.S. Food and Drug Administration (FDA) for the treatment of secondarily progressive MS and appears to be beneficial in slowing progression. However, its potential for cardiac toxicity limits the total lifetime dose and requires vigilant cardiac monitoring.

Paroxysmal symptoms, such as spasms, sensory deficits, dysarthria/ataxia, and pain disorders, have shown some response to anticonvulsants, such as valproic acid, carbamezepine, and gabapentin. Seizures, while not a common symptom of MS, are more common than in the general population.

Several medications, including benzodiazepines, baclofen or tizanidine, may reduce muscle spasticity and, especially, painful spasms.

Modafinil or amantidine may help symptoms of fatigue.

Bladder spasticity may be treated with anticholinergic or other bladder antispasmodic medications. In cases of bladder dysynergia, these medications can cause urinary retention.

Physiotherapy may improve movement, but benefits are usually short–lived.

Other symptoms of the disease, including pain, depression, and fatigue, can be treated by symptom–specific therapy.

Interferon beta 1a has shown some benefit with regard to preserving cognitive function in patients with relapsing–remitting MS.²¹

Statins, normally used to lower cholesterol, may have benefit in MS, but human studies are needed.

Cannabis and similar pharmaceutical agents have shown inconsistent results.