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Multiple Sclerosis Centers of Excellence


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Treatment and Management Options for Multiple Sclerosis

The goals for MS therapies are to reduce the frequency of relapses, slow the progression of the disease, manage symptoms, and improve quality of life. Medications for MS focus on controlling the immune system and managing symptoms. People with MS should work with their MS Multidisciplinary Care Team to find the best approach to address their MS symptoms.

Disease Modifying Therapies

Over sixteen different disease modifying therapies (DMTs) have been approved by the US Food and Drug Administration (FDA) for the treatment of MS. These include injectable, oral, and infused medications. DMTs have been shown to reduce relapses and neurologic disability, but be aware that DMTs do not treat chronic symptoms or restore lost function.

People with MS who are good candidates for a DMT should start treatment as soon as possible. Research shows that early treatment with DMTs can reduce long-term disability from MS. Use of DMTs is not limited by the frequency of relapses, age, or level of disability. Treatment is not stopped unless it is it clearly no longer effective, there are intolerable side effects, or a better treatment becomes available.

As with all medications, there can be side effects. Your health care provider will discuss these with you and help you to select the most appropriate medication. If your condition changes or you experience bothersome medication side effects, your VA health care team will work with you to find solutions.

Choosing the Best DMT For You

  • Discuss your MS disease course with your health care provider as well as the benefits and risks of therapies.
  • Contemplate the route of the therapy - oral, self-injection by needle, or clinic appointment infusion (into the vein) - and your ability to take the therapy as prescribed.
  • Understand how often you’ll need to be seen for exams, labs, infusions, and follow-up care.
  • Consider your overall health
    and family planning

Information on medications for MS can be found on the DMTs for MS page, which provides links to National MS Society information.

Symptomatic Therapies

People with MS may suffer from a variety of symptoms including bladder problems, bowel dysfunction, depression, dizziness, walking difficulties, sexual dysfunction, pain, and fatigue. Fortunately, there are a number of medications, interventions, and therapies that can effectively manage these symptoms. Therapies and interventions can include physical therapy for walking difficulties and muscle stiffness, occupational therapy for tremor, or a cooling vest for heat sensitivity. Other lifestyle changes, like a healthy diet and safe exercise plan, can significantly help with symptoms and improve overall health. These treatment approaches may not always make the symptom go away completely, but can often make symptoms easier to manage.

If the first treatment does not work or has too many side effects, there are others you can try. It may be important to address the most bothersome symptom first. Discuss your options with your health care team to create an individualized treatment plan for you.

Relapse Management

An MS relapse (also known as an MS exacerbation or MS flare) is when inflammation in the brain and/or spinal cord causes a new symptom or worsening of an old symptom. Symptoms from an MS relapse must last over 24 hours, most relapses last from a few days to several weeks or months. Symptoms with a relapse can range from mild to severe. Occasionally, infection, stress, and heat can make old symptoms worse, also called a pseudo-relapse. Unlike an MS relapse, a pseudo-relapse does not reflect new inflammation or MS progression. Your MS specialist can help determine whether worsening symptoms are from an MS relapse or a pseudo-relapse.

Steroid medications may help speed up recovery from a severe relapse, though milder relapses may not require steroids. You and your health care team should make the decision together whether steroids are a good option for you. During and after a relapse, you may need to work with a rehabilitation therapist to help with any changes to your ability to perform activities of daily living. If you think you may be experiencing a relapse, contact your MS specialist right away.

Complementary Therapies and Integrative Medicine

The term “complementary and alternative medicine” (CAM) generally refers to products and practices that are not currently part of "mainstream" medicine. Complementary medicine is used with standard care, whereas alternative medicine is used instead of standard care. The term "integrative medicine" refers to care that blends both mainstream and complementary practices.

Some CAM approaches include nutritional supplements, lifestyle changes like stress reduction techniques, mindfulness meditation, physical programs like yoga or chiropractic manipulation, and pain management. VA continues to research the safety and effectiveness of CAM therapies for MS. VA supports the use of appropriate integrative medicine, which combines the practices of complementary and standard care. Always check with your health care provider before trying complementary therapy; some may not be helpful for people with MS or can make the symptoms of MS worse.

Additional Information

Disclaimer: Links are provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by MSCoE of any of the products, services, or opinions of the organization. MSCoE bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.