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Managing MS Symptoms

In multiple sclerosis, damage occurs to myelin in the central nervous system (CNS) and to nerve fibres themselves.  This interrupts the transmission of nerve signals between the brain and spinal cord and other parts of the body.  This disruption of nerve signals leads to symptoms of MS.  Symptoms may vary depending on where the damage has occurred.

Over the course of MS, some symptoms may come and go, while others may be more lasting.  The chart below lists many of the symptoms that can be experienced with MS.  It also lists medications as well as a brief overview of strategies used to manage the symptom.  For more comprehensive information on many of the individual symptoms, see our publications section.

In general, strategies to manage symptoms can be multi-pronged.  Often medications, such as those listed below, can be helpful.  In addition, it is important to consider non-pharmaceutical approaches, such as physiotherapy, changes in daily regimes (diet, exercise, sleep patterns, energy expenditure), and/or use of assistive devices.  Many people also turn to complementary and alternative therapies.  While these strategies have not been explored here, you can read more about this approach on our complementary and alternative medicines page.

While the range of symptoms experienced in MS can be quite diverse, in general, people with MS will not experience all of the symptoms below. 

» Bladder dysfunction

Bladder dysfunction is a very common MS symptom. Bladder symptoms can be caused by a failure to store urine, a failure to empty completely, or a combination of the two. The cause of the symptom will direct the management strategy to be used. Sometimes it can be managed through changes in habits related to diet and fluid intake, through medications, and where necessary, intermittent or continual catheterization.

Key Healthcare Professionals: Family physician, urologist, neurologist, and nurse

Symptom Management Generic Medication Name Examples of Brand Names Available in Canada (Note: includes both approved and off label indications for use)*
Urinary antispasmodic Tolterodine Detrol Yes
Oxybutynin Ditropan
Propantheline Pro-Banthine
Flavoxate Urispas
Baclofen Lioresal
Tizanidine Zanaflex
Imipramine Tofranil
Promote the flow of urine Tamsulosin Flomax Yes
Prazosin Minipress
Darefenasin Enablex No
Suppression and Treatment of Urinary tract infections Sulfamethoxazole Bactrim, Septra Yes
Ciprofloxacin Cipro
Nitrofurantoin Macrodantin
Urinary suppressant Desmopressin DDAVP
Intermittent self-catheterization or indwelling catheter - - Discuss with your urologist

» Bowel Dysfunction

Bowel dysfunction – constipation or incontinence - is not uncommon in MS. This symptom can often be managed by good habits related to diet, bowel schedule, fluid intake, and activity, as well as through medication.  As a new symptom, any change in bowel function should be evaluated by a physician to rule out non MS causes of the symptom.

Key Healthcare Professionals: Family physician, nurse, nutritionist, pharmacist or if required a gastroenterologist.

Symptom Management Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Stool softener Docusate oral Colace Yes, no prescription required
Docusate stool-softener enema Enemeez Mini Enema
Constipation Bisacodyl Dulcolax
Sodium phosphate Fleet Enema
Psyllium hydrophilic mucilloid Metamucil
Magnesium hydroxide Phillips’ Milk of Magnesia

» Cognitive change

Approximately half of those with MS will experience some degree of cognitive change.  Only 5-10% of individuals will have moderate to severe change.  Cognitive change can be managed through cognitive rehabilitation.

Key Healthcare Professionals: Family physician, nurse, psychologist, neuropsychologist, occupational therapist speech/language pathologist

Symptom Management Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Cognitive rehabilitation - - Consult with health professionals for compensatory strategies, and/or improving function

» Depression

Depression is common in MS. It will affect over 50% of people with MS at some point in their illness.  Depression is a serious condition and should be distinguished from normal grieving associated with the diagnosis of MS. Depression can be managed through counselling and/or medication.

