Multiple Sclerosis (MS)

Treatment can make living with multiple sclerosis (MS) easier. Your type of treatment will depend on the severity of your symptoms and whether your disease is active or in remission.

Initial treatment

In an attempt to slow down the progression of multiple sclerosis (MS), treatment with medication is usually recommended when MS has been diagnosed. Findings from clinical studies indicate that people treated soon after being diagnosed with MS may have better results than those who delay treatment. Permanent damage to the nervous system may occur in the initial stages of the disease. Early treatment may help prevent or delay some of this damage.

Three types of medicines are used most often to reduce the frequency of relapses and possibly slow down the progression of MS. These are called disease-modifying therapies, and the medications include:

• Interferon beta (Avonex, Betaseron, and Rebif).
• Glatiramer acetate (Copaxone).
• Mitoxantrone (Novantrone).

Interferon beta and glatiramer acetate suppress or alter the activity of the immune system.

Although these medications do not cure MS, they may reduce the overall number, frequency, and severity of relapses in some people who have the relapsing-remitting MS. They may also reduce or delay disability with this type of MS. Betaseron and Novantrone may slow disease progression in some people with secondary progressive MS.

If you decide not to try disease-modifying therapy at this time, you can work with your doctor to regularly evaluate whether the disease is progressing. For more information on this decision, see:

Should I have disease-modifying therapy for MS?

Physical therapy, occupational therapy, and nonmedical treatment done at home can help you manage symptoms and adjust to living and working situations. For more information, see:

Multiple sclerosis: Rehabilitation programs.

Ongoing treatment

If you have been diagnosed with multiple sclerosis (MS), you may need to take interferon beta or glatiramer indefinitely.

The medicines most commonly used to treat MS are:

• Interferon beta (Avonex, Betaseron, and Rebif).
• Glatiramer acetate (Copaxone).
• Mitoxantrone (Novantrone).

If you do not have any improvement or benefit using one of the treatment listed above, your doctor may have you try:

• Natalizumab (Tysabri). Tysabri was taken off the market in 2005 after studies showed the medicine could possibly be linked to a serious infection called progressive multifocal leukoencephalopathy (PML). Soon after, the U.S. Food and Drug Administration (FDA) re-approved Tysabri for use in people with relapsing forms of MS. If you are taking Tysabri, you will be watched closely for signs of any serious side effects.
• Intravenous immune globulin (IVIG). Intravenous means the medicine is given in a vein. Immune globulin is a protein in human blood and tissue fluids. These proteins are similar to antibodies, which help the body's immune system recognize and destroy foreign substances, such as bacteria and viruses. How or if it works in MS is not certain.

These medications suppress or alter the activity of the immune system. Evidence suggests that MS is an autoimmune disease, a disease in which the immune system attacks normal body tissue. In this case, the myelin coating surrounding nerve fibers is attacked by the immune system.

You also can take other medication during attacks or relapses. Corticosteroids are commonly used to shorten relapse time and may limit its severity. However, corticosteroids do not prevent permanent disability from MS and have not been shown to delay or prevent the progression of the disease.

If you are not taking disease-modifying therapy at this time, you can continue to work with your doctor to regularly evaluate the disease's progress. If new lesions develop or existing lesions grow, you may want to reconsider your decision and begin treatment. For more information, see:

Should I have disease-modifying therapy for MS?

You and your health professional will set up a schedule of periodic appointments to monitor and treat your symptoms and follow the progress of your MS. Monitoring your condition helps your doctor determine whether you may need to try a different treatment.

Physical therapy, occupational therapy, and nonmedical treatment done at home can help you manage symptoms and adjust to living and working situations. For more information, see:

Multiple sclerosis: Rehabilitation programs.

Treatment if the condition gets worse

Medications should relieve symptoms that cause discomfort and disability from multiple sclerosis (MS). Symptoms such as spasticity (stiff, tight muscles), pain, fatigue, tremor, depression, sexual difficulties, and bladder problems often respond well to medications.

Physical therapy, occupational therapy, and nonmedical treatment done at home may also help you manage symptoms and adjust to living and working situations. For more information, see:

Multiple sclerosis: Rehabilitation programs.

What To Think About

Findings from clinical trials indicate that people treated soon after being diagnosed with MS may have better results than those who delay treatment.

The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and active, relapsing disease start treatment with interferon beta or glatiramer acetate. This groups adds that treatment with medicine may also be considered after the first attack in some people who are at a high risk for MS.⁹

Still, taking the medication has several significant drawbacks. The decision is a difficult one for many people with MS. Some wait to see whether their symptoms get worse before they make a decision to start therapy. A small percentage of people diagnosed with MS may never have more than a few mild episodes and never develop any disability, but there is no way to know yet who will fall into this group.

End-of-life issues

In rare cases, multiple sclerosis (MS) is life-threatening. If your condition worsens considerably, you may want to consider making a living will, which allows your wishes to be carried out if you are not able to make decisions for yourself. For more information, see the topic Care at the End of Life.