Symptomatic therapy of multiple sclerosis

Despite the important advances being made in disease-modifying multiple sclerosis (MS) therapies, patients are often affected by a wide variety of symptoms caused by neurologic injury in MS. Common symptoms that patients with MS experience during the course of their illness include weakness, ambulatory impairment, sensory disturbances that may be unpleasant or even painful, ataxia and tremor, bladder and bowel dysfunction, sexual dysfunction, fatigue, spasticity, vertigo, depression and other psychiatric symptoms, cognitive impairment, and paroxysmal symptoms such as cramps, spasms, Lhermitte symptom, and Uhthoff phenomenon. These MS symptoms can cause loss of vocation and social isolation. Neurologic care of patients with MS often involves a greater degree of management of the symptoms caused by MS than appropriate prescription of disease-modifying treatments. In addition, many of the disease-modifying therapies have unpleasant side effects that may also require treatment. This article will focus on medical treatments, use of rehabilitation medicine, and, in select cases, surgical interventions for management of MS symptoms.