Medically Reviewed

Multiple Sclerosis Treatment

There are more treatment options for MS than ever before. There may not be a cure (yet), but there's an excellent chance that you'll be able slow the disease's progression and even prevent flares.

Updated Sep 15, 2023

Medical ReviewerShaheen Lakhan, M.D., neurologist

Patient Advocate ReviewerJackie Zimmerman

Our Experts: Meghan Beier, Ph.D.; Bruce Cohen, M.D.; Neeta Garg, M.D.

Meghan Beier, Ph.D.Assistant Professor of Physical Medicine and Rehabilitation and Clinical Neuropsychologist Johns Hopkins Medicine Multiple Sclerosis Center Baltimore

Bruce Cohen, M.D.Chief of MS/Neuroimmunology, Department of Neurology Northwestern University Feinberg School of Medicine Chicago

Neeta Garg, M.D.Associate Professor of Clinical Neurology University of Miami Miller School of Medicine Miami

There may not be a cure for multiple sclerosis (MS) quite yet, but staggering advances in scientific research and medication development in the past several years means people with MS now have a better chance than ever to live well—and even thrive—with this type of autoimmune disease that affects the myelin sheath, the protective tissue that surrounds nerves. Damage to this sheath contributes to some of the common MS symptoms, like numbness, pins and needles, and blurry vision.

There are three main types of MS:

• Relapsing-remitting (RRMS), characterized by periods of disease activity followed by periods of remission.

• Primary progressive MS (PPMS), when symptoms get progressively worse.

• Secondary progressive (SPMS), which typically evolves from RRMS.

Which type you have will determine your treatment path.

What Are the Treatments for MS?

With no known cause, multiple risk factors, and a constellation of potential symptoms, a condition like MS requires more than one treatment approach. That's because your experience with MS is unique to you. The approach that worked for your friend with MS may not be the one that works for you, and vice versa.

But what’s most important to know is that a range of new therapies—many of which were not available even a generation ago—enable many people with MS to take more control of their symptoms (and their lives), supplemented by a healthy diet, active lifestyle, stress management, and other daily choices that put physical and emotional well-being first.

Let’s take a look at some of the options available to treat your MS.

Perhaps no area has caused more excitement and hope than DMTs. A mere 25 years ago, drugs that slowed the progression of multiple sclerosis did not exist.

Now, people diagnosed with relapsing-remitting MS have multiple options to choose from. There are even new treatments for people with the progressive forms of the disease (more on these below).

DMTs work to alter the inflammation process, primarily by slowing the production of immune cells that attack myelin. Less inflammation, means less scarring. Less scarring means fewer flares. These drugs are usually classified by how they’re delivered:

Injections

Betaseron (interferon 1b), the very first DMT, changed the face of MS treatment with its FDA approval back in 1993. You inject Betaseron and similar DMTs like Copaxone (glatiramer acetate) yourself, directly under the skin or into a muscle, daily or a few times a week, depending on what your doctor prescribes.

These are some of the common injections used for RRMS:

• Betaseron (interferon beta-1b)

• Avonex (interferon beta-1a)

• Plegridy (pegylated interferon beta-1a)

• Copaxone or Glatopa (glatiramer acetate, or GA)

• Kesimpta (ofatumumab)

Since these medications have the benefit of nearly three decades of use, they are not only well-studied, they are considered effective and safe.

Side effects are generally mild—some people experience irritation at the injection site and/or flu-like symptoms—although most people have few or no adverse effects. These first-wave DMTs have become the standard to which newer treatments are compared.

Infusions

Like injections, infusions are delivered via needle, but instead of going under the skin or into a muscle, they go directly into the bloodstream through an I.V. drip.

Depending on the DMT your HCP prescribes will dictate the frequency of the infusions. Infusion medications such as Tysbari (natalizumab) and Ocrevus (ocrelizumab) can slow down MS and disability even more than injections because they target the specific proteins that are driving inflammation. In other words, they aim to cut it off at the source.

These are some of the infusions for RRMS that your doctor may prescribe:

• Tysbari (natalizumab)

• Ocrevus (ocrelizumab)

• Rituxan (rituximab)

• Ruxience (rituximab)

• Truxima (rituximab)

• Lemtrada (alemtuzumab)

Oral Medications

Many people find taking a pill once or twice a day to be less annoying than a daily shot. Plus, they slow MS progression as well as infusion and are even better than older meds at staving off relapses.

