Multiple sclerosis: treatment of its symptoms

Amanda Piquet MD (

Dr. Piquet of the University of Colorado received a consulting fee from Sanofi Genzyme.

)
Anna Shah MD (

Dr. Shah of The University of Colorado has no relevant financial relationships to disclose.

)
Anthony T Reder MD, editor. (

Dr. Reder of the University of Chicago received honorariums from Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Mallinckrodt, Mylan, Serono, and Teva-Marion for service on advisory boards and as a consultant as well as stock options from NKMax America for advisory work.

)
Originally released September 11, 2002; last updated February 5, 2020; expires February 5, 2023

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 the care of patients with multiple sclerosis, to become well versed at managing the symptoms that frequently affect patients with multiple sclerosis. Although there is a need for neurologists to be familiar with newer disease-modifying therapies for patient's long-term care, the knowledge about symptomatic management is critical given their prominent role in daily functionality and quality of life. In this update, nonpharmaceutical treatments of fatigue and spasticity as well as neurobehavioral findings in patients with multiple sclerosis are highlighted. References used in this review and in prior updates have been cited selectively.

Key points

 

• Patients with multiple sclerosis 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.

 

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

 

• It is critical for neurologists to hone their skills in symptom management.

Historical note and terminology

The past couple of decades have led to increasingly rapid advances in disease-modifying therapies for multiple sclerosis. As such, there has been a plethora of information for neurologists to become familiar with in order to provide effective and safe long-term treatment options. However, the emphasis placed on our ability to modulate the immune system may sometimes distract neurologists from focusing their attention on multiple sclerosis symptom management. Multiple sclerosis affects each patient in a unique manner, and symptoms of multiple sclerosis may range widely among different patients. These are symptoms that may affect our patients on a daily basis with an impact on their quality of life. As such, it is crucial that neurologists master not only making the diagnosis of multiple sclerosis and the disease-modifying therapy options but also the symptom management of the plethora of symptoms our patients face. It is key to involve all stakeholders in potential solutions, working in a multidisciplinary way to ensure that patients with multiple sclerosis are part of the team in shared decision-making and disease management (Members of the MS in the 21st Century Steering Group et al 2018).

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 simultaneously treat their disease and day-to-day symptoms. 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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