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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 ( 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.

Currently, interferon beta (Avonex and Rebif, and Betaseron),
glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) 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.

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), modafinil
  (Provigil), 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 medications may be tried. Prescription
  medications commonly used to reduce pain associated with MS include baclofen
  (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).
  Nonprescription medications may include acetaminophen, ibuprofen, or naproxen
  sodium.
• Depression. Antidepressant medications may be used to
  reduce depression that often occurs as a result of having MS.
  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.

MS can affect many parts of the nervous system and produce a wide
range of symptoms. The choice of medications depends on your symptoms.
Medication may be used only some of the time or regularly, depending on how
severe or constant a particular symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See the
Home Treatment section of this topic.

Medication Choices

Symptom management

Medications used to treat symptoms of an attack of multiple
sclerosis (MS) and help you recover more quickly from a relapse include:

• Corticosteroids (such as
  methylprednisolone).
• ACTH (adrenocorticotropic
  hormone).
• Intravenous immunoglobulin (IVIG) or
  plasma exchange (neither is used frequently).

MS

Medications used specifically for relapsing-remitting MS to
reduce the number and severity of relapses and possibly delay disability
include:

• Interferon beta (Avonex, Rebif, and
  Betaseron).
• Glatiramer acetate
  (Copaxone).
• Mitoxantrone (Novantrone) for relapsing-remitting MS
  that is rapidly getting worse.

Secondary-progressive MS

Medications used to treat and possibly delay the progression of
secondary progressive MS that is also relapsing include:

• Interferon beta-1b (such as
  Betaseron).
• Mitoxantrone (Novantrone).

MS

No medicines have been clearly proven to help, and none have
been approved for primary-progressive MS. Some of the newer and experimental
medications, such as
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) are being tested for
primary-progressive MS.

Medications being studied

A variety of
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) have been tried as
therapy for MS. While none have been clearly proven beneficial and none have
been approved for treatment of MS, these medications may be used when standard
therapy fails.

Several medicines are currently being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to participate in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at http://www.nationalmssociety.org.

What To Think About

Long-term treatment with interferon beta and glatiramer acetate
can improve the quality of life for some people who have relapsing-remitting MS
by making relapses less frequent and less severe. Some evidence suggests that
these medications may also reduce or delay future disability caused by this
form of the disease.

The National Multiple Sclerosis Society recommends that treatment
with interferon beta or glatiramer acetate be started as soon as it is clear
that you have MS. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

Despite the recommendation, however, some people find it
difficult to decide whether to begin disease-modifying therapy, especially when
their symptoms have been fairly mild. Some may not want to bear the risks and
flu-like side effects of interferon therapy when they are not sure they need
it. Some may want to see whether their disease worsens before starting therapy.
A small percentage of people diagnosed with MS may never have more than a few
mild episodes and may never develop any disability, but the disease is
unpredictable. For more information, see:

Should I have disease-modifying therapy for
MS?

If you decide not to try disease-modifying therapy at this time,
work with your doctor to monitor your health through regular checkups and
periodic MRI scans to evaluate whether the disease is progressing. If new
lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

Treating symptoms and relapses

The need and desire for medication vary. If your symptoms are
mild, you may choose to manage them without any medication. If you have
specific symptoms that are causing problems, certain medications may help you
keep them under control. Or you may want to use medication only during a
relapse.

You may also want to consider:

• The possible side effects of using steroids
  or other medications to treat symptoms or control a relapse. Some people have
  only minor side effects, but others may have side effects that concern them
  more than their MS symptoms.
• The costs of treating symptoms and
  controlling relapses. In some cases, using medication to control symptoms and
  relapses may reduce the need for hospital stays.
• Other personal
  issues that you face at work or at home.

Also keep in mind that it can be hard to tell whether
medication is helping. Multiple sclerosis is a disease with spontaneous
remissions, which means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment does not mean
that a treatment is working.