How Is Multiple Sclerosis Treated?

Multiple sclerosis (MS) is a disease that affects the central nervous system—which includes your brain and spinal cord. People with MS experience symptoms that can affect their thinking, vision, muscle movement and coordination, speech, sexual health, and more.

There’s no cure for MS, but researchers have made great progress in developing treatments to slow the disease—called disease-modifying therapies (DMTs).

In addition to slowing the progression of this disease, treatment can reduce your symptoms and improve your daily life. People with MS may take medications for specific symptoms such as muscle spasms, fatigue, or urinary problems.

A healthcare provider, such as your primary care provider or a neurologist (a doctor who specializes in brain and nervous system conditions), can diagnose MS and develop a specific treatment plan. In some cases, you may be referred to other healthcare providers to help manage symptoms with lifestyle changes and non-medication interventions, such as occupational therapy (which assists with performing daily activities like driving and making meals) or physical therapy (which provides exercises to help maintain muscle movement).

Types of MS 

Your treatment plan can depend on the type of MS you have.

Most people with MS experience symptom attacks (relapses) followed by periods of no symptoms (remission)—this type of MS is called relapsing-remitting MS (RRMS). For most people with RRMS, symptoms can get consistently worse after about 25 years since developing MS, resulting in a type of MS called secondary progressive MS (SPMS).

Another type of MS is called primary progressive MS (PPMS), where symptoms are more constant and get worse over time. This type has fewer periods of remission and relapse. About 10% of people with MS have PPMS.

Disease-Modifying Therapies (DMTs)

Disease-modifying therapies (DMTs) can slow the worsening of MS either by controlling or blocking parts of the immune response that can lead to inflammation.  

This is a standard type of treatment across different forms of MS, including relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS. A healthcare provider, such as a neurologist, can prescribe these medications to treat MS and its symptoms.

DMTs come in three different forms:

Platform injections: These are injected intramuscularly (into the muscle) or subcutaneously (under the skin). The drugs are immunomodulators, which alter your immune cells to help reduce inflammation. One subgroup is beta-interferon drugs. Examples include: 

• Avonex and Rebif (interferon beta-1a)
• Betaseron and Extavia (interferon beta-1b)
• Plegridy (peginterferon beta-1a)
• Copaxone and Glatopa (glatiramer acetate)

Infusions, also called intravenous (IV) therapy: These DMTs are administered through a needle into the vein. The drugs are monoclonal antibodies, which mimic certain proteins in your immune system (antibodies) and help target specific triggers for inflammation. These include:

• Tysabri (natalizumab), administered monthly
• Ocrevus (ocrelizumab)—the only DMT that’s FDA-approved for PPMS and administered every six months
• Lemtrada (alemtuzumab), administered monthly for five days, then for three days a year later
• Novantrone (mitoxantrone), administered four times a year and FDA-approved for severe RRMS and SPMS

Oral medications: This group of DMTs are taken as pills or tablets. The following are examples of oral DMTs that are FDA-approved for people with relapsing forms of MS (including RRMS or SPMS) for specific age groups:

• Gilenya (fingolimod)—for people ages 10 and older
• Tecfidera (dimethyl fumarate)—for adults
• Mayzent (siponimod)—for adults
• Vumerity and Tecfidera (diroximel fumarate)—for adults
• Aubagio (teriflunomide)—for adults
• Mavenclad (cladribine)—for adults

Your healthcare provider may recommend taking a DMT as soon as possible following a diagnosis. Early treatment can lead to better long-term outcomes for people with RRMS.

Shared decision-making with a healthcare provider can improve your health outcomes. Ask a healthcare provider about these medications’ potential side effects, costs, availability, dosing schedules, and convenience. For example, some people may not be able to get regular injections and may prefer to take their treatment orally. You and your provider can discuss the severity of your symptoms, how much risk you can tolerate, and what your goals for treatment are.

Effectiveness

Disease-modifying therapies (DMTs) are less effective for progressive types of MS (SPMS and PPMS). For example, your healthcare provider may recommend Ocrevus (ocrelizumab)—an infusion DMT for treating PPMS, only if you are under 55 years old or have ongoing signs of MS-related inflammation (active MS)—which can be detected with magnetic resonance imaging (MRI).

Even for people with RRMS, DMTs are not cures, and they’re only partially effective in reducing the rate of flare-ups. Research on whether DMTs help with long-term disability is ongoing. You’ll likely need regular MRIs, other lab tests, and check-ins with your healthcare provider.

