Medications for multiple sclerosis (MS) may be used:

• During a relapse, to make the attack shorter and less severe.
• Over a long period of time, to alter the natural course of the disease (disease-modifying therapy).
• To control specific symptoms as they occur.

Controlling a relapse

Medications can shorten a sudden relapse and help you recover more quickly. Temporary treatment with medications called corticosteroids is the most common treatment used to control a relapse. These medications have not been shown to affect the long-term course of the disease or to prevent disability.

Altering the course of MS using disease-modifying treatment

Strong evidence suggests that MS is caused by the immune system causing inflammation and attacking the myelin-the coating surrounding the nerve and nerve fibers. Medications that change the activity of the immune system can reduce the number and severity of attacks that damage the protective myelin.

Interferon beta (Avonex, Betaseron, and Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri) are the only medications that have been approved for this purpose. For people with relapsing-remitting MS, these medications can reduce the number and severity of relapses and can result in fewer brain lesions. They may also delay disability in some people. Betaseron and Novantrone may delay disease progression in some people with secondary progressive MS.

Currently, there is no effective disease-modifying treatment for primary progressive MS.

Some people have only one episode of a neurological symptom such as optic neuritis, but MRI tests suggest they may have MS. This is known as a clinically isolated syndrome. Many of these people go on to develop MS over time. In some cases, doctors will prescribe interferon beta for people who have had a clinically isolated syndrome. These medicines, when taken early or even before you have been diagnosed with MS, may keep the disease from getting worse or make your time without disease longer.

Relieving symptoms

Treating specific symptoms can be effective, even if it does not stop the progression of the disease. Symptoms that can often be controlled or relieved with medication include:

• Fatigue. Medications to reduce fatigue or help you sleep better may include amantadine (Symmetrel) or fluoxetine (Prozac).
• Muscle stiffness (spasticity) and tremors. Medications that may reduce muscles spasms or stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam (Klonopin). Sometimes a combination of these medications works best to reduce your muscle symptoms.
• Urinary problems and constipation. Medications used to reduce frequent urination may include propantheline (Pro-Banthine), oxybutynin (Ditropan), or tolterodine (Detrol). Medications sometimes used to relieve constipation include bulk agents such as psyllium (Metamucil) or daily use of laxatives.
• Pain and abnormal sensations. Depending on the severity of the pain, both prescription and nonprescription medications may be tried. Over-the-counter medications may include acetaminophen, ibuprofen, or naproxen sodium. Prescription medications commonly used to reduce pain associated with MS include baclofen (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).
• Depression. Antidepressant medications may be used to reduce depression that often occurs as a result of having MS. Antidepressants often tried include tricyclic antidepressants-such as amitriptyline (Elavil), desipramine (Norpramin), or imipramine (Tofranil)-or selective serotonin reuptake inhibitors (SSRIs)-such as fluoxetine (Prozac) or sertraline (Zoloft) among others.
• Sexual difficulties. Medications used to relieve sexual difficulties that can be associated with MS include sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also be given to improve erectile dysfunction.