Cheshire West and Chester Council use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we’ll assume that you are happy to receive all cookies on our website. However, if you would like to, you can at any time.

Cheshire West & Chester Council logo

Do it online.

Report it, pay for it, find it

A-Z of health

Content supplied by NHS Choices

 

 

You can search for full details of a range of treatments or conditions simply by selecting a letter.

MS

Treating multiple sclerosis

[Original article on NHS Choices website]

Treatment overview

There is no cure for MS, however, there are many treatments that can relieve symptoms and relapses and which may slow the progression of the condition.

If you have benign MS, or your symptoms are mild, you may not need treatment unless you experience a relapse.

Treatment for MS can be split into three main categories:

  • treatment for relapses of MS symptoms (steroids)
  • treatment for specific MS symptoms
  • treatment to slow the progression of MS (disease-modifying medicines)

Want to know more?

Treatment for MS relapses

Whenever you experience a relapse of your MS symptoms, see your GP or MS specialist nurse. A recurrence of your symptoms could be due to a secondary cause, such as an infection, so your GP or nurse must identify what's causing the relapse before they treat it.

If your symptoms are due to a relapse, you may be given a three to five-day course of a high-dose steroid, called methylprednisolone, to help speed up your recovery. This can be given either orally as tablets, or intravenously (injected into a vein). You may receive the treatment in hospital or at home.

It's not fully understood how steroids speed up your recovery from a relapse, but they are thought to suppress your immune system so that it no longer attacks the myelin in your central nervous system. They may also help reduce the amount of fluid around any nerve fibre damage.

While steroids can be useful in helping you recover from a relapse they do not have any significant effect in altering the course of the disease or preventing further relapses.

As steroids may cause long-term side effects, such as osteoporosis (weak and brittle bones), weight gain and diabetes, you should not take them for more than three weeks at a time. Do not take more than three courses of treatment in a year.

Want to know more?

Treatment for specific MS symptoms

If you have MS, you may have several different symptoms, which can vary in severity. There are treatments that can relieve each specific symptom, although some symptoms are more easily treated than others.

Visual problems

If your visual problems are mild – such as having trouble reading – see your optician for an eye test. The problem may not be due to MS. However, if your visual problems are more severe or you have difficulty focusing (nystagmus), you may be prescribed medication called gabapentin.

Muscle spasms and spasticity

Muscle spasms and spasticity can be improved with physiotherapy. Stretching movements can help prevent spasticity (stiffness). You may be referred to a physiotherapist trained in MS treatment if muscle spasms and spasticity are restricting your movements.

If your muscular spasms are more severe, you may be prescribed a medicine that can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which would be best for you with your GP or MS specialist nurse.

In rare cases, medicines may not be enough to control muscle spasms and spasticity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur as extreme skin sensitivity, or a burning sensation. This type of pain can be treated using the medicines gabapentin or carbamazepine, or with an antidepressant called amitriptyline.

Musculoskeletal pain

You will probably have musculoskeletal pain if you have muscle spasms and spasticity, as it is caused by excess pressure and stiffness in your joints.

A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions. If your pain is more severe, you may be prescribed painkillers (analgesics) or antidepressants (which can also help with pain). Alternatively, you may have a procedure that stimulates your nerve endings, known as transcutaneous electrical nerve stimulation (TENS).

Mobility problems

As with musculoskeletal pain, mobility problems are usually the result of muscle spasms and spasticity or muscle weakness. Your joints may tighten, making it hard to move around.

If you have mobility problems, it's best to try to prevent muscle spasms and spasticity in the first place with physiotherapy or medication (see above). Your muscles can tighten to the point where it's painful and difficult to move at all, which is known as a contracture.

If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help relax your muscles.

Muscle weakness can be helped by strengthening exercises or learning to compensate for weakness by using other muscles.

There are medicines, exercises and equipment that can relieve a tremor (ataxia) or dizziness caused by MS. These are available from your neurological rehabilitation team.

Cognitive problems (difficulty with thought, memory and speech)

If you experience cognitive problems, any treatment you receive will be fully explained and recorded so that it's clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them. You may receive treatment from a speech therapist if necessary.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms. This could be a clinical psychologist. They may suggest treatment with an antidepressant. If you do not want antidepressants, learning techniques to control your emotions can help.

People with MS who have depression can be treated with antidepressants. If you often feel anxious or worried, your GP or neurologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. Clinical psychologists can help you with depression by using psychotherapy, such as cognitive behavioural therapy (CBT). If you have severe or persistent depression, you may be referred to a psychiatrist for further advice.

Fatigue and tiredness

Many people with MS experience extreme tiredness. Your GP or MS specialist nurse should assess this to see if there's another reason for your fatigue other than MS, such as medication or poor diet.

If your fatigue is due to MS, you may be prescribed medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to prevent fatigue, such as exercise and energy-saving techniques.

Bladder problems

If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine. This will help make the need to pass urine more predictable. The need to pass urine frequently at night can be treated with a medicine called desmopressin.

If you have an underactive bladder which is not emptying properly, you may undertake intermittent catheterisation or be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as bladder exercises or electrical treatment for your bladder muscles.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your rectum, or an enema. An enema involves having a liquid medication rinsed through your rectum and colon, which softens and flushes out your stools.