Some medications may be more effective than others on average, but they may work differently for you. Eventually, you may need or choose to switch DMTs. Check in regularly with a healthcare provider about your symptoms and how you respond to a specific treatment.

Side Effects

All DMTs come with potential risks for side effects.

Some people with MS choose to start with highly effective therapies, such as infusions like  Tysabri (natalizumab) or Ocrevus (ocrelizumab)—but these carry risks of serious side effects (like the potential to develop severe COVID-19). Other people choose to start with injectable beta interferons or glatiramer acetate, which have a lower risk for serious side effects but may be less effective when compared to infusions.

Medications to Manage Symptoms

Because it affects your central nervous system, MS can cause a range of symptoms throughout different parts of your body. These include impaired thinking (cognition), decreased mood, fatigue, loss of balance, bowel dysfunction, and more. 

Depending on your specific symptoms, your healthcare provider might recommend the following prescription medications and lifestyle changes:

• Loss of bladder control (urinary incontinence): A medication like Oxytrol (oxybutynin) can reduce the frequent need for bladder emptying, though a potential side effect is confusion. If you often wake up during the night to urinate, Ddavp (desmopressin) may help decrease the frequency. 
• Constipation: You might take over-the-counter laxatives to treat constipation. There are several types of laxatives, but a first choice is usually a subtype called bulk-forming laxatives, including Metamucil (psyllium), Citrucel (methylcellulose), FiberCon (calcium polycarbophil), and Benefiber (wheat dextrin). Your healthcare provider may also recommend increasing how much fluid and fiber you consume in your diet. 
• Diarrhea: If you have trouble holding your feces (fecal incontinence), such as with diarrhea, your healthcare provider might recommend antidiarrheal medication such as Diamode (loperamide). You can also avoid certain foods temporarily until symptoms clear.
• Depression: It is common for people with MS to also have depression. Your healthcare provider may prescribe antidepressants along with therapy. Antidepressant options vary depending on what other symptoms you have along with depression. For example, Prozac (fluoxetine) or Wellbutrin (bupropion) may help if you also experience fatigue; whereas, Cymbalta (duloxetine) may be prescribed if you also have nerve pain.
• Fatigue: Your healthcare provider may first recommend treatments for symptoms that can worsen your fatigue—including depression, anemia (low red blood cell count), or disrupted sleep. Medications such as Provigil (modafinil) or Adderall (dextroamphetamine-amphetamine) may be used—but these are prescribed off-label and only after symptoms don’t improve with non-medication options, like exercise or therapy.
• Changes in walking (gait impairment): Ampyra (dalfampridine) can improve walking for some people with MS, but it may cause side effects like anxiety. Your healthcare provider will likely recommend physical therapy first before considering medication. 
• Muscle stiffness (spasticity): Your healthcare provider may recommend physical therapy and prescribe muscle relaxant medications such as Gablofen (baclofen), Zanaflex (tizanidine), and Dantrium (dantrolene).

Discuss with a healthcare provider what treatments would be appropriate for you. They may recommend a non-medication approach like physical therapy or exercise first before trying prescription options.

Medications to Decrease Attack Severity

If you have RRMS, certain medications can help reduce the number and severity of your symptom attacks—though they aren’t helpful for long-term MS. 

These include corticosteroids, a type of anti-inflammatory drug. One common example is Medrol (methylprednisolone), which is administered intravenously (by IV) over three to five days to quickly reduce inflammation. You may then need to take a course of oral corticosteroids.

If your symptoms don’t improve with corticosteroids, your healthcare provider may recommend plasmapheresis. This a plasma exchange procedure that may help reduce severe MS flare-ups. It involves drawing your blood into a machine to filter out harmful components of your plasma (the liquid portion of the blood); the remaining plasma and other blood components (red and white blood cells) is then returned to your body, along with plasma replacement fluid (i.e. a solution of albumin—a blood protein—and salt water).

Non-Medication Therapies

Along with medication, your healthcare provider may recommend various therapies to help manage specific symptoms of MS and refer you to special therapists. These therapies can be helpful for managing both physical and mental health. 

