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Multiple Sclerosis (cont.)

Medical Author:
Fernando Dangond, MD
Medical Editor:
Jay W. Marks, MD
Jay W. Marks, MD
Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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How are the physical manifestations of multiple sclerosis treated?

There are numerous medications that are used to manage complications associated with MS. The following table lists common complications, examples of drug and non-drug therapies, and comments about complications and/or management. Among these, only dalfampridine (Ampyra) has been approved by the FDA as a symptomatic (non-DMD) treatment for MS.

Multiple Sclerosis Complications with Examples of Drug and Nondrug Management*
Complication Drugs Nondrug Management and Comments
Difficulty walking (slowness) Dalfampridine (Ampyra) Dalfampridine (Ampyra) was FDA-approved in 2010 to improve walking in patients with MS. Physical therapy, orthotic equipment, and walking aids also may be of benefit.
Muscle spasticity Baclofen (Lioresal)
Tizanidine (Zanaflex)
Diazepam (Valium)
Clonazepam (Klonopin)
Dantrolene (Dantrium)
 Physical therapy also may provide benefit. Most drugs are given by mouth. Some drugs are given via spinal pumps.
Weakness None Physical therapy and exercise are used primarily. Foot braces, canes or walkers are of benefit.
Eye problems (acute optic neuritis) Methylprednisolone (Solu-Medrol) Solu-Medrol is given during the acute attack intravenously, sometimes followed by a corticosteroid by mouth.
Fatigue, emotional outbursts Antidepressants
Amantadine (Symmetrel) for fatigue;
Modafinil (Provigil) for fatigue 		Decrease or avoid physical activity and heat exposure. Amitriptyline is used for sudden laughing/weeping.
Pain Aspirin
Ibuprofen
Acetaminophen
Anticonvulsants
Antidepressants
 Aspirin, NSAIDs, acetaminophen, or physical therapy are used for muscle and back pain. Anticonvulsants, like carbamazepine (Tegretol) or gabapentin (Neurontin) are used for face or limb pain. Antidepressants or electrical stimulation are used for prickling pain, intense tingling, and burning. Referral to pain specialist is recommended with severe pain.
Bladder dysfunction Antibiotics
Vitamin C
Oxybutynin (Ditropan)
 Antibiotics are used to manage infections.
Vitamin C and cranberry juice are used to prevent infections.
Catheters are used to relieve retention of urine. Oxybutynin (Ditropan, Ditropan LX, Oxytrol) or tolterodine (Detrol, Detrol LA) is used for bladder dysfunction.
Constipation Increase fluids and fiber.
Sexual dysfunction Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Papaverine
Vaginal gels		 For males, erectile dysfunction drugs, papaverine, penile implant, or electrostimulation are used. For females, vaginal gels or a vibrating device are used.
Tremors Often resistant to treatment. Sometimes drugs or surgery are used if tremors are severe.
*This list is not exhaustive; most of the drugs listed below are used to treat multiple sclerosis symptoms even though they have not been FDA-approved for these particular purposes.
Reviewed by Jay W. Marks, MD on 4/16/2013

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