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Home > MSAA Publications > The Motivator > The Motivator: Winter/Spring 2009 > Cover Story - Symptom Management Update

COVER STORY

Symptom Management Update

Sections

SECTION 1: FATIGUE

SECTION 2: SPASTICITY

SECTION 3: WEAKNESS

SECTION 4: BALANCE

SECTION 5: DIZZINESS AND VERTIGO

SECTION 6: TREMOR

SECTION 7: PAIN

SECTION 8: DEPRESSION

SECTION 9: ANXIETY

SECTION 10: SLEEP DISTURBANCES

SECTION 11: COGNITIVE FUNCTION

SECTION 12: BLADDER

SECTION 13: BOWEL

SECTION 14: SPEECH AND SWALLOWING

SECTION 15: VISION

SECTION 16: SEXUALITY

Resources

A comprehensive overview of strategies and medications used to manage MS symptoms, along with initial findings on many experimental treatments presently being studied


Written by Diana M. Schneider, PhD
Edited by Susan Wells Courtney
Reviewed by Jack Burks, MD and Randall T. Schapiro, MD

Based on the positive review to the "MS Research Update" articles that appeared in the Summer 2007 and 2008 issues of The Motivator, this article expands the coverage of MS management to discuss the second arm of the MS treatment spectrum, the management of the many symptoms of the disease. Although most of the media attention given to MS focuses on the disease modifying agents, many of the symptoms of MS can and should be managed effectively. The article is organized by symptom, and discusses both non-pharmacologic and pharmacologic approaches. For each medication, we have provided basic information on usage, dose, and effect. This is not a complete list and not all studies and their research are included.

The information provided is based on a wide range of sources, including the extensive journal literature on MS and its management, a review of ongoing clinical trials, and papers presented at major national and international meetings dedicated to neurologic conditions and MS. These include the annual meetings of the American Academy of Neurology (AAN), the Consortium of Multiple Sclerosis Centers (CMSC), and the American and European Committees for Treatment and Research in Multiple Sclerosis (ACTRIMS and ECTRIMS).

Editor's note: MSAA does not endorse or recommend any specific products or therapies. Readers are advised to consult their physician before making any changes to their medication, diet, exercise, or other regimen.

General Comments and Discussion

Multiple sclerosis (MS) may be associated with a wide variety of symptoms, which can occur in almost any combination and vary widely among individuals. These symptoms are managed with both rehabilitation strategies - including physical and occupational therapy - and a range of pharmacologic agents.

Many people with MS take multiple medications, and it is important that any physician prescribing any new drug know ALL of the medications you are currently taking. This is especially important for those drugs that have either a depressant or stimulant effect on the central nervous system (CNS). Such depressants include the benzodiazepines and other tranquilizers, sedatives, prescription medications used for pain, antihistamines, and alcohol. Stimulants include drugs used to manage fatigue.

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Some drugs are used to manage more than one symptom. For example, some antidepressants are also effective in managing fatigue, and a number of agents originally developed as anti-seizure medications are helpful in managing pain and spasticity. For these multi-use agents, we have included the drug under its major indication, and cross-referenced it as appropriate.

Many - even most - of the medications used to manage the symptoms of MS were first developed for use in other conditions, or the same symptom in people who do not have MS. When a drug has been approved by the United States ' Food and Drug Administration (FDA) for use in one condition, physicians may use it on an "off-label" basis in other situations, whose symptoms may resemble that of the one for which the drug was originally approved. Because FDA approval includes a detailed review of safety and reliability testing, the physician can be reasonably confident that the side effects of the drugs are well known.

We note recommended dosages for drugs wherever guidelines exist, although each individual responds differently and optimal dosages may be outside this range depending on a variety of factors. In the case of many drugs used off-label, the dosage may be different than that used for the original condition for which the drug was approved, and will be adjusted for each individual to maximize therapeutic benefit and minimize side effects.

All drugs have side effects, and it can be difficult to determine the specific cause of any new side effect to a specific agent if you are taking multiple medications. Many of the drugs used to treat MS have side effects that include dizziness, sleepiness, fatigue and weakness, confusion, and gastrointestinal disorders. Most of these symptoms disappear as your body becomes used to the medications. However, report any sudden changes in your physical or psychological health to your physician to rule out an unusually severe effect of a new medication.

In most cases, medications used to treat any symptom of MS should not be discontinued abruptly. These medications are usually tapered off gradually, as indicated by your healthcare provider, and some drugs may have severe side effects if suddenly stopped. Please consult a physician before making any change to your medications. In the event of a severe or allergic reaction to a drug, contact a medical professional or seek emergency help immediately.

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A Word about Complementary and Alternative Medicine (CAM)

The term "CAM" can be broadly defined as therapies that are somewhat outside of the medical mainstream, and used to manage various symptoms or illnesses. Some, such as acupuncture, have been the subject of major studies that have shown a positive effect on specific symptoms. Others, such as tai chi, yoga, and meditation, are generally beneficial to many people, not just those with MS. Still others, including a wide variety of herbs, should be used with caution as they have the potential to interact with medications that you may be taking. Don 't begin any program or supplement without first discussing with your physician or nurse whether the therapy might affect your MS adversely or interact with your current medications.

In the pages to follow are the most commonly reported symptoms of MS, along with the different strategies used in treating these symptoms. Just as the symptoms of MS differ from one person to another, how an individual reacts to a certain treatment will differ from person to person as well. Often a physician will need to try different therapies, dosages, and even combinations, before finding the treatment plan best suited for a specific patient. The following information is not to be used to determine treatment, but rather to inform readers of the different treatment strategies available. As noted earlier, MSAA does not endorse or recommend any specific products or therapies. And as always, please consult a physician before making any changes to your treatment regimen.

At the conclusion of this listing is a page of resources for more information. This includes books, videos, and MSAA publications. Readers looking for more information or support are also encouraged to speak with one of MSAA 's Helpline consultants by calling (800) 532-7667.

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Last Updated on Monday, 25 March 2013 11:34