These therapies include the following:

• Memory loss (cognitive impairment): Your healthcare provider may suggest attending cognitive behavioral therapy with a licensed mental health provider. Another option is cognitive training—a set of mental exercises that may be a potential treatment option to help with memory loss. These may help improve learning, memory span, working memory, and immediate visual memory.
• Depression: Cognitive behavioral therapy is also a common treatment option for people with depression, along with antidepressants.
• Changes in walking (gait impairment) and balance: Physical therapy can help manage muscle coordination, balance, and movements, especially if you experience ataxia— imbalanced, uncoordinated walking. If you have severe ataxia, you may also use mobility aids such as a cane, walker, or wheelchair. 
• Fatigue: You can try occupational therapy, which can help you learn to use mobility aids or reduce sources of excess physical activity throughout your day. Stress management programs, psychotherapy, or relaxation training can help you relax and reduce stress. 
• Slurred speech (dysarthria) or swallowing difficulties (dysphagia): Your healthcare provider may refer you to a speech-language therapist (SLP)—commonly called a speech therapist. An SLP can examine your mouth and ability to swallow and provide treatment with speech therapy.
• Respiratory dysfunction: If you have a poor cough or shortness of breath, a healthcare provider may recommend respiratory muscle training (RMT)—or exercises to improve breathing. Other options are chest physical therapy (CPT), or chest physiotherapy—a set of techniques to clear a blocked airway, along with cough assist devices and non-invasive ventilation.  
• Pain: Physical therapy such as massages, muscle exercises, and heat therapy may help improve blood flow and reduce pain. 
• Muscle weakness and spasticity: Physical therapy and water therapy, as well as yoga, can help with stretching and exercising your muscles. 
• Sexual dysfunction: You may try psychological counseling in addition to or ahead of medications.
• Loss of bladder or bowel control: Physical therapy can strengthen your pelvic floor muscles, which in turn may reduce urinary or fecal incontinence.

Lifestyle Changes to Manage MS

Exercise and physical activity are essential for the management of MS. Researchers and healthcare providers from the National Multiple Sclerosis Society recommended at least 150 minutes per week of exercise and/or physical activity (which can include household activities).

These goals may be difficult for people with MS, especially if symptoms get worse. Try to increase physical activity gradually and talk to a healthcare provider about the best way to do so, considering your condition, preferences, and safety. If MS severely affects your movement, you may need to visit a physical therapist (PT) to figure out what physical activity you can do.

Here are some other lifestyle changes that may help with MS:

• Avoid hot drinks, hot showers, and saunas, as excess heat can worsen symptoms; instead use ice cold showers, cold drinks, or air conditioning to cool down 
• Use ice packs or cooling vests and pads can help reduce fatigue and pain
• Use planners, alarms, and reminders to help remember things and stay organized
• If possible, work remotely so you can rest when needed
• Avoid foods that are difficult to swallow or can upset or block your digestive tract 
• Ensure your home is safe and set up to prevent falls (for example, by removing loose rugs or fixing uneven floors)
• Avoid stress and increase relaxation as much as possible
• Maintain good sleep hygiene
• Drink water and eat more high-fiber foods, especially if you have constipation

Living With and Managing Multiple Sclerosis

If you have MS, you may have symptoms that can affect different parts of your body and may improve or get worse at different times in your life. But there are several medications, therapies, and lifestyle changes that can help manage symptoms. Talking to a healthcare provider, particularly one who specializes in MS, can help you decide what treatment and lifestyle interventions work for you. 

After you start treatment, check in regularly with your provider. They will keep track of your progress and adjust medications if needed. They may also recommend additional steps as needed, such as seeing a physical therapist and other types of therapists or getting a mobility aid, like a cane, crutch, or wheelchair. 

Social workers and counseling services can provide you with the right resources. Organizations like the National Multiple Sclerosis Society, the Multiple Sclerosis Association of America, and the Multiple Sclerosis Foundation can be helpful sources as well.

There are also MS support groups where you can connect with people who share your experience and learn more about the disease. 

A Quick Review

A healthcare provider can diagnose multiple sclerosis (MS) and provide appropriate treatments and other ways to help manage your symptoms.

Disease-modifying therapies (DMTs) are often the first-approach medications and may help slow MS from getting worse. Your healthcare provider will consider the potential risks and benefits for treatment, including the type of MS and symptoms you’re experiencing. Other medications can treat specific symptoms of MS or reduce symptom flare-ups for relapsing-remitting MS. 

Physical therapy, cognitive behavioral therapy, and other therapies, as well as lifestyle changes like reducing heat exposure can all play a role in treatment of MS.