MS - Treating multiple sclerosis

Treatment overview

There is no cure for MS, but treatments can relieve symptoms and reduce the number of relapses someone has.

If your symptoms are mild, you may not need treatment unless you experience a relapse.

Treatment for MS can be split into three main categories:

treatment for relapses of MS symptoms (steroids)
treatment for specific MS symptoms
treatment to reduce the number of relapses (disease-modifying medicines)

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Treatment for MS relapses

If you think you are having a relapse, you should see your GP or MS specialist nurse. Sometimes a flare up of symptoms can be caused by something other than a relapse, such as an infection, so your GP or nurse needs to check for other possible causes.

If your symptoms are the result of a relapse, you may be given a three to five day course of a high-dose steroid, called methylprednisolone, to help speed up your recovery. This can be given either orally as tablets, or intravenously (injected into a vein). You may receive the treatment in hospital or at home.

It's not fully understood how steroids speed up your recovery from a relapse, but they are thought to suppress your immune system so that it no longer attacks the myelin in your central nervous system. They may also help reduce the amount of fluid around any nerve fibre damage.

While steroids can be useful in helping you recover from a relapse, they do not affect the outcome of the relapse. They also do not alter the course of the disease or prevent further relapses.

As steroids may cause long-term side effects, such as osteoporosis (weak and brittle bones), weight gain and diabetes, you should not take them for more than three weeks at a time. Do not take more than three courses of treatment in a year.

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Multiple Sclerosis Trust: Steroids

Treatment for specific MS symptoms

If you have MS, you may have several different symptoms, which can vary in severity. There are treatments that can relieve each specific symptom, although some symptoms are more easily treated than others.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment. However, if your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with eye movement (nystagmus), you may be prescribed medication such as gabapentin, baclofen or clonazepam.

Muscle spasms and spasticity

Muscle spasms and spasticity can be improved with physiotherapy. Stretching movements can help prevent spasticity (stiffness). You may be referred to a physiotherapist trained in MS treatment if muscle spasms and spasticity are restricting your movements.

If your muscular spasms are more severe, you may be prescribed a medicine that can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which would be best for you with your GP or MS specialist nurse.

Read more information about specific medications on the multiple sclerosis medicines guide.

Medicines and physiotherapy may not be enough to control muscle spasms and spasticity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur as extreme skin sensitivity, or a burning sensation. This type of pain can be treated using the medicines gabapentin or carbamazepine, or with an antidepressant called amitriptyline.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and nerves in your body.

A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions.

If your pain is more severe, you may be prescribed painkillers or antidepressants (which can also help with pain). Alternatively, you may have a device that stimulates your nerve endings, known as a transcutaneous electrical nerve stimulation (TENS) machine.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity or muscle weakness. They can also be caused by problems with balance or dizziness.

The treatment you receive for your mobility problems will depend on what is causing them.

If you have mobility problems, it's best to try to prevent muscle spasms and spasticity in the first place with physiotherapy or medication (see above). Your muscles can tighten to the point where it's painful and difficult to move at all, which is known as a contracture.

If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help relax your muscles.

Muscle weakness can be helped by strengthening exercises or learning to compensate for weakness by using other muscles.

There are medicines, exercises and equipment that can relieve a tremor (ataxia) or dizziness caused by MS. These are available from your neurological rehabilitation team.

Cognitive problems (difficulty with thought and memory)

If you experience cognitive problems, any treatment you receive will be fully explained and recorded so that it's clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms. This could be a clinical psychologist. They may suggest treatment with an antidepressant. If you do not want antidepressants, learning techniques to control your emotions can help.

People with MS who have depression can be treated with antidepressants. If you often feel anxious or worried, your GP or neurologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. Clinical psychologists can help you with depression by using psychotherapy, such as cognitive behavioural therapy (CBT). If you have severe or persistent depression, you may be referred to a psychiatrist for further advice.

Fatigue and tiredness

Many people with MS experience extreme tiredness. Your GP or MS specialist nurse should assess this to see if there's another reason for your fatigue other than MS, such as medication or poor diet.

If your fatigue is caused by MS, you may be prescribed medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to manage fatigue, such as exercise and energy-saving techniques.