Bowel incontinence can be treated with anti-diarrhoea medication or by doing pelvic floor exercises to strengthen your rectal muscles.

Treatment to slow the progression of MS

MS cannot be cured, but there are treatments that can reduce the number and severity of relapses. These treatments may also help slow the progression of MS, although research into their long-term effects is limited.

Disease-modifying medicines

These treatments are injected into your muscle or under your skin. They can only be prescribed by a neurologist who is part of a specialist neurological rehabilitation team. Your MS specialist nurse can help you with the injections until you're ready to carry them out yourself.

Disease-modifying medicines reduce the amount of damage and scarring to the myelin in your central nervous system, which cause MS relapses.

Disease-modifying medicines are not suitable for everyone with MS. They are only prescribed to patients with relapse remitting MS (RRMS) and secondary progressive MS (SPMS) who meet certain criteria.

MS Decisions is a structured decision aid that can help you decide whether or not to start a course of disease modifying drugs (DMDs). The decision aid guides you through the options, your lifestyle and preferences, and can help you decide, together with your neurologist, which of the five drugs currently available would be best for you.

Want to know more?

Interferon beta

The types of interferon beta licensed for use in the UK are interferon beta-1a (Avonex and Rebif) and interferon beta-1b (Betaferon and Extavia). All four brands of interferon beta are given by injection.

All interferons can cause mild side effects, such as flu-like symptoms (headaches, chills and mild fever) for 48 hours after they are injected. Interferon beta is not suitable for people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking interferon beta, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. Glatiramer acetate is injected under the skin every day. It does not usually cause any noticeable side effects, although in rare cases it may cause tightness in your chest. Glatiramer acetate is only licensed for use by people with relapsing remitting MS (RRMS).

Like interferon beta, glatiramer acetate is not suitable for people under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you're pregnant while taking glatiramer acetate, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Natalizumab

Natalizumab is the most recently licensed disease-modifying medicine for MS relapses in the UK. It is known by the brand name Tysabri. Natalizumab is injected into a vein (intravenously) once every 28 days. It can cause several side effects, including headaches, nausea and vomiting, and an itchy rash. In rare cases, natalizumab has been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition that breaks down myelin on nerve fibres, in a similar way to MS. It can cause problems with vision and speech and, eventually, paralysis.

Natalizumab is only licensed for use by people who still have highly active relapsing remitting MS (RRMS) after treatment with interferon beta, or for people who have rapidly evolving RRMS. Rapidly evolving RRMS is defined as having:

  • two or more severe relapses within one year
  • two consecutive MRI scans that show increased damage and scarring to myelin.

Natalizumab is not suitable for people under the age of 18 or over the age of 65, people with cancer, or people with a weakened immune system, such as those who are HIV positive.

Want to know more?

Clinical trials

Much progress has been made in MS treatment due to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you're asked to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

Want to know more?

Complementary and alternative therapies for MS

Some people with MS find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of MS. However, there is no clinical evidence to show they are effective in controlling MS symptoms.

Many people think that complementary treatments have no harmful effects. However, they can be harmful and, as with any complementary or alternative treatment, it's never a good idea to use them instead of the medicines prescribed by your doctor. If you decide to use an alternative treatment along with your prescribed medicines, it's important to let your doctor know.

Want to know more?

Diet to modify MS

It has been suggested that a diet high in linoleic acid may reduce the duration and severity of MS relapses and slow the progression of the condition. However, there isn’t enough medical evidence to recommend this treatment.

Ask your GP or dietitian for advice about increasing your intake of linoleic acid. Aim to incorporate 17-23g of linoleic acid into your daily diet. This may not be advisable if you're overweight.

Linoleic acid is found in:

  • sunflower spread and oil 
  • safflower or sesame seed oils 
  • nuts and seeds, such as walnuts, brazil nuts, peanuts and almonds
  • certain supplements, including blackcurrant seed oil, grape seed oil and evening primrose oil

Want to know more?

Newer treatments

A number of newer treatments for MS have been introduced in the last few years. These are discussed below.

Fingolimod

A new type of DMD called fingolimod was licensed in 2011. It is designed for people with relapsing remitting MS that appears to be rapidly getting worse.

A practical advantage of fingolimod is that it is available in capsule form, which you take once a day, so you do not have to have injections.

Side effects of fingolimod include:

  • persistent coughing
  • chest pain
  • feeling sick
  • being sick
  • diarrhoea

Percutaneous venoplasty

Percutaneous venoplasty is a type of surgery based on the idea that a possible cause of MS is poor blood flow out of the brain due to narrowed veins (read more about the possible causes of multiple sclerosis).

During surgery, a needle is placed through the skin and into one of the narrowed veins. Attached to the needle is a small balloon, which is inflated to widen the vein.

Since news about this type of surgery was made public, percutaneous venoplasty has caused a lot excitement in some sections of the MS community. Some commentators speculated that it could provide a ‘wonder treatment’ for MS.

However, both the main MS charities (the MS Society and the MS Trust) have urged caution. They have pointed out the theory underpinning the surgery is still unproven and there is limited evidence about whether this type of surgery is safe and effective in the long-term.

If you do undergo this type of surgery, it is highly recommended you receive it in a clinical trial.










Related links

  • A-Z of health

Listen to this page

Rate this page

Cheshire West & Chester Council, HQ, Nicholas Street, Chester, CH1 2NP