Oral treatments for MS include:

• Gilyena (fingolimod)

• Teceiferda (dimethyl fumarate)

• Aubagio (teriflunomide)

• Mayzent (siponimod)

• Mavenclad (cladribine)

• Zeposia (ozanimod)

Like all medications, DMTs for MS have potential side effects, including some serious ones like an increased risk for certain infections, heart disease, and liver problems. Your doctor will review all the risks and benefits for any recommended treatment with you (including options that fit best with your lifestyle), and if they don't, be sure to ask.

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These powerful anti-inflammatories can be delivered as infusions, pills, shots, inhalers or topical creams. One of the most commonly used forms of steroids for flare is IV. And if you're having a monster flare, steroids are pretty effective at quickly taming that MS beast. However, they're not meant to be used long-term because they can bring a host of side effects, including:

• Stomach pain and indigestion

• Insomnia

• A metallic taste in your mouth

• Mood swings, anxiety, restlessness

• Headache

• Increased appetite

• Palpitations (a faster than normal heart rate)

• Chest pain

• Rash

To prevent the effects of long-term treatment, your medical team will likely give you no more than three courses of steroids in one year. However, if steroids don't do the the trick, your doctor may suggest plasmapheresis, which is a fancy term for recycling your own blood. Plasmapheresis actually replaces your blood, or at least part of it. It works like this:

• Doctors draw your blood from a large vein.

• The blood goes into a centrifuge or filtration system to separate the liquid (plasma) from the red and white blood cells.

• The cells are mixed with a plasma-replacement fluid and then put back into you.

The idea is that when the plasma is removed, some of the antibodies that attack myelin—the process at the heart of MS—hitch along for the ride and also get removed. The American Academy of Neurology (AAN) recommends plasmapheresis for RRMS relapses when steroids haven’t worked. It recommends against plasmapheresis for PPMS because it’s been shown to be ineffective.

DMTs for Progressive Forms of MS

To refresh: disease-modifying therapies (DMTs) reduce the number of relapses and lesions on the brain, ultimately curbing long-term disability by preventing damaging inflammation.

Ocrevus (ocrelizumab), the first therapy approved for RRMS as well as primary and secondary progressive MS hit the market in 2017. Compared to a placebo, this infusion cut the risk of progression by a quarter and boosted walking speed by 29%, according to results from one study. This medication reduces the number of certain B cells, which are immune cells that likely play a role in damaging myelin and causing lesions.

While Ocrevus is so far the only drug approved for PPMS, these are additional options for SPMS: Mavenclad (cladribine); Mayzent (siponimod); and Novantrone (mitoxantrone).

Stem Cell Therapy for MS

Stem cell therapy is an experimental approach that has shown promise in the treatment of MS, but it is not yet considered a standard or proven treatment.

Stem cell therapy for MS typically involves the transplantation of stem cells, often hematopoietic stem cells (found in bone marrow or blood), to attempt to replace or repair damaged nerve cells and suppress the autoimmune response that causes MS. This procedure is known as hematopoietic stem cell transplantation (HSCT).

The goal of hematopoietic stem cell transplant, per the National Multiple Sclerosis Society, is to “reset” the immune system and prevent inflammation in the body.

Some studies and clinical trials have reported positive outcomes for individuals with MS who have undergone HSCT, particularly for people with relapsing MS who meet very specific characteristics, showing improvements in disease progression and symptom management. However, the long-term effectiveness and safety of this treatment are still being studied, and it is not widely available or recommended as a first-line treatment for MS.

Complementary and Natural MS Treatments

MS may throw some challenges your way, and there’s no one-size-fits-all lifestyle plan to combat it. People with MS might have to work within the limits of their condition, but there are still some things you have control over that can improve your day to day living with this disease, including:

• Sleep

• Diet

• Exercise

• Brain training

• Managing stress

Let’s take a closer look.

Make Sleep a Priority

If you’re living with MS, healthy sleep hygiene is essential. Problems with insomnia, spasticity, stress, nerve pain, and depression can all contribute to your not getting enough shuteye—even when shuteye is exactly what you need most to combat the fatigue that comes with a disease flare. Here’s what you can do to get your nightly sleep:

• Establish a bedtime ritual: Going to bed and waking up at approximately the same times each day helps you set your circadian rhythm, the body’s inner clock, which may set you up for a better night’s sleep.

• Limit caffeine: Stimulants like caffeine can keep you tossing and turning.

• Avoid or limit alcohol: Alcohol is a sleep-disrupter. Try to have the last drink a few hours before bedtime to allow enough time for the alcohol to metabolize.

• Stay calm: Meditation has been shown to help reduce stress, which in turn promotes good sleep.

• Limit liquids: People with MS often have to get up more than once in the night to urinate. Do your best to limit liquids for a few hours before going to bed.

