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Multiple Sclerosis Treatment & Management

Multiple sclerosis affects all aspects of the patient’s lives and can significantly reduce their quality of life. The complications that result from multiple sclerosis are multi-systemic.

Multiple Sclerosis Complications include:

Intractable tremors. Depression
Muscle spasms. Heat sensitivity
Chronic pain. Sexual dysfunction
Bladder dysfunction. Fatigue
Urinary Tract Infections.Cognitive deficits
Constipation/ Fecal incontinence

Here, we will briefly discuss the pharmacological and non-pharmacological management of each of them.

Intractable tremors: are a common symptom in MS patients. They can be managed by use of devices like weights on the hands, deep brain stimulation, or surgery of the Thalamus in the brain. Pharmacotherapy includes the use of anticonvulsants like Clonazepam. Other drugs that have been used are Mysoline, Ondansetron, and Propranolol.

Muscle spasms: may also be present and are treated by encouraging the patients to participate in exercise and stretching regularly. Other treatments such as physiotherapy and occupational therapy have been shown to be of benefit. Drugs used to reduce spasticity include Diazepam (Valium), Baclofen, Dantrolene, and Tizanidine. These are skeletal muscle relaxing agents.

Pain: is another primary symptom MS patients will experience over a prolonged period. It is managed using anticonvulsants, tricyclic antidepressants, and anti-arrhythmic agents. These include agents like gabapentin, phenytoin and carbamazepine 100 -1000 milligrams per day. Weakness often occurs and is managed using potassium channel blockers such as 4-aminopyridines.

Bladder dysfunction: often occurs and is managed by restriction of fluids during evening hours, advising the patients to void their bladders frequently, and encouraging pelvic floor exercises (Kegels). If these measures fail, drugs like propantheline bromide and oxybutynin have been used successfully in conjunction with pseudoephedrine. Urinary tract infections are common due to increased residual volumes after voiding. They can be treated by encouraging intake of acidic fluids like orange juice and cranberry juice that have been shown to lower the pH of urine and as a result, prevent the proliferation of bacteria. Prophylactic antibiotics can also be administered as well as draining the urine intermittently via urinary catheters.

Constipation or fecal incontinence: In the case of constipation, the management involves increasing fluid and fiber intake, stool softeners, and the use of laxatives when needed. Fecal incontinence can be reduced by limiting the amount of fiber in the patient’s diet.

Depression: may result from the impact of the disease on the patient’s life. A diagnosis of multiple sclerosis may cause the patient to feel hopeless or like they are no longer useful to their families. Some may even have suicidal thoughts. This can be managed by counseling of the individual or recommending they see a psychiatrist or psychologist. Other methods of management would include group therapy as well as encouraging the patient to join a support group so they can learn from other people dealing with the same condition. Drugs that are used for management of depression include Fluoxetine (Prozac), Sertraline and Amitriptyline.

Heat sensitivity: occurs due to nerve dysfunction in multiple sclerosis as well as the inflammatory processes involved. This can be managed by avoiding heat, cooling using ice packs, and having an air conditioner in the room.

Sexual dysfunction: may occur as sequelae of the nerve dysfunction as well as the psychological and physical impact of the disease. It can be managed by use of lubricants and sexual aids during sexual intercourse and drugs such as sildenafil (Viagra).

Fatigue: may occur in conjunction with the muscle spasticity or as an isolated phenomenon. Its effect on the patient’s life can be reduced if they have help around the house and don’t have to perform many tasks. Alternatively, stimulants such as methylphenidate can be used.

Cognitive problems: can effect patients with multiple sclerosis. This may present as memory lapses and reduced attention spans. Drugs that increase the neurotransmitters in the brain such as Donepezil have been shown to be beneficial.

Many of the patients suffering from multiple sclerosis suffer from permanent disabilities such as motor paralysis and blindness that result in the inability to go about their daily activities and as a result, the majority end up losing their source of livelihood once the diagnosis is arrived at. It is important for these patients to have social support systems that enable them to live their lives free off wondering where their next meal will come from or how their children will get school fees. Professional help exists in the form of occupational therapists that train them to enable the maximal use of the motor function left as well as therapists who enable them to change their outlook on life and improve their quality of life.

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