Treatment of Multiple Sclerosis Symptoms

Treatment of Multiple Sclerosis Symptoms

People with multiple sclerosis are often afraid of the consequences of the disease. Hence counseling of the patients is extremely important. The patients are advised regular exercise to reduce spasticity but at the same time are instructed against severe exercise to avoid fatigue. As the disease progresses, the patients may need assistive devices to help them move around. They may need the help of occupational therapists to adapt their work to their physical condition. Patients are advised to avoid excessive heat since they could get very fatigued. In some patients multiple sclerosis progresses to such an extent that they get bedridden and need total care.


Symptoms that need treatment are:

Spasms

The patient is advised to undergo regular exercise including stretching. Physical therapy and yoga are also beneficial. Drugs such as diazepam, tizanidine and baclofen help to control the spasms.

Pain

Pain of multiple sclerosis responds to antidepressants like amitriptyline and antiseizure medications like carbamazepine and gabapentine.

Tremors / Lack of coordination

Drugs such as clonazepam and propranolol help to control tremors and loss of coordination. The patient may require gait training to maintain his balance.

Bladder problems

A patient with multiple sclerosis may be unable to store urine or to empty the bladder. He/she is advised to limit fluid intake at night and repeatedly empty the bladder during the day. If these methods do not work, the patient is given medications. Drugs such as oxybutinin and tolterodine relax the bladder, hence can be given to patients unable to store urine in the bladder. Inability to empty the bladder is treated with drugs such as terazosin, doxazosin and tamsulosin. Some cases may respond to bethanechol. The patient or his caregiver may need to perform repeated catheterization to empty the bladder. A patient with urine infection needs antibiotics.

Sexual problems

A multiple sclerosis patient with sexual problems needs counseling. Drugs like sidenafil (Viagra) may be useful in some patients.

Constipation

Constipation is treated using high - fiber diet and increasing fluid intake. Some cases may need laxatives.

Depression

Depression is treated with antidepressants like amitriptyline and fluoxetine.

Fatigue

Fatigue associated with multiple sclerosis is treated with amantadine or modafinil. Take up swimming, once or twice a week to reduce fatigue and depression.

Reference � Multiple Sclerosis

1. Coyle PK. Disease-modifying agents in multiple sclerosis. Ann Indian Acad Neurol. 2009 Oct�Dec; 12(4): 273�282.
2. Gasperini C, Ruggieri S, Pozzilli C. Emerging oral treatments in multiple sclerosis � clinical utility of cladribine tablets. Therapeutics and Clinical Risk Management 2010; (6): 391�399
3. Goodman AD, Brown TR,� Krupp LB, Schapiro RT, Schwid SR, Cohen R, Marinucci LN, Blight AR, on behalf of the Fampridine MS-F203 Investigators. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial.� The Lancet 2009; 373 (9665): 732-8.
4. Calabresi PA. Diagnosis and Management of Multiple Sclerosis. Am Fam Physician. 2004 Nov 15;70(10):1935-1944.
5. Harrison�s Principles of Internal Medicine 17th Edition.

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