Multiple Sclerosis

Treatment

Mayo Clinic's multidisciplinary approach provides expertise in the management of neurological diseases, including MS. The practice is streamlined to allow a timely diagnostic evaluation and has evolved to meet the needs of patients, efficiently and supportively.

At Mayo Clinic, treatment includes managing the symptoms of multiple sclerosis, as well as treating the disease before permanent damage causes symptoms. Treatment may include:

Careful Monitoring

If attacks are mild or infrequent, physicians may advise a wait-and-see approach, with counseling and close observation.

Medications to Treat MS

Beta Interferons

Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) are genetically engineered copies of proteins that occur naturally in the body. These medications reduce flare-ups of MS. It's uncertain which of their many actions lead to a reduction in disease activity and what their long-term benefits are. Beta interferons should never be used in combination with one another. Only one medication should be used at a time.

The U.S. Food and Drug Administration (FDA) has approved beta interferons only for people with relapsing forms of MS who can still walk. Beta interferons don't reverse damage and haven't been proven to prevent permanent disability. Some people develop antibodies to beta interferons, which may make them less effective. Other people can't tolerate the side effects, which may include symptoms similar to those of the flu (influenza).

Mayo Clinic neurologists generally recommend beta interferons for people who have more than one attack of MS a year and for those who don't recover well from flare-ups. The treatment may also be used for people who have a significant buildup of new lesions as seen on an MRI scan, even without major new symptoms of disease activity.

Glatiramer

This medication is an alternative to beta interferons if the patient has relapsing-remitting MS. Glatiramer shouldn't be used at the same time as beta interferons. Glatiramer is as effective as beta interferons in curbing MS attacks. Physicians believe that glatiramer blocks the immune system's attack on myelin. Glatiramer must be injected subcutaneously once daily. Side effects may include flushing and shortness of breath after injection.

Medications That Treat MS Symptoms

Corticosteroids

Oral or intravenous corticosteroids are prescribed to reduce inflammation in nerve tissue and shorten the duration of flare-ups. Prolonged use of these medications, however, may cause side effects such as osteoporosis and high blood pressure (hypertension).

Muscle Relaxants

Tizanidine (Zanaflex) and baclofen (Lioresal) are oral treatments for muscle spasticity. Patients who have MS may experience muscle stiffening or spasms, particularly in their legs, which can be painful and uncontrollable. Lioresal often increases weakness in the legs. Zanaflex appears to control muscle spasms without leaving legs feeling weak but can be associated with drowsiness or a dry mouth.

Medications to Reduce Fatigue

These may include the antiviral drug amantadine (Symmetrel) or a medication for narcolepsy called modafinil (Provigil). Both appear to work because of their stimulant properties.

Other Medications

Medications may also be used for depression, pain and bladder or bowel control problems that can be associated with MS.

Physical and Occupational Therapy

The goal of physical and occupational therapy is to preserve independence through strengthening exercises and devices to ease daily tasks.

Counseling

Individual or group therapy may help people with MS and their families cope with the disease and relieve emotional stress.

Special Therapies

Mayo Clinic researchers have developed and are evaluating new approaches to treating MS including:

Plasma Exchange

This procedure involves removing some blood and mechanically separating the blood cells from the fluid (plasma). Blood cells then are mixed with a replacement solution, typically albumin or a synthetic fluid with properties like plasma. The solution with the blood is then returned to the body. It is not clear why plasma exchange works. Replacing plasma may dilute the activity of the destructive factors in the immune system. This treatment is only for people with sudden, severe attacks of MS-related disability who don't respond to high doses of steroid treatment. The treatment is most helpful for people with a mild pre-existing disability before the attack. Plasma exchange has no proven benefit beyond three months from the onset of neurologic symptoms.