Table 2.
Suggested symptomatic treatments in MS
| Drug* | Interventional | Multi-disciplinary input | |
|---|---|---|---|
| Fatigue | Amantadine | Occupational therapy and physiotherapy: fatigue management assessment and exercise programme | |
| Cognition/low mood | Depression: eg citalopram duloxetine | Neuropsychology service, cognitive behavioural therapy, occupational therapy | |
| Spasticity | Baclofen, gabapentin, tizanidine, clonazepam, dantrolene | Intrathecal baclofen, botulinum toxin | Physiotherapy |
| Bladder | Frequency/urgency: oxybutynin, solifenacin, tolterodine, mirabegron
Nocturia: desmopressin/DDAVP spray |
Residual bladder volume >100 ml: intermittent self-catheterisation or permanent catheter; intravesicular botulinum toxin, | Uro-neurology |
| Sexual dysfunction | Sildenafil, tadalafil, alprostadil, yohimbine | Uro-neurology | |
| Constipation | Fibre/fluid, bulking agents, osmotic stimulant laxatives, suppositories, transanal irrigation | ||
| Faecal incontinence | Codeine, loperamide | Biofeedback, neuro-gastroenterology | |
| Pain | Amitriptyline, pregabalin, gabapentin, lamotrigine | ||
| Ataxia/tremor | Propranolol, clonazepam, levetiracetam, isoniazid (with pyridoxine), carbamazepine, ondansetron | Botulinum toxin, thalamotomy | Physiotherapy, occupational therapy, audiovestibular therapy |
| Oscillopsia | Gabapentin, memantine, levetiracetam, clonazepam, baclofen | Neuro-ophthalmology | |
| *These may be unlicensed indications | |||