• Exercise regularly: Get better rest from a regular workout—just be sure to finish exercising several hours before hitting the sheets.

• Turn off blue-lit screens: The blue light emitting from most digital screens activates your brain in the same way sunshine does—triggering a wakeful response.

Focus on Your Nutrition

If you’re looking for a diet specifically tailored to help MS symptoms, you won’t find one. However, here are some good guidelines for anti-inflammatory, healthy eating (and drinking):

• Eat more low-fat dairy

• Dine on fatty fish

• Enjoy more fruits and veggies

• Try fermented foods

• Reach for more nuts and seeds

• Skip the salt

• Eat (and drink) less sugar

It’s worth noting that people with MS are more likely to have other chronic diseases such as high blood pressure (HBP), high cholesterol, and type 2 diabetes. Keep those in mind as well when you’re making your day-to-day diet choices. And guess what the standard diet advice is for those diseases? Yep, all of the above.

Exercise

When you’re exhausted and in pain during an MS relapse, you may think activity could only make everything worse. It’s actually the opposite. Exercise helps in almost every way. People with MS who exercise:

• Preserve brain function: Moving your body may actually help you better maintain your brain—and even stave off the progression of damage to it. In a 2018 study published in the Multiple Sclerosis Journal, researchers found that when people with MS performed twice-weekly resistance-training workouts (strength training or swimming are both good) for 24 weeks, MRI scans showed that overall brain damage from MS had not progressed.

• Fight weakness and build strength: A common symptom of MS is a feeling of weakness, which comes from interrupted nerve signals from the brain to the muscles, compounded by lowered endurance from not using these same muscles as much as you once did. Try resistance training (strength training, yoga, or swimming are all good) to help retain, and even build upon, strength.

• Improve balance and coordination: People with MS may experience unsteady walking, spasticity, and difficulty with balance and muscle coordination. Without exercise, these symptoms can worsen. But research shows that those who engage in daily exercise can improve such symptoms. Hit the mat to stretch and do some downward dogs, take to the streets for a nice walk, or jump in the pool to swim a few laps. (You can work these balance moves into your routine, too.)

• Up energy levels: Major fatigue is common in people with MS and can even occur outside a relapse or attack. One study shows how 45 minutes of swimming three times each week improved symptoms of fatigue in women with MS, compared women with MS who did not exercise in this way. Go on, dive in.

• Protect bone density: Bone health can be an issue for people with MS, due to reduced physical exercise and muscle strength from nerve conduction issues, lower levels of vitamin D, as well as some MS medications that can strip bone density. So it makes sense that weight-bearing exercises like daily walking and yoga may be especially helpful.

• Improve bladder control: Incontinence—when you pee with urgency, and all too frequently—is a typical symptom of MS. Studies show how pelvic floor training (also known as kegel exercises) can help women with MS who regularly battle with their bladders improve their symptoms.

• Boost mood: Clinical depression is more common in people with MS than in the general population—and regular exercise has been shown to improve symptoms of low mood.

A few additional notes on working up a sweat: Although exercises for MS are largely the same as those that people without MS do, it’s important to work within any limitations of your disease. If your symptoms are dizziness and vertigo, for instance, you might do better on a stationary bike instead of a treadmill.

Water exercises are often favored by people with MS. Water walking and water aerobics can be easier on the joints than their dry-land counterparts—just make sure the water’s not too hot. In fact, heat is something you’ll have to watch closely, since symptoms can flare up or become worse when your body overheats.

If it’s feasible, seek out a physical therapist, especially one who’s worked with people who have MS, who can modify exercises appropriately. Always follow your doctor’s instructions—and, have fun! Remember: The point is to feel good.

Physical Therapy

Physical therapy is a crucial component of the comprehensive management of multiple sclerosis. It focuses on improving and maintaining physical function, mobility, and overall quality of life for individuals with MS. Here’s what to expect with physical therapy:

• Customized exercise program: Based on an assessment of your mobility and needs, the physical therapist designs a personalized exercise program tailored to your goals. These exercises may target specific muscle groups to address weakness and spasticity, improve flexibility, and enhance overall strength.

• Balance and coordination training: Balance problems are common in individuals with MS, and physical therapists can work on improving balance and coordination through exercises and activities that challenge stability and proprioception.

• Gait training: Walking difficulties and gait abnormalities are often seen in MS. Physical therapists can teach techniques to improve walking, including the use of assistive devices like canes or walkers when necessary.

• Stretching and range of motion exercises: To prevent muscle contractures and maintain joint flexibility, physical therapists incorporate stretching exercises into the program.