Key Healthcare Professionals: Family physician, nurse, psychologist, psychiatrist, neurologist, social worker

Treatment Options
(Not an exhaustive list)
Generic Medication Name Example of Brand Names Availability in Canada
(Note: includes both approved and off label indications for use)*
Tricyclic antidepressant Amitriptyline Elavil Yes
Imipramine Tofranil
Nortriptyline Aventyl
SSRI Fluoxetine Prozac
Paroxetine Paxil
Sertaline Zoloft
Venlafaxine long acting Effexor XR
Duloxetine Cymbalta
Citalopram Celexa
Escitalopran Lexapro
Counselling - - Psychologist, psychiatrist

» Fatigue

According to some studies, over 90% of people with MS experience fatigue.

Fatigue can be a primary symptom (due to active inflammatory disease) or a secondary symptom (the result of other symptoms or conditions such as sleep disorders, depression, or muscle weakness) and managed by changes in lifestyle (e.g., employing energy effective strategies), as well as medication.

Key Healthcare Professionals: Family physician, nurse, neurologist, occupational therapist, physiotherapist, social worker

Method of Action Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
CNS stimulant Amantadine Symmetrel Yes
Methylphenidate Ritalin
Modafinil Alertec

» Numbness

Numbness of the face, body or extremities (arms and legs) is one of the most common symptoms of MS. (There are no medications approved to relieve numbness but corticosteroids have been used to try to reduce the symptoms especially during acute exacerbations). Fortunately, however, most instances of numbness are not disabling, and tend to remit on their own.

Key Healthcare Professionals: Family physician, nurse, neurologist, occupational therapist

Symptom Management Generic Medication Name  Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
  Corticosteroids (in very severe cases). Prednisone or Solumedrol may be used. Deltasone Yes

» Pain

More than half of those diagnosed have experienced pain as a symptom of MS.

Pain in MS can be managed, but it requires careful identification of the type of pain, and often persistence in determining the best medication and/or dosage.  Acute, paroxysmal pain responds well to medication.  “Chronic pain is more difficult to manage and is often poorly treated.  It frequently requires multidisciplinary input and, if severe, may benefit from the expertise of a pain clinic.”[1]

Key Healthcare Professionals: Family physician, nurse, neurologist, physiotherapist

Symptom Management Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Neuropathic pain and paresthesias Amitriptyline Elavil Yes
Nortriptyline Aventyl
Gabapentin Neurontin
Pregabalin Lyrica
Carbamazepine Tegretol
Phenytoin Dilantin
Cannabis sativa L. extract Sativex
Cyclobenzaprine Flexeril
Muscle relaxant Methocarbamol Robaxin
Baclofen Lioresal
Analgesics and anti-inflammatory agents Acetaminophen Tylenol Yes, no prescription required
Ibuprofen Advil
Narcotics Oxyontin   Yes
Codeine  
Oxycodone  

» Relapses (Exacerbations, Attacks)

Relapses are medically defined as the appearance of new or worsening of old symptoms, lasting at least 24 hours. 

Relapses are often treated with corticosteroids (also known as steroids)which are medications used to reduce the severity of an individual relapse of MS, and hasten recovery.

Key Healthcare Professionals: Family physician, nurse, neurologist

Method of Action Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Reduce inflammation that occurs in the CNS during an MS relapse Prednisone Deltasone Yes
Methylprednisone intravenous (IV) Solu-Medrol

» Sexual dysfunction

Sexual symptoms can occur in MS for both men and women.  These symptoms can be primary (stemming directly from disease activity in the Central Nervous System), or secondary (due to fatigue, spasticity, body image etc). 

Sexual dysfunction can be managed with medications, products (e.g., lubrication for women), and the re-evaluation of ideas and practices related to intimacy and sexuality.

Key Healthcare Professionals: Family physician, nurse, neurologist, urologist, psychologist, sex therapist

Symptom Management Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Erectile dysfunction

 

Alprostadil Caverject, Muse, Prostin VR Yes
Papaverine -
Sildenafil Viagra
Tadalafil Cialis
Vardenafil Levitra
Decreased vaginal lubrication Water soluble lubricants KY Jelly
Relief of dysethesias (pain) Carbamazepine Tegretol
Phenytoin Dilantin

» Spasticity (muscle stiffness)

Spasticity refers to feelings of stiffness.  It is one of the more common symptoms of MS. While spasms – painful, cramp-like muscle contractions – are often associated with spasticity, they are not the same thing.  See the section on Pain for spasms.

