Multiple Sclerosis Treatment

There's no cure for multiple sclerosis (MS).

Still, being diagnosed with MS is not a death sentence — in fact, far from it.

In addition to there being several types of MS drug treatments that can reduce the number and intensity of relapses and slow the progression of the disease overall, there are also numerous types of rehabilitative therapies that can help people maintain their mobility and independence and manage their MS symptoms.

Many people with MS also try one or more complementary therapies to address symptoms, relieve stress, and improve quality of life.

People diagnosed with relapsing-remitting MS (RRMS) have the largest number of disease-modifying therapies — those that can lower the frequency and severity of relapses and slow the progression of MS — to choose from.

However, those options are not all equally effective, so each person with RRMS should discuss the best choice of MS drug with their doctor. Increasingly, many MS doctors believe — and evidence from research supports this belief — that starting MS treatment with a highly effective drug leads to less disability in the long run than starting with a less effective drug with fewer side effects.

RELATED: Early, Aggressive MS Treatment Superior to Escalation Approach, Study Shows

During relapses, people with RRMS may be treated with corticosteroids to help shorten the relapse. For those people who can’t take or don’t respond to corticosteroids, several other treatments can be tried to reduce inflammation and relieve symptoms during relapses.

In recent years, the number of drugs approved to treat “active” secondary-progressive MS (SPMS) have increased. SPMS is a stage of MS that follows RRMS, and typically, people with SPMS see a steady progression of MS symptoms with few or no relapses. A person with “active” SPMS is one who still experiences some relapses.

For people with primary-progressive MS (PPMS), there is only one approved disease-modifying therapy, namely Ocrevus (ocrelizumab).

That being said, some doctors prescribe the drug Rituxan (rituximab) off-label in place of Ocrevus for people with either RRMS or PPMS. The two drugs are very similar in their mechanism of action, but Rituxan is much less expensive and may be an option for people for whom Ocrevus is unavailable or unaffordable.

In addition to disease-modifying therapies, people at any stage of MS may be prescribed other drugs that target specific symptoms and health problems related to MS.

Learn More About Medications for Multiple Sclerosis

Multiple sclerosis can affect a person’s ability to walk, speak, swallow, perform daily tasks — such as taking a shower or preparing meals — and even think.

In most cases, help is available to find alternative ways to perform these functions, sometimes by using assistive devices, and sometimes by retraining the muscles or establishing new habits.

Physical Therapy A physical therapist (PT) can help with problems of physical functioning, such as walking and balance problems and lack of manual dexterity (the ability to do things with your hands). A PT may design an individualized exercise program for you, advise you on stretching and strengthening your muscles, prescribe balance exercises, and teach you how to use an assistive device, such as a cane or walker. A PT with specialized training can help with bladder retraining.

Occupational Therapy Occupational therapists (OTs) look for ways to enable persons with MS to perform the tasks and engage in the activities that are important to them. This can include activities at home, school, in the workplace, or elsewhere. It can also include driving or learning to use public transportation. An OT may advise you on home modifications to keep you safer and more comfortable, as well as on the use of assistive devices.

Speech-Language Therapy If you’re having trouble speaking or swallowing, a speech-language pathologist is the expert you want to see to determine what’s going wrong and how best to deal with it. A speech-language pathologist may prescribe oral strengthening exercises or exercises to improve articulation, or the way sounds are produced.

Cognitive Rehabilitation MS can affect your memory as well as your ability to learn new information and remember it, retrieve the word you want to say, plan and organize tasks, and multitask, or focus on more than one thing at a time. Cognitive rehabilitation therapy may focus on improving these functions or finding ways to compensate for or minimize the effects of cognitive impairments.

A diagnosis of multiple sclerosis deals an emotional blow, and while not everyone feels the same, it’s common to experience sadness, grief, anxiety, and often depression when first receiving the diagnosis or at some later point while living with the disease.