• Functional training: Physical therapists help individuals work on everyday activities such as getting up from a chair, climbing stairs, and reaching for objects. They may use adaptive techniques and equipment to make these tasks more manageable.

• Assistive devices: When appropriate, physical therapists may recommend and train you on the use of assistive devices like orthotics, braces, mobility aids, and adaptive equipment.

Medications for MS Flares

Flares medications in multiple sclerosis are primarily aimed at reducing inflammation and speeding up recovery. These medications do not cure MS but can help manage the symptoms and duration of relapses. The choice of medication and treatment approach may vary based on the severity and specific symptoms of the relapse. Some common medications used to treat MS flares include:

• Corticosteroids: Medications like methylprednisolone or prednisone are potent anti-inflammatory drugs that can help reduce inflammation in the central nervous system during an MS relapse. They are typically administered intravenously (IV) over a few days.

• Plasma Exchange (Plasmapheresis): In severe or refractory relapses, plasma exchange may be used. This procedure involves removing the patient's blood, separating the plasma (which contains antibodies and other factors contributing to inflammation), and then returning the blood to the patient with replacement plasma. This can help remove harmful antibodies and reduce inflammation.

• Immune Modulating Therapies: In some cases, disease-modifying therapies (DMTs) that are typically used for long-term management of MS may also be used to manage relapses. These include drugs like interferon-beta, glatiramer acetate, or natalizumab.

Drugs used to manage MS symptoms are part of a comprehensive MS treatment plan. Symptoms are individualized with the disease, but these are some of the most common ones.

Fatigue

Fatigue is one of the most frequently occurring symptoms of MS. And we're not talking about the kind of tired you feel when you stay up too late. MS can lead to a level of exhaustion that makes it impossible to get out of bed, even after you've slept and slept. In fact, there's a name for that: lassitude. Doctors aren't exactly sure what causes it, but it's likely that all that inflammation that's happening in your body literally tires you out. It's also possible that sleep disturbances, depression, even your medications are compounding the problem.

Depending on what you're dealing, your doctor may prescribe a range of medications to help. They include:

• Provigil (modafinil) and Nuvigil (armodafinil). These stimulants promote wakefulness and fight sleepiness. Originally developed for people with narcolepsy and other sleep disorders, they're usually prescribed at lower doses in people with MS.

• Ritalin (methylphenidate). This ADHD medication can also help people with MS focus and feel more energized when they’re experiencing fatigue.

• Symmetrel (amantidine). This antiviral to increase the amount of the neurotransmitter dopamine in the brain. Dopamine may help tamp down the overactive immune cells that are a hallmark of MS. Fewer of those hyped up immune cells can mean less fatigue.

Spasticity

It's really not fun to have the muscles in your arms, legs, back or torso clench randomly and involuntarily, and it's something that most people with MS have to deal with at some point. Spasticity occurs when the nerve messages to the muscles get scrambled, leading to pain, balance problems, and walking trouble.

To treat it, your doctor may prescribe muscle relaxants. These drugs work on the CNS to, yep, relax muscles to prevent them from clenching and twitching. They come in pill form or as a surgically implanted pump that delivers the medication directly to the spinal cord.

Other meds your doctor may prescribe for spasticity include:

• Baclofen: A muscle relaxant that can help reduce muscle stiffness and spasms.

• Tizanidine: Another muscle relaxant that can alleviate spasticity symptoms.

• Dantrolene: This medication can directly affect muscle contractions and is used for severe spasticity.

• Botulinum Toxin (Botox): Injected directly into specific muscles, it can temporarily weaken them and reduce spasticity.

• Gabapentin: Sometimes used to manage spasticity, especially if other medications are not effective.

• Pregabalin: Similar to gabapentin, it can be used to control spasticity.

Depression

Depression is one of the most common co-occurring conditions (a.k.a., comorbidities) of MS, and if you're struggling emotionally, psychotherapy is an excellent place to start. Your therapist may choose any numbers of approaches, including talk therapy and “behavioral activation”—which involves creating a plan to do things you enjoy—and then actually doing them. You might literally schedule activities like "play my guitar for 30 minutes" or "go for a walk after dinner" into your calendar. It's all about building motivation and setting goals. You can also think of it an anti-wallow distraction plan. You'll be too busy doing stuff. Some studies suggest up to half of all people with MS will become clinically depressed at some point, and if that happens to you, this approach—chasing your joy—can help to combat low mood.

That said, the inflammation that causes MS can also create mood changes that require medication. Working with a therapist can help you figure that out, too.

Antidepressants help combat