Treatments for Multiple Sclerosis

There's no cure for multiple sclerosis (MS), but medicines and lifestyle changes can help you manage the disease. Work closely with your doctor to find the treatment that's best for you and causes the fewest side effects.

Disease-Modifying Drugs

If you have a type of multiple sclerosis called relapsing-remitting MS and your condition is acting up, your doctor may first treat you with a disease-modifying drug. These medicines slow down the advance of your disease and prevent flare-ups.

The drugs work by curbing the immune system -- your body's main defense against germs -- so that it doesn't attack the protective coating called myelin that surrounds the nerves.

Some drugs come as injections under your skin or into a muscle. The shot might make your skin sore, red, itchy, or dimply. They include:

Beta interferons: These are some of the most common drugs used to treat MS. They ease the severity and frequency of flares. They can also cause flu-like symptoms, like aches, fatigue, fever, and chills, but these should fade within a few months. They may make you slightly more likely to get an infection. That’s because they lower the number of white blood cells, which help your immune system fight illnesses. They include:

  • Avonex (interferon beta-1a)
  • Betaseron (interferon beta-1b)
  • Extavia (interferon beta-1b)
  • Plegridy (peginterferon beta-1a)
  • Rebif (interferon beta-1a)

Glatiramer (Copaxone, Glatopa): This medication stops your immune system from attacking the myelin that surrounds and protects your nerves.

You can take other medications as a pill:

Teriflunomide (Aubagio) is a tablet you take once a day. The most common side effects include diarrhea, abnormal liver tests, nausea, and hair loss. It does carry a "black box" warning, the FDA's most serious warning, because it can lead to liver problems and birth defects. If you take it, your doctor will likely do regular tests to check how well your liver is working. Don’t take it if you're pregnant.

Fingolimod (Gilenya) is also a once-daily tablet. If you haven’t had chickenpox, you’ll need a vaccine. Common side effects include headache, diarrhea, back pain, cough, and abnormal liver tests. Because the medicine may slow your heart rate, the doctor will watch you closely after your first dose. The drug is also linked to progressive multifocal leukoencephalopathy (PML), a rare brain infection.

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Dimethyl fumarate (Tecfidera) is a tablet you take twice a day. It can lower your immune cells, so the doctor will do regular blood tests to keep an eye on them. The drug's most common side effects are flushing, stomach pain, diarrhea, nausea, and vomiting. An active ingredient similar to the one in Tecfidera is linked to four cases of PML.

Other medications are given by infusion into a vein in a doctor’s office or a hospital. But you only have to go once every few months:

Natalizumab (Tysabri) and ocrelizumab (Ocrevus) are options if other drugs don't work for you. Natalizumab prevents immune cells from getting to your brain and spinal cord, where they can damage nerves. Ocrelizumab attacks certain B cells and stops your immune system from attacking your body. The drugs are linked to PMI, so your doctor will do blood tests to check for it.

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Alemtuzumab (Lemtrada) and mitoxantrone (Novantrone) are chemotherapy drugs designed to treat cancer. They’re an option if you don’t respond to other mediations. They curb your immune system and prevent it from attacking nerve coverings. Novantrone has an FDA "black box" warning because it can lead to heart damage and a type of leukemia.

Treating Flares

If you’re taking other medication, mild flares will eventually go away on their own. If they aren’t bothering you, you don't need to treat them.

Steroids: If a flare gets in the way of your life, your doctor may give you high-dose steroids through a vein (intravenously) or by mouth to ease your symptoms quickly. These drugs will calm the flare, but they won't slow the course of your disease. The most common ones are:

Plasma exchange: This can help when a flare doesn’t respond to steroids. Your doctor will remove some of your blood and separate the liquid portion (called plasma) from your blood cells. The cells are mixed with a protein solution and go back into your body.

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Symptom Control

Your doctor may recommend treatments for:

Muscle stiffness and spasms: Muscle relaxants like baclofen (Lioresal) and tizanidine (Zanaflex), or sedatives like clonazepam (Klonopin) and diazepam (Valium)

Fatigue: Amantadine (Symmetrel), armodafinil (Nuvigil), modafinil (Provigil)

Depression: Antidepressants, such as bupropion (Wellbutrin), fluoxetine (Prozac), and sertraline (Zoloft)

Bladder problems: Oxybutynin (Ditropan) or tolterodine (Detrol)

She may also suggest:

Physical therapy: A trained health care professional can teach you exercises that help you stay active. You might also learn how to use a cane, walker, or other assistive device to get around more easily.

Lifestyle Changes You Can Make

Medications aren’t the only answer. Taking good care of yourself will help you live better with MS. Every day, make sure you:

Get plenty of rest: Keep a regular sleep schedule and make sure your bedroom is cool, dark, and screen-free.

Eat healthy food: There is no “MS diet.” Choose foods low in saturated fats and high in fiber. The U.S. Department of Agriculture’s MyPlate website is a good starting point.

Get some exercise: Even a walk around the block can help. Exercise builds bones and strengthens muscles. It keeps depression at bay and helps you sleep better.

Manage your stress: It may make your symptoms worse. Whether you meditate, read, journal, or chat with friends, find something that helps you control the ups and downs.

Stay cool: A rise in body temperature can make your symptoms worse. Stay in the AC if you can. Wear loose, breathable clothes outside.

Are There Alternative Treatments?

Many products claim to help MS symptoms. Be wary of those that don’t have scientific studies behind them or make claims that seem too good to be true. Talk to your doctor about anything you’re tempted to take. Some supplements can change the way your medicines work.

Current research suggests these treatments are worth a try:

Vitamin D: Low levels of vitamin D in your blood can boost your chances of having MS. Studies are under way to see if vitamin D supplements can help. You should get your doctor to check your levels and discuss if you need to take a supplement.

Acupuncture: This traditional Chinese treatment holds that energy called chi flows along your body in lines called meridians. When your chi is out of whack, illness or pain results. An acupuncturist slides thin needles into points along the meridians to change your energy flow. Studies show it can help MS symptoms like fatigue, pain, mood, spasticity, numbness, tingling, and bladder problems.

WebMD Medical Reference Reviewed by Neil Lava, MD on March 13, 2018

Sources

SOURCES:

National MS Society: “Acupuncture,” “Complementary & Alternative Medicines,” “Diet & Nutrition,” “Emotional Well-Being,” “Exercise,” “Heat & Temperature Sensibility,” “Medications,” “Ocrevus,” ”Vitamins, Minerals & Herbs in MS.”

Mayo Clinic: “Multiple sclerosis: Diagnosis & treatment.”

News Release, National MS Society.

Medscape: “Plasmapheresis.”

National Multiple Sclerosis Society: "Disease Management Consensus Statement," "Fingolimod," "Novantrone (mitoxantrone),"  "Exacerbations,"  "FDA Approves Plegridy (Pegylated Interferon Beta) For Relapsing MS."

John Ratchford, MD, assistant professor of neurology, Johns Hopkins School of Medicine.

NINDS: "Multiple Sclerosis Information Page."

Goldman, L. Cecil Medicine, Saunders Elsevier, 2007.

FDA: "Safety Update on Progressive Multifocal Leukoencephalopathy (PML) Associated with Tysabri," "FDA approves new multiple sclerosis treatment Aubagio," "FDA investigating rare brain infection in patient taking Gilenya (fingolimod)."

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