Multiple sclerosis - Treatment 

Contact your specialist MS nurse or GP if you think you're having a relapse.

A flare up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.

Treatment for a relapse usually involves either:

• a five-day course of steroid tablets taken at home
• injections of steroid medication given in hospital for three to five days

Steroids can help speed up your recovery from a relapse, but they don't prevent further relapses or stop MS getting worse over time.

They are only given for a short period of time to avoid possible steroid side effects, such as osteoporosis (weak bones), weight gain and diabetes, although some people will still experience problems.

Not using steroids more than three times a year (if possible) will also help to reduce the risk of side effects.

Want to know more?

• MS Trust: steroids
• MS Society: treatments

MS can cause a range of symptoms that can be treated individually. Treatments for some of the main symptoms are outlined below.

Fatigue

Many people with MS experience fatigue.

For fatigue caused by MS, you may be prescribed amantadine, although this medication may only have a limited effect. You should also be given general advice on ways to manage fatigue, such as exercise, keeping healthy sleep patterns, energy-saving techniques and avoiding medications that can worsen fatigue (including some painkillers).

Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), can also help some people with MS cope with their fatigue.

Visual problems

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

If you have problems with involuntary eye movements, medication such as gabapentin can sometimes help. Some people with double vision need help from ophthalmologists (eye specialists).

Muscle spasms and stiffness

Muscle spasms and stiffness (spasticity) can be improved with physiotherapy. Techniques such as stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. 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 of these would be best for you with your specialist MS nurse or GP.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity (see above), but they can also be caused by muscle weakness, or problems with balance or dizziness.

If you have problems with mobility, you might benefit from:

• an exercise programme supervised by a physiotherapist
• special exercises called vestibular rehabilitation, if you have problems with balance
• medication for dizziness or tremors
• mobility aids, such as a walking stick, or occasionally a wheelchair
• home adaptations such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations that may be of help.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation.

This type of pain can be treated using the medicines gabapentin or carbamazepine, or with a medication called amitriptyline. This is an older type of antidepressant, but these days it's mainly used for pain control.

Musculoskeletal pain

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

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

If your pain is more severe, you may be prescribed painkillers. Alternatively, you may have a device that stimulates your nerves, called as a transcutaneous electrical nerve stimulation (TENS) machine.

Problems with thinking, learning and memory

If you experience problems with thinking and memory, 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 specialist such as a clinical psychologist. They may suggest treatment with an antidepressant.

People with MS who have depression can also be treated with antidepressants or therapy, such as CBT.

If you often feel anxious or worried, you may be prescribed antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect.

Sexual problems

Men with MS who find it hard to obtain or maintain an erection (erectile dysfunction) may be prescribed medication to temporarily increase the blood flow to the penis, such as sildenafil (Viagra). This is provided by the NHS if you have MS.

Relationship counselling or seeing a sex therapist may also help both men and women with MS who are having problems with reduced interest in sex or difficulty reaching orgasm.

Bladder problems

Various medications are available if you have an overactive bladder or need to pee frequently during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can also help some people to start peeing or to empty the bladder.

Occasionally, a catheter can be used to empty the bladder when needed. In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely.

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

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

Speech and swallowing difficulties

A speech and language therapist can help you find ways to overcome problems with speech and swallowing.

For example, they can offer advice about foods that are easy to swallow and they can recommend exercises to strengthen the muscles used in speech and swallowing.

If swallowing problems become very severe, some people need to be fed using a tube, which is fitted into the stomach through the skin.

Want to know more?

• MS Trust: treating MS symptoms
• MS Society: signs and symptoms

Although MS can't currently be cured, there are medicines that can help to reduce the number and severity of relapses in some people. These are called "disease-modifying therapies".

These aim to reduce the amount of damage and scarring to the myelin sheath (layer surrounding your nerves), associated with MS relapses.

These treatments may also help to slow worsening disability in MS, although definitive research into their long-term benefits is limited.

Disease-modifying therapies are not suitable for everyone with MS. They're only prescribed to those with relapsing remitting MS or secondary progressive MS who meet certain criteria, such as the number of relapses they've had.

