Treatments and drugs

By Mayo Clinic Staff

Multiple sclerosis (MS) has no cure. Treatment usually focuses on strategies to treat MS attacks, manage symptoms and reduce the progress of the disease. Some people have such mild symptoms that no treatment is necessary.

Strategies to treat attacks

  • Corticosteroids. Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone (Solu-Medrol). Side effects may include mood swings, seizures, weight gain and an increased risk of infections.
  • Plasma exchange (plasmapheresis). This procedure removes some blood from your body and mechanically separates your blood cells from your plasma, the liquid part of your blood. Doctors then mix your blood cells with a replacement solution and return the blood to your body.

    Plasma exchange sometimes may be used to help combat severe symptoms of multiple sclerosis relapses in people who aren't responding to intravenous steroids.

Strategies to slow progress of the disease

  • Beta interferons. These types of drugs — such as Avonex, Betaseron, Extavia and Rebif — appear to slow the progress of multiple sclerosis, reduce the number of attacks and lessen the severity of attacks. Interferons can cause many side effects, including reactions in the injection area and liver damage. However, it's rare to have serious, permanent side effects. You'll likely need blood tests to monitor your liver function and blood count.
  • Glatiramer acetate (Copaxone). This medication may reduce the number of MS attacks. Doctors believe that glatiramer acetate works by blocking your immune system's attack on myelin. You must inject this drug under your skin (subcutaneously) once daily. Side effects are uncommon, but may include flushing, chest pain or heart palpitations after injection and reactions at the injection sites.
  • Fingolimod (Gilenya). An oral medication given once daily, this works by trapping immune cells in lymph nodes. It may reduce attacks of MS and short-term disability.

    To take this drug, you'll need to have your heart rate monitored for six hours after the first dose because the first dose can slow your heartbeat (bradycardia). You'll also need to be immune to the chickenpox virus (varicella-zoster virus). Other side effects may include diarrhea, cough and headache.

  • Natalizumab (Tysabri). This medication may reduce the number of MS attacks by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord.

    Natalizumab generally is reserved for people who see no results from or can't tolerate other types of treatments. This medication increases the risk of progressive multifocal leukoencephalopathy (PML) — a brain infection that usually is fatal.

    A blood test helps detect whether you've been exposed to the JC virus, a virus that causes PML, before or while taking this medication. This virus, as well as other risks, may cause development of PML in people taking this medication. Other side effects of natalizumab may include allergic reactions, infections or liver damage.

  • Mitoxantrone. This immunosuppressant medication can be harmful to the heart, and it's associated with development of blood cancers like leukemia. Because of these risks, it's usually only used to treat active severe, advanced multiple sclerosis, based on both clinical assessment and MRI studies.
  • Teriflunomide (Aubagio). This oral medication reduces attacks and lesions in people with MS. You'll need blood tests to monitor liver function, as it may cause serious liver damage. It can also cause serious fetal damage, and it must not be taken during pregnancy. It may also cause side effects such as diarrhea and nausea.

    The medication stays in your system for months. If you have complications, additional medications must be administered in order to help your body rapidly eliminate the drug.

Strategies to treat symptoms

  • Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises and show you how to use devices that can make it easier to perform daily tasks.
  • Dalfampridine (Ampyra). This oral medication may improve walking speed in some people. The major side effect is seizures.
  • Muscle relaxants. If you have multiple sclerosis, you may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may improve muscle spasticity.

    Baclofen may increase weakness in the legs and cause side effects such as weight gain and excessive sweating.

    Tizanidine may cause drowsiness or a dry mouth.

  • Medications to reduce fatigue. Medications such as amantadine may help reduce fatigue due to multiple sclerosis.
  • Other medications. Medications also may be prescribed for depression, pain, and bladder or bowel control problems that may be associated with multiple sclerosis.

A number of other medications and procedures to treat multiple sclerosis are under investigation. For example, stem cell transplantation is being studied. In a stem cell transplant, doctors inject healthy stem cells into your body to replace diseased stem cells.

Dec. 15, 2012