2 Chapter 2 – Symptom Management

Treating Flares

An exacerbation of MS is the occurrence of new symptoms or the worsening of old symptoms. It can range from mild to severe enough to interfere with function. For flares, high dose steroids are given intravenously to ease symptoms. The most commonly prescribed are: methylprednisolone, prednisone, dexamethasone and adrenocorticotropic hormone (ACTH). For flares not responding to steroids, plasma exchange may be considered.

Treating Disabilities

MS patients will experience a range of symptoms even during remission including: depression, spasticity, fatigue, and bladder problems. Often physical therapy is prescribed in addition to pharmacological management.

Muscle Stiffness, Weakness or Spasms

Baclofen – GABA receptor agonist, reduces spasticity
Tizanidine – central alpha-2-adrenergic receptor agonist, reduces spasticity
*Sedatives are sometimes also considered for muscle stiffness and spasms.*
Dalfampridine – potassium channel blocker, increases muscle strength

Fatigue

Amantadine – Non-competitive agonist of the NMDA receptor which increases dopamine release and prevents dopamine reuptake
Armodafinil – A stimulant that inhibits dopamine reuptake and increases signaling to the hypothalamic orexin and histamine neurotransmitter pathways

Bladder Problems

Oxybutynin – Inhibits muscarinic receptors on smooth muscle
Tolterodine – Competitive antagonist of muscarinic receptors