Spasticity can be managed through stretching exercises, medication, and appropriate assistive devices. AN onset of spasticity as a new symptom should be evaluated by a physician to rule out secondary causes such as infection.

Key Healthcare Professionals: Physiotherapist, family physician, neurosurgeon

Method of Action Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Muscle relaxant Baclofen (injection) Intrathecal Baclofen (ITB  Therapy)

Yes

Baclofen (oral) Lioresal
Dantrolene Dantrium
Diazepam Valium
Lorazepam Ativan
Tizanidine Zanaflex

» Speech and swallowing difficulties

Speech and voice problems occur in approximately 25-40 percent of people with MS. There are two types of speech dysfunction: dysarthria, which refers to changes in the production of speech, including slurring, unclear articulation of words, and difficulty controlling loudness; and dysphonia, which involves changes in voice quality, such as hoarseness, breathiness, or nasality.  Assessment and management by a speech therapist is helpful, and in some cases communication aids may be useful.

Swallowing difficulties (dysphagia) can sometimes occur in MS.  Mild dysphagia is often easily managed with assessment and advice from a speech therapist.  More extreme cases are at risk of aspiration pneumonia.  In the most severe (and uncommon) cases, it may be necessary to acquire nutrients through a feeding tube.

Key Healthcare Professionals: speech/language pathologist, occupational therapist

Symptom Management Generic Medication Name Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Management strategies via a speech pathologist - - Yes, contact the appropriate health professionals
Occasionally, medication may be used to dry a mouth that is over-secreting Anticholinergics Ditropan

» Tremor

Tremor is one of the more difficult symptoms to treat in MS.  The type of medication depends on the type of tremor (e.g., postural v/s intention).  The interventions below have been tried with varying degrees of success.

Key Healthcare Professionals: Physiotherapist, occupational therapist, family physician, neurologist

Symptom Management Generic Medication Name   Examples of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Anticonvulsant Primidone Mysoline Yes
Beta blocker Propranolol Inderal
Surgical intervention - - Experimental

» Vertigo/Dizziness

Vertigo or dizziness is sometimes experienced in MS.  When experienced at the same time as other symptoms such as double vision or in-coordination (ataxia), this can have a great impact on mobility and/or safety.  Medication can be helpful, as can physiotherapy exercises.

Key Healthcare Professionals: Physiotherapist, occupational therapist, family physician, neurologist

Method of Action Generic Medication Name

 

Example of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Antiemetic Dimenhydrinate Gravol Yes
Ondansetron Zofran
Meclizine Bonamine
Prochlorperazine Stemetil
Physiotherapy – including Cawthorne-Cooksey exercises - - Available through appropriate health professionals

» Vision problems

Vision problems, such as double vision, poor contrast, blurring, or eye pain are often the first symptoms of MS.

Vision problems usually resolve themselves.  Sometimes medication can be helpful.

Key Healthcare Professionals: Neuro-opthomologist, neurologist, occupational therapist, opthomologist

Medication Type Generic Medication Name Examples of Brand Names Available in Canada
(Note: includes both approved and off label indications for use)*
Prednisone or solumedrol can be used on their own, or in tandem (solumedrol first, then prednisone). Corticosteroids Solu-Medrol (IV) Yes
Deltasone (by mouth)

» Walking (gait), balance and coordination problems

Difficulty with walking is among the most common mobility limitations in MS. Gait problems can be related to other symptoms such as spasticity, weakness, loss of balance, sensory deficit, and fatigue.

Most problems related to gait can be helped to some extent by physiotherapy, the use of appropriate assistive devices and, in some cases, medications related to particular symptoms.

Key Healthcare Professionals: Physiotherapist, occupational therapist, family physician

 

* Off-label prescriptions: medications which are approved in Canada, but which are generally prescribed for a different indication, population, or dosage than is intended. 

Disclaimer: The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy, but provides information to assist individuals in making their own decisions.

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[1] Multiple Sclerosis: The Guide to Treatment and Management.  Edited by Chris H. Polman et al.  6th Edition.  Demos: New York, 2006.

 

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