Finding the Right Multiple Sclerosis Treatment

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Stepping Up Your Multiple Sclerosis Treatment

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    As MS Progresses, Treatment May Need to Be Adjusted
    With the treatments available today, multiple sclerosis (MS) is rarely a fatal disease, and most people will live a normal life span. But because the type of MS you have may change over time, you may need to try different treatments. By working with your MS doctor, typically a neurologist, you can adjust your treatment as MS progresses. Physical and occupational therapists can also help, as can eye specialists and even mental health providers knowledgeable about MS.

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    First Treatment for Relapsing MS
    If you're like 85% of people with MS, you have the type that comes and goes. This is relapsing-remitting MS and you'll probably start on a disease-modifying drug. These are usually injections. You'll continue with them unless they're not working or you can't tolerate them. They include interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), glatiramer acetate (Copaxone), and ocrelizumab (Ocrevus). They decrease the number of MS attacks you have and reduce damage and disability.

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    Oral Options for Relapsing MS
    If you don't do well with injections or don't respond well to disease-modifying drugs, your doctor may have you try one of three new oral drugs for MS. They include fingolimod (Gilenya), teriflunomide (Aubagio), or dimethyl fumarate (Tecfidera). They work by changing the immune system in ways that decrease MS attacks and help prevent damage. They also have side effects that you should discuss with your doctor.

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    Second-Line Therapy
    If you have relapsing MS that has not responded to any other first-line therapy, your doctor may want you to try natalizumab (Tysabri) or Alemtuzumab (Lemtrada). These medications are not first-line treatments because they can have rare, but severe side effects. If you are on Tysabri or Lemtrada,  your doctor will carefully monitor you. 

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    Progressive Types of MS
    Some people start out with a progressive type of MS or their MS becomes progressive after several years.  In 2017, the first drug ever approved to treat primary progressive MS, ocrelizumab (Ocrevus), came to the market. In clinical trials, this drug, given by infusion every six months, slowed disease progression and significantly decreased brain lesions. Patients with progressive MS can also try mitoxantrone (Novantrone), approved for reducing disability and relapses in progressive types of MS that are getting rapidly worse. It's a chemotherapy drug, similar to drugs used for cancer. You get it intravenously every three months. Because it can cause heart damage, you can stay on this drug for only about two to three years.

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    Drugs for Treating MS Symptoms
    Even with treatment, you may still have certain MS symptoms. There are different drugs you can take to ease many of them. If you have trouble walking because of MS, the drug dalfampridine (Ampyra), a pill, may improve your walking speed. Botulinum toxin (Botox) injection may help with hand and arm spasticity. Botox is better known as a wrinkle remover. Another way to treat spasticity is with the muscle relaxer Baclofen, which is available by pill or injection.

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    Adding Rehabilitation
    If you're having trouble with daily activities, rehabilitation services may help. Physical therapy may improve strength and flexibility using specific exercises. Occupational therapy may improve your day-to-day functioning at home or at work. And speech and language therapy may help if you're having trouble talking. A physical therapist can also show you how to best use assistive devices like a scooter or cane.

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    Making Lifestyle Changes for MS
    Exercise, a nutritious diet, and other healthy lifestyle choices are an important part of MS management at every stage of the disease. Constipation is a common problem. So drink lots of water and eat a diet rich in fiber from whole grains, fruits, and vegetables. Becoming overheated or sick from a cold or flu often makes MS worse. So take steps to stay cool and avoid infections. Use air conditioning when necessary, and get your flu shot every year.

Stepping Up Your Multiple Sclerosis Treatment

About The Author


  1. Frequently Asked Questions About Multiple Sclerosis. Multiple Sclerosis Association of America. http://mymsaa.org/ms-information/faqs/
  2. Long-Term Treatments for MS. Multiple Sclerosis Association of America. http://mymsaa.org/ms-information/treatments/long-term/
  3. Treating MS. National Multiple Sclerosis Society. http://www.nationalmssociety.org/Treating-MS
  4. Novantrone. National Multiple Sclerosis Society. http://www.nationalmssociety.org/Treating-MS/Medications/Novantrone
  5. Tysabri. National Multiple Sclerosis Society. http://www.nationalmssociety.org/Treating-MS/Medications/Tysabri-®
  6. MS the Disease. National Multiple Sclerosis Society. http://www.nationalmssociety.org/About-the-Society/Press-Room/MS-the-Disease
  7. Lemtrada. National Multiple Sclerosis Society. http://www.nationalmssociety.org/Treating-MS/Medications/Lemtrada
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 31
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