People without relapses are very unlikely to benefit from the treatments and could still experience side effects from them.

Want to know more?

• MS Society: disease-modifying therapies
• MS Trust: disease-modifying drugs
• MS Decisions

Beta interferon

The types of beta interferon licensed for use in the UK are interferon beta-1a (Avonex, Rebif and Plegridy) and interferon beta-1b (Betaferon and Extavia). These are all given by injection.

You may be offered treatment with one of these medicines if either:

• you've got relapsing remitting MS and you've had a recent relapse and/or MRI scans show that your MS is active
• you have secondary progressive MS and still have significant relapses

All beta interferons often cause mild side effects, particularly flu-like symptoms (headaches, chills and mild fever), for 24-48 hours after they’re injected, and temporary pain or redness at the injection site.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. It's injected under the skin either every day or at a higher dose three times a week.

You may be offered treatment with glatiramer acetate if you've got relapsing remitting MS and you've had a recent relapse, and/or MRI scans show that your MS is active.

Common side effects of glatiramer acetate include problems with redness or hardening of the skin at the injection sites, and occasionally palpitations or flushing after the injection.

Teriflunomide

Teriflunomide, branded as Aubagio, is a tablet taken once a day.

You may be offered treatment with teriflunomide if you have relapsing remitting MS and you've had a recent relapse, and/or MRI scans show that your MS is active.

Common side effects of teriflunomide include headaches, feeling sick, diarrhoea and hair thinning or hair loss. You'll also need blood tests frequently in the early months of treatment to check for problems with liver function.

Natalizumab

Natalizumab, branded as Tysabri, is injected into a vein (known as an infusion) once every 28 days.

You may be offered treatment with natalizumab if you have severe relapsing remitting MS that's getting worse quite quickly – for example, if you've had two or more severe relapses within a year and MRI scans show that your MS is getting worse.

Side effects of natalizumab are rare, but can include an increased risk of an itch or rash (hives), headaches, dizziness, joint pain, and feeling or being sick at the time of the infusions.

The main concern of treatment with natalizumab is a risk of a brain infection called progressive multifocal leukoencephalopathy (PML). This is uncommon, but can become a significant problem with long-term treatment in some people.

Fingolimod

Fingolimod, branded as Gilenya, is taken as a capsule once a day.

You may be offered treatment with fingolimod if you have relapsing remitting MS and you experience the same or an increased number of relapses, despite treatment with other medications such as beta interferons.

The medication doesn’t usually cause significant side effects, but some people experience an increased risk of infections, headaches, diarrhoea, liver problems and visual problems.

Alemtuzumab

Alemtuzumab, branded as Lemtrada or Genzyme, is initially given into a vein once a day for five consecutive days. This is followed by a second course of treatment a year later, which lasts for three consecutive days.

You may be offered treatment with alemtuzumab if you've got relapsing remitting MS and you've had a relapse in the past year, and/or MRI scans show that your MS is active.

Common side effects of alemtuzumab include an increased risk of infections, headaches, rashes and fever. Regular blood and urine tests will be carried out to monitor treatment.

Dimethyl fumarate

Dimethyl fumarate, branded as Tecfidera, is a tablet taken twice a day.

You may be offered treatment with dimethyl fumarate if you've got relapsing remitting MS and you've had a recent relapse and/or MRI scans show that your MS is active.

Common side effects of dimethyl fumarate include hot flushes, diarrhoea, nausea, abdominal (tummy) pain and headaches. Stomach upsets usually settle after a month or so. The flushes can continue, but aren't normally a major issue.

Want to know more?

• NICE: beta interferon and glatiramer acetate for the treatment of multiple sclerosis
• NICE: teriflunomide for relapsing-remitting multiple sclerosis
• NICE: natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis
• NICE: fingolimod for the treatment of highly active relapsing-remitting multiple sclerosis
• NICE: alemtuzumab for treating relapsing-remitting multiple sclerosis
• NICE: dimethyl fumarate for treating relapsing-remitting multiple sclerosis

If you find it difficult to look after yourself, your local authority may be able to provide you with some help. Ask for a care and support needs assessment. For more information, read about:

• assessing your care and support needs
• planning for your future care needs
• care and support plans