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  • Updated 10.25.2023
  • Released 09.11.2002
  • Expires For CME 10.25.2026

Multiple sclerosis: treatment of its symptoms



This article will highlight treatment strategies of the most common symptoms experienced by patients with multiple sclerosis. Neurologists often become the primary health care professionals for patients with multiple sclerosis. Therefore, it is incumbent on neurologists to not only be familiar with the management of disease-modifying therapies but also to be well versed at managing the symptoms that can accompany this diagnosis. Multiple sclerosisrelated symptoms have a prominent role in daily functionality and quality of life; thus, knowledge about symptomatic management becomes critical. In this update, there is a focus on nonpharmacologic management of multiple symptoms, including cognition, sexual dysfunction, as well as gait disturbances, in those with higher disability scores.

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 neurologic symptoms.

• The goal of individualized medicine is to treat each unique person in an individual way; this includes addressing symptoms in persons with multiple sclerosis that affect their quality of life.

• 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 to provide effective and safe long-term treatment options. However, the emphasis placed on our ability to modulate the immune system may sometimes distract attention from 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 symptoms may have a significant impact on the quality of life in patients with such symptoms. 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 faces. 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 (80). Suboptimal symptom management may also be mistaken as progression of the disease, and knowledge about optimizing this management may help differentiate this diagnostic dilemma.

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 (16). 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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