Negative emotions may occur primarily at times of loss — of physical or cognitive abilities, relationships, employment, or once-loved activities — but there doesn’t have to be a specific loss or incident to trigger emotional distress. The unpredictability of MS, and the effects of the disease itself on the brain, can lead to anxiety and depression.

For all of these reasons, finding emotional support is crucial for individuals living with MS and their close family members and friends.

Such support might come in the way of a patient support group or a mental healthcare professional. It can also help to find a wellness program geared toward people with MS. Wellness programs are typically exercise or activity groups offered through an organization like the National Multiple Sclerosis Society or through a specialized MS treatment center.

While having the support of friends, family, and others living with MS goes a long way toward buffering the emotional stresses of living with a chronic disease, remember that if you or a loved one is depressed, it’s important to seek professional help.

Many people with MS turn to natural remedies — also called complementary and alternative medicine, or CAM therapies — to manage symptoms.

But most natural treatments for multiple sclerosis haven't been thoroughly studied by medical researchers.

In general, the AAN found that while some of these approaches seemed to be somewhat helpful, more clinical data is needed before they can be deemed truly safe and effective.

Here is what the AAN concluded regarding the complementary therapies for which it found enough evidence to make practice recommendations:

• Cannabinoids, or marijuana products, may reduce symptoms of spasticity and pain.
• Ginkgo biloba is possibly effective at alleviating fatigue but not cognitive function.
• Magnetic therapy is probably effective for reducing fatigue.
• Reflexology is possibly effective at relieving paresthesia (burning or prickling sensations).

Learn More About Natural Remedy Dos and Don’ts for Multiple Sclerosis

The use of marijuana to treat MS is a controversial issue that's still undergoing long-term study.

According to the AAN, Marinol (dronabinol), which is synthetic medical marijuana in pill form, may reduce spasticity and the pain it causes.

Learn More About Medical Marijuana for MS Symptoms

Mind-body therapies are practices that take advantage of the connection between mind and body.

Some, such as yoga and tai chi, involve moving the body but are noted to have positive effects on mood as well as physical fitness, while others, such as meditation, involve using primarily the mind but can have positive physical effects such as reduced pain in addition to reduced psychological stress.

Practicing yoga on a regular basis has been found to help reduce fatigue and improve quality of life for people living with MS.

If you're interested in trying yoga, look for a class that suits your abilities. Many yoga studios offer chair yoga, for example, which can be helpful if standing is difficult for you. You can also look for “adaptive” yoga classes, which are generally geared toward people with disabilities.

Doing tai chi can improve balance and reduce stress for people with MS. Tai chi usually involves moving your weight slowly from one side to the other using flowing movements. While advanced tai chi practitioners may perform deep bends or squats, beginner routines typically remain more upright. Chair tai chi is also an option if standing is difficult.

The Feldenkrais Method, which uses slow repetitions of movements to teach the body easier ways to perform physical tasks, has been shown to increase physical comfort and mobility in those with MS.

Many people with MS use massage therapy to relax, ease muscle tension, and reduce stress and depression.

Although there's no hard evidence that massage can relieve MS symptoms, it's generally considered a safe therapy to pursue, especially if it makes you feel better.

Acupuncture, which involves inserting very thin needles into specific points on the body, is a popular pain-relief strategy among people with MS.

Some feel acupuncture also helps with muscle spasms and bladder problems, though scientific evidence has not confirmed these connections.

Exercise can be helpful if you have MS.

Walking and water aerobics are particularly helpful for people with MS, because these exercises are less likely to cause fatigue or heat exhaustion than a higher-impact workout.

Reflexology involves putting pressure manually on certain points on your feet, hands, or ears that are believed to connect to the body's organs.

The evidence supporting this treatment for MS is weak, but it suggests that reflexology may help treat tingling, numbness, and other skin sensations associated with the disease.

But it's unlikely that music alone will be effective in controlling these symptoms.