Treatment for Specific Symptoms of Multiple Sclerosis
Treatment for specific symptoms of multiple sclerosis may include the following:
Treatment for Muscle Weakness, Numbness, and Stiffness
Muscle weakness, numbness, and stiffness (spasticity) may be treated using medication taken regularly or as needed. These drugs include muscle relaxants, such as tizanidine (Zanaflex®) and baclofen (Loresal®), benzodiazepines, such as diazepam (Valium®), and anticonvulsants, such as carbamazepine (Tegretol®).
Side effects of baclofen and tizanidine include drowsiness, dizziness, and fatigue. These drugs should not be discontinued abruptly. Carbamazepine may cause severe side effects including aplastic anemia, low white blood cell count (leukopenia), cancer that develops in cells found in blood and lymph (lymphoma), heart failure, and seizures.
Treatment for Fatigue
Fatigue may be treated using amantadine hydrochloride (Symmetrel®) or modafinil (Provigil®) when frequent napping, adequate sleep at night, and daily exercise do not help. Side effects include nausea, dizziness, and headache.
Treatment for Balance and Equilibrium Abnormalities
Balance and equilibrium abnormalities (e.g., difficulty walking, uncoordinated movements, tremor) may be treated using medications such as benzodiazepines (Valium®), clonazepam (Klonopin®), propranolol (Inderal®), and mysoline (Primidone®). Side effects include drowsiness, confusion, and depression.
Treatment for Bladder Dysfunction
Bladder dysfunction (e.g., incontinence, nocturia) may be treated using medications such as oxybutynin (Ditropan®), tolterodine (Detrol®), and hyosciarnine (Levsin®). Bladder-emptying regimen, intermittent catheterization, and surgery may also be used. Side effects of medication include headache, dry mouth, constipation, and dizziness.
In August 2011, the U.S. Food and Drug Administration (FDA) approved onabotulinumtoxin A (BOTOX) injections to treat urinary incontinence caused by multiple sclerosis. This treatment may improve bladder relaxation, increase storage capacity of the bladder and decrease incontinence. The injection is performed using cystoscopy, a procedure in which the health care provider is able to visualize the bladder, and may help reduce incontinence for about 9 months. Adverse reactions include urinary tract infection (UTI) and urinary retention.
Treatment for Constipation
Constipation may be worsened by inactivity. Treatment includes eating a high-fiber diet, increasing fluid intake, daily exercise, and stool softeners. Rectal suppositories or enemas occasionally may be required.