Bladder problems

If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine. This will help make the need to pass urine more predictable. If these medicines do not work, you may be prescribed a newer medicine called mirabegron. The need to pass urine frequently at night can be treated with a medicine called desmopressin.

If you have an underactive bladder that is not emptying properly, you may need to be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin, bladder exercises or electrical treatment for your bladder muscles.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. An enema involves having a liquid medication rinsed through your bottom and large bowel, which softens and flushes out your stools.

Bowel incontinence can be treated with anti-diarrhoea medication or by doing pelvic floor exercises to strengthen your rectal muscles.

Disease-modifying medicines

MS cannot be cured, but if you have relapsing remitting MS there are treatments that can reduce the number and severity of relapses. These treatments may also help slow the progression of MS, although research into their long-term effects is limited.

There are a number of different medicines available, depending on criteria such as the number of relapses you have had.

Disease-modifying medicines reduce the amount of damage and scarring to the myelin in your central nervous system, which cause MS relapses.

Disease-modifying medicines are not suitable for everyone with MS. They are only prescribed to patients with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) who meet certain criteria.

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Interferon beta

The types of interferon beta licensed for use in the UK are interferon beta-1a (Avonex and Rebif) and interferon beta-1b (Betaferon and Extavia). All four brands of interferon beta are given by injection.

You may be offered treatment with one of the interferon betas if you have had at least two relapses in the past two years. They can also be prescribed to people with secondary progressive MS who are still having relapses, as long as those relapses are the main cause of their increasing disability.

All interferons can cause mild side effects, such as flu-like symptoms (headaches, chills and mild fever) for 48 hours after they are injected. Interferon beta is not suitable for people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking interferon beta, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. Glatiramer acetate is injected under the skin every day. It does not usually cause any noticeable side effects, although in rare cases it may cause tightness in your chest. Glatiramer acetate is only licensed for use by people with relapsing remitting MS (RRMS).

You may be offered treatment with glatiramer acetate if you have had at least two relapses in the past two years.

Like interferon beta, glatiramer acetate is not suitable for people under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking glatiramer acetate, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Teriflunomide

Teriflunomide, branded as Aubagio, is an oral tablet taken once a day. It is generally well tolerated, although some people may have side effects including liver problems, nausea, headaches, diarrhoea, and hair thinning or loss.

You may be offered treatment with teriflunomide if you have had at least two relapses in the past two years.

Teriflunomide is not suitable for people with severe liver problems, people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking teriflunomide, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Natalizumab

Natalizumab, branded as Tysabri, is injected into a vein (intravenously) once every 28 days. It can cause several side effects, including headaches, nausea and vomiting, and an itchy rash. In rare cases, natalizumab has been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition that breaks down myelin on nerve fibres, in a similar way to MS. It can cause problems with vision and speech and, eventually, paralysis.

You may be offered treatment with natalizumab if you have had either:

an increase in the severity or number of relapses, despite treatment with one of the interferon betas or glatiramer acetate
two or more relapses in one year and an increase in lesions, shown on an MRI scan

Natalizumab is not suitable for people under the age of 18 or over the age of 65, people with cancer, or people with a weakened immune system, such as those who are HIV positive.

Fingolimod

Fingolimod, branded as Gilenya, is an oral tablet taken once a day. It is generally well-tolerated, although some people may experience side effects including an increased risk of infections, a problem with vision known as macular oedema, and liver problems. When you take the first dose of fingolimod, it can cause your heart rate to slow down or become irregular. Because of this you would take the first dose in hospital so you can be monitored.

You may be offered fingolimod if you are still having relapses despite treatment with one of the interferon betas.

Fingolimod is not suitable for people with certain heart problems, people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking fingolimod, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

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Clinical trials

Much progress has been made in MS treatment thanks to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you're asked to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

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Complementary and alternative therapies for MS

Some people with MS find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of MS. However, there is very little or no clinical evidence to show they are effective in controlling MS symptoms.

Many people think that complementary treatments have no harmful effects. However, they can be harmful and, as with any complementary or alternative treatment, it's never a good idea to use them instead of the medicines prescribed by your doctor. If you decide to use an alternative treatment along with your prescribed medicines, it's important to let your doctor know.

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Diet to modify MS

It has been suggested that a diet high in linoleic acid may reduce the duration and severity of MS relapses and slow the progression of the condition. However, there isn’t enough medical evidence to recommend this treatment.

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