Invasive Therapies in Multiple Sclerosis

Multiple sclerosis is a progressive disease despite so many recent therapy agents. Many symptoms can be seen that can affect the quality of daily life, such as spasticity, urinary incontinence, sensory disturbances, and tremor. These complaints may be refractory to the medical treatments, and the invasive treatment methods may be the only option to improve the quality of life of the patient. Intrathecal baclofen pump therapy can effectively reduce the spasticity in a patient with an inadequate response to oral baclofen. On the other hand, deep brain stimulation significantly reduces tremor and can provide the patient to eat by his/her self. Sacral neuromodulation may be beneficial in a patient with a history of urge incontinence which doesn't respond to oral agents. Adequate pain control can be achieved with spinal cord stimulators when a patient is unresponsive to the neuropathic pain treatment. Common features of all these invasive therapies are that they are used in patients who do not respond to medical treatments, they have a small number of randomized controlled clinical trial, and almost all of them are incompatible with MRI devices. According to the latest researches, more randomized controlled clinical trials and MRI compatible devices have been produced in recent years. We wanted to discuss these treatment methods even they have not yet been used routinely. We think they would be beneficial in clinical practice after their deficiencies have been overcome.