HEALTH CONDITION

Treatment

There's currently no cure for multiple sclerosis (MS), but it's possible to treat the symptoms with medicines and other treatments.

Treatment for MS depends on the specific symptoms and difficulties the person has.

It may include:

  • treating relapses of MS symptoms (with steroid medicine)
  • treating specific MS symptoms
  • treatment to reduce the number of relapses (disease-modifying therapies)

You'll be supported by a team of different healthcare professionals working together.

This may include a neurologist (specialist in treating conditions of the nervous system), a physiotherapist, a speech and language therapist, and a number of other professionals.

Your team will also include a specialist MS nurse, who'll usually serve as your main point of contact.

Further information

Treatment for MS relapses

Contact your specialist MS nurse or GP if you think you're having a relapse.

A flare-up of symptoms can sometimes be caused by something other than a relapse, such as an infection, so your nurse or GP needs to check for other possible causes.

Treatment for a relapse usually involves either:

  • a 5-day course of steroid tablets taken at home
  • injections of steroid medicine given in hospital for 3 to 5 days

Steroids can help speed up your recovery from a relapse, but they don't prevent further relapses or stop MS getting worse over time.

They're only given for a short period of time to avoid possible steroid side effects, such as osteoporosis (weak bones), weight gain and diabetes, although some people will still experience problems.

Not using steroids more than 3 times a year (if possible) will also help to reduce the risk of side effects.

Further information

Treatment for specific MS symptoms

MS can cause a range of symptoms that can be treated individually.

Treatments for some of the main symptoms are discussed below.

Fatigue

Many people with MS experience fatigue.

You may be prescribed amantadine for fatigue caused by MS, although this medicine may only have a limited effect.

You should also be given general advice on ways to manage fatigue, such as:

  • exercise
  • keeping healthy sleep patterns
  • energy-saving techniques
  • avoiding medicine that can worsen fatigue (including some painkillers)

Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), can also help some people with MS cope with their fatigue.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment.

If your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with involuntary eye movements, medicine such as gabapentin can sometimes help.

Some people with double vision need help from ophthalmologists (eye specialists).

Muscle spasms and stiffness

Muscle spasms and stiffness (spasticity) can be improved with physiotherapy. 

Techniques like stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles.

This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which of these would be best for you with your specialist MS nurse or GP.

If these medicines are not effective, you may be offered a 4-week trial of nabiximols (Sativex). This is a cannabis-based medicine sprayed into the mouth. Read about medical cannabis.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity, but they can also be caused by muscle weakness, or problems with balance or dizziness.

If you have problems with mobility, you might benefit from:

  • an exercise programme supervised by a physiotherapist
  • special exercises called vestibular rehabilitation if you have problems with balance
  • medicine for dizziness or tremors
  • mobility aids, such as a walking stick or occasionally a wheelchair
  • home adaptations, such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations that may be of help.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves, and is usually sharp and stabbing.

It can also occur in the form of extreme skin sensitivity or a burning sensation.

This type of pain can be treated using the medicines gabapentin or carbamazepine, or with a medicine called amitriptyline.

This is an older type of antidepressant, but these days it's mainly used for pain control.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and joints in your body.

A physiotherapist may be able to help with this pain by suggesting exercise techniques or better seating positions.

If your pain is more severe, you may be prescribed painkillers.

Alternatively, you may have a device that stimulates your nerves called a transcutaneous electrical nerve stimulation (TENS) machine.

Problems with thinking, learning and memory

If you experience problems with thinking and memory, any treatment you receive will be fully explained and recorded so it's clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a specialist like a clinical psychologist.

They may suggest treatment with an antidepressant.

People with MS who have depression can also be treated with antidepressants or therapy, such as CBT.

If you often feel anxious or worried, you may be prescribed antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect.

Sexual problems

Men with MS who find it hard to obtain or maintain an erection (erectile dysfunction) may be prescribed medicine to temporarily increase the blood flow to the penis, such as sildenafil (Viagra). This is provided by the NHS if you have MS.

Relationship counselling or seeing a sex therapist may also help both men and women with MS who are having problems with reduced interest in sex or difficulty reaching orgasm.

Bladder problems

Various medicines are available if you have an overactive bladder or need to pee frequently during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help.

Handheld external stimulators can also help some people start peeing or empty the bladder.

Occasionally, a catheter can be used to empty the bladder when needed.

In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin injections, bladder exercises or electrical treatment for your bladder muscles.

Read more about treating urinary incontinence.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema.

An enema involves having a liquid medicine rinsed through your bottom and large bowel, which softens and flushes out your stools.

Bowel incontinence can sometimes be treated with anti-diarrhoea medicine or by doing pelvic floor exercises to strengthen your rectal muscles.

Speech and swallowing difficulties

A speech and language therapist can help you find ways to overcome problems with speech and swallowing.

For example, they can offer advice about foods that are easy to swallow and recommend exercises to strengthen the muscles used in speech and swallowing.

If swallowing problems become very severe, some people need to be fed using a tube, which is fitted into the stomach through the skin.

Further information

Disease-modifying therapies

If you have relapsing MS talk to you specialist team about other possible treatments to help with your symptoms.

Although MS can't be cured, there are medicines that can help people have fewer and less severe relapses. These are called disease-modifying therapies.

These aim to reduce the amount of damage and scarring to the myelin sheath (a layer surrounding your nerves), which is associated with MS relapses.

These treatments may also help to slow worsening disability in MS, although definitive research into their long-term benefits is limited.

Disease-modifying therapies aren't suitable for everyone with MS. They're only prescribed to those with relapsing-remitting MS or secondary progressive MS who meet certain criteria, such as the number of relapses they have had.

People without relapses are very unlikely to benefit from the treatments and could still experience side effects from them.

Further information

You can find further information about disease-modifying therapies on these websites:

Clinical trials

Much progress has been made in MS treatment thanks to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they're worthwhile and safely conducted.

Participants in clinical trials sometimes do better overall than those in routine care.

Speak to your care team if you're interested in taking part in a clinical trial.

Further information

Complementary and alternative therapies for MS

Some people with MS find that complementary therapies help them feel better.

Many complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are.

Many people think that complementary treatments have no harmful effects. But people can occasionally experience problems, and it's not a good idea to use them as an alternative to medicines prescribed by your doctor.

If you're considering using an alternative treatment alongside your prescribed medicines, it's important to let your doctor know your plans.

Further information

Care and support

If you find it difficult to look after yourself, your local authority may be able to provide you with some help. Ask for a care and support needs assessment.

For more information, read about:


Page last reviewed: Mon Dec 2021 Next review due: Wed Feb 2020

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