Treatment of symptoms in MS

It is important to emphasize that symptoms of MS are best treated first by finding a therapy which reduces new injuries to the nervous system. However, many treatments are available to help diminish individual symptoms arising from MS. Fatigue, the most common symptom, is often difficult and requires many attempts at treatment. First, the quality of night time sleep is examined. If one does not awake feeling rested, usually the night time sleep is disturbed. Trouble getting to sleep is often helped by a sleep aid, while trouble staying asleep in the middle or latter part of the night usually responds to antidepressant medications. Individuals who snore, or have leg movements frequently, may have very disturbed sleep efficiency resulting in poorly restful sleep.

The most common fatigue in MS is excessive mid or later day fatigue. This may respond to stimulant therapies. An older stimulant, amantadine, or a newer nonnarcotic stimulant called Provigil, are proven therapies in MS. Stronger stimulants of the amphetamine family are sometimes used but require much closer supervision.

Painful sensations are common, and may respond to a variety of medications, including certain antidepressant medications such as venlafaxine or nortriptyline, anti-seizure medications such as gabapentin or carbamazepine, and nonnarcotic pain killers such as tramadol. Rarely high dose narcotic medication may be helpful, but this usually must be conducted under close supervision.

Vertigo sensations often respond to small doses of medication in the Valium family, and also to medication to deal with the nausea or motion sickness which may result. Vertigo also can be effectively treated by exercises.

Bladder dysfunction is of multiple types and can be difficult to diagnose or treat. Failure the empty to bladder, or continually keeping large amounts of urine can lead to infection and kidney injury. This may respond to medication to relax the valve on the bladder, but is also treated by self catheterization, a simple procedure of inserting a tube in the bladder to achieve effective drainage. A more common problem is urinary urgency or overactive bladder, in which the reflex to empty the bladder is overactive and not entirely under voluntary control. Antispasmodic medication for the bladder can reduce this, but can lead to difficulty emptying in some cases. Loss of urine involuntarily, or urinary incontinence, can occur for either because of failing to empty or from overactive reflexes, and in addition in women can be due to a weak pelvic floor from prior surgery or childbirth.

Depressed mood a common occurrence in MS and presumably occurs because of damage to nerve cells which make chemicals to produce normal mood. These symptoms include changes in drive, loss of pleasure, changes in appetite, irritability, changes in sleep, and a sense of guilt, hopelessness, or desire to die. It is usually effectively treated and kept away by antidepressant medication. Depression is sometimes worsened by interferon treatment, but usually does not require stopping medication.

Sexual dysfunction can occur in MS for many reasons, too extensive to go into in a brief discussion. Many of these problems are treatable.

Spasticity refers to overactive reflexes causing stiffness or involuntary movements. This occurs when loss of voluntary control over a limb is a problem. A leg may stiffen or jerk, move slowly, or tremor uncontrollably as the reflexes fight each other. Pills are available which dampen these reflexes, and injections and surgery are available for controlling this problem when severe.

Tremor can occur in some individuals, often in the head or hands. Medication can diminish this, or in rare cases brain surgery.

Trouble with walking or balance may require aids and special training to use them to assist one in doing daily activities.