Table 4. Management of symptoms in MS patients .
FDA: Food and drug administration, PT: Physical therapy, OD: Once daily, PFT: Pelvic floor therapy, CS: Corticosteroids, TMS: Transcranial magnetic stimulation, SCS: Spinal cord stimulation, CBT: cognitive behavioural therapy, TENS: Transcutaneous electrical nerve stimulation, TCAs: Tricyclic antidepressants [173-177]
| Symptoms | Pharmacological Treatment | Non-Pharmacological Treatment |
| Impaired gait, balance and co-ordination | Dalfampridine-FDA approved potassium channel blocker for improved walking (10 mg OD orally), meclizine, promethazine | Mobility aids, fall prevention stratergies, physiotherapy (PT), gait training |
| Tremors and ataxia | High doses of isoniazid, carbamazepine, propranolol, glutethmifr, topiramate | PT, rehabilitation, stereotactic operations - deep brain stimulation thalamotomy of ventralis intermedius |
| Spasticity | Baclofen (oral and intrathecal), tizanidine, dantrolene, cannabis, botulinum toxin, intrathecal CS | PT, hydrotherapy, TMS |
| Fatigue | Amantadine, modafinil, methylphenidate, 4-aminopyridine, pemoline | Energy conservative measures, mobility assistance, cooling therapy, aerobic training |
| Bladder disturbance | Anticholinergics to reduce detrusor activity, alpha-blockers, desmopressin, oxybutynin, botulinum toxin A | Bladder training, pelvic floor therapy (PFT), electrical stimulation, TMS, SCS |
| Bowel dysfunction | Metoclopramide, domperidone for bowel motility, laxatives like lactulose and bisacodyl | PFT, PT, sufficient fluid and fibre intake, enema |
| Sexual dysfunction | Men - Sildenafil, Tadalafil, intracavernous vasodilator agents like alprostadil Women - flibanserin | Counseling, lubricants, sexual aids to enhance stimulation |
| Cognitive dysfunction | Acetylcholinesterase inhibitors, memantine, beta interferons | Cognitive rehabilitation, retraining programme for specific attention deficits |
| Depression | Antidepressants | Counselling, psychotherapy - cognitive behavioural therapy (CBT) |
| Visual symptoms | Gabapentin or memantine in pendular nystagmus, baclofen for upbeat nystagmus | Adaptive equipment, environmental modifications |
| Pain | TCAs, anti-convulsants like gabapentin | Counseling, yoga and meditation, acupuncture, PT, transcutaneous electrical nerve stimulation (TENS), SCS |
| Trigeminal neuralgia | Carbamazepine, baclofen,gabapentin | CBT, radiofrequency rhizotomyrhizotomy |
| Mood disorders | Antidepressants | CBT, exercise, yoga and meditation |