Multiple Sclerosis Health Center

There is no cure for multiple sclerosis, but there are treatments to control the disease. Medications are used to slow disease progress, treat MS attacks — or exacerbations — and manage symptoms. While some patients with mild symptoms may not need treatment, others will require these medications.

Slowing progress of MS

Over time, MS can lead to debilitating nerve damage, which cannot be reversed. Fortunately, there are medications that can change the course of disease. These medications include the following:

• Beta interferons: These medications — which include Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Extavia (interferon beta-1b) and Rebif (interferon beta-1a) —are used to slow the progress of MS, reduce the number of MS attacks and to reduce the severity of attacks. While interferons can cause side effects like liver damage and reactions at the injection site, serious and permanent side effects are rare.
• Copaxone (glatiramer acetate): This medication appears to block immune system T-cells from damaging myelin. Research has shown that glatiramer acetate may reduce the number of MS attacks. Glatiramer acetate is injected under the skin either once a day or three times a week. Side effects usually resolve on their own and do not require medical attention unless they last for several weeks. Such side effects may include injection-site reactions — such as swelling, formation of a hardened lump, redness, warmth of the skin and itching — as well as runny nose, tremor, tiredness or weakness and weight gain.
• Gilenya (fingolimod): Scientists believe that fingolimod works by keeping certain white blood cells — called lymphocytes — trapped in the lymph nodes, which may reduce the number of MS attacks and short-term disability. Fingolimod is a capsule taken orally once a day. This medication may cause a patient's hear rate to slow down. Therefore, patients must have their heart rate monitored in the six hours after taking their first dose. Before taking fingolimod, patients must be immune to chickenpox. Other possible side effects include headache, flu, diarrhea, back pain, liver issues and cough.
• Tysabri (natalizumab): This medication may reduce the number of MS attacks and lower the risk of worsening disability. Because natalizumab raises the risk for a serious brain infection known as progressive multifocal leukoencephalopathy (PML), natalizumab is usually recommended for patients who have not responded well to other treatments. Other possible side effects include liver damage, allergic reactions and a number of infections.
• Novantrone (mitoxantrone): Before being approved for use in MS, mitoxantrone was used to treat certain kinds of cancer. In patients with MS, mitoxantrone works by blocking immune system cells that are thought to play a role in the attack on the myelin sheath. This medication has been linked to heart troubles and blood cancers such as leukemia. Mitoxantrone is mainly used to treat severe and advanced multiple sclerosis.
• Aubagio (teriflunomide): This oral medication blocks the function of certain immune cells that are thought to play a role in MS. Terflunomide may reduce attacks and lesions in people with MS. Since teriflunomide can cause serious liver damage, doctors use blood tests to monitor liver function in patients taking this medication. Teriflunomide also may cause birth defects if used by women during pregnancy. Other possible side effects include diarrhea, nausea, influenza and alopecia (hair thinning).

Treating attacks

• Corticoteroids: Neurologists often recommend corticosteroids for severe attacks (relapses) of MS. Such attacks can involve vision loss, severe weakness and poor balance. These symptoms and others can limit a patient's mobility and overall ability to function. Corticosteroids are used to reduce inflammation during these attacks, and are most commonly prescribed in high-doses for three to five days. Examples of corticosteroids used to treat MS include oral prednisone and intravenous (injected) methylprednisolone (Solu-Medrol). Side effects may include weight gain, mood swings, seizures and increased infection risk.
• Plasma exchange (plasmapheresis): For this procedure, a doctor takes blood from the patient's body and mechanically separates blood cells from the plasma (the liquid part of blood). Then the doctor replaces the plasma with another solution, mixes that solution with blood cells and returns the blood to the patient's body. Plasma exchange is typically used in MS patients who haven't responded well to steroid treatment.

Treating symptoms

A wide array of medications are used to treat the many symptoms of MS. There are dozens of medications to treat bladder problems, bowel dysfunction, depression, dizziness and vertigo, emotional issues, fatigue, itching, pain, sexual problems, spasticity (stiff or rigid muscles), tremors and walking difficulties. Tell your doctor or neurologist if you need more help managing these symptoms.

Physical therapy is also used to manage symptoms of MS. Physical and occupational therapists can walk MS patients through stretching and strengthening exercises. They can also teach patients how to properly use assitive devices.