Multiple sclerosis: treatment of its symptoms

Regina Berkovich MD PhD (Dr. Berkovich of the USC Keck School of Medicine and St-Petersburg Pavlov State Medical University received honorariums from Questcor, Teva Pharmaceutical, Acorda, Bayer, and Biogen Idec.)
Daniel Kantor MD (Dr. Kantor of Neurologique Foundation received honorariums from Allergan, Accorda, Avanir, Biogen Idec, Genzyme (Sanofi), Teva Neurosciences, Questcor, Merz, Depmed, Osmotica, Novartis, US World Meds, and Medicis.)
Anthony T Reder MD, editor. (Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Questcor/Malinkrodt, Serono, and Teva-Marion.)
Originally released September 11, 2002; last updated March 4, 2013; expires March 4, 2016
Notice: This article has expired and is therefore not available for CME credit.

Overview

In this article, the authors discuss treatment of the most common symptoms experienced by patients with multiple sclerosis. It is incumbent upon neurologists, as the primary professionals involved in multiple sclerosis patient care, to become well adept at managing the symptoms important to patients and their care partners/caregivers. Although there is increased attention on new disease-modifying agents, patients need therapeutic plans that improve their daily quality of life and enhance functioning (through neurofunctional enhancers). Advances in ongoing clinical trials for multiple sclerosis–related spasticity and pain are highlighted. The realistic clinical vignette provides practical, easy-to-apply lessons in patient management. Off-label uses of therapy are discussed. References used in this review and in prior updates have been cited selectively.

Key points

 

• Multiple sclerosis patients present with a wide variety of differing symptoms.

 

• The goal of individualized medicine is to treat each unique person in an individual way; this includes addressing symptoms affecting their quality of life.

 

• The goal of symptomatic therapy is to optimize the functioning of patients with neurologic dysfunction due to multiple sclerosis; a subset of these treatments may act as neurofunctional enhancers.

 

• There are a wide variety of pharmacologic and non-pharmacologic therapies that may benefit individual patients.

 

• It is incumbent upon neurologists to hone their skills in symptom management.

Historical note and terminology

Multiple sclerosis affects each patient in a unique manner, and symptoms of multiple sclerosis may range widely among different patients. Neurologists are classically taught to localize lesions and to ascertain their etiology in pursuit of a diagnosis. Beyond this important step, patients need neurologists who can treat their disease and also address their day-to-day symptoms. The past 2 decades have led to increasingly rapid advances in 9 branded multiple sclerosis disease-modifying agents. The emphasis placed on our ability to modulate the immune system may sometimes distract neurologists from focusing their attention on multiple sclerosis symptom management. This is why comprehensive care models, composed of neurologists as well as allied health professionals, are so crucial (Burks 1998). However, it behooves neurologists to become adept at managing multiple sclerosis symptoms, even in the absence of a larger team; knowledge gained during residency training programs may be supplemented by journal articles in the Multiple Sclerosis Journal, International Journal of MS Care, and Multiple Sclerosis and Related Disorders.

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