Multiple Sclerosis: Symptomatic Treatment

Therapy for multiple sclerosis (MS) that prevents exacerbation of the disease and slows the progression of disability has not diminished the importance of treating symptoms. Because the new agents are not curative and rarely reverse existing deficits, many patients under treatment have or will have persistent symptoms. Many neurologic symptoms are seen in patients with MS, but it is important to recognize that some nonneurologic symptoms, such as pain, fatigue, and mood disturbance, are common and may cause significant disability. The first and most important step in the management of symptoms is to discuss the symptoms with the patient on an ongoing basis. The second step is to recognize treatable symptoms and to apply the appropriate strategies for management. There have been promising results with experimental agents, primarily potassium channel blockers, that may improve function in demyelin-ated fiber pathways and that offer the possibility of treatment for a range of symptoms. At present, the management of symptoms varies, depending on the symptom, and it involves the coordinated application of a range of treatment approaches including medication, lifestyle changes, rehabilitation, and, in some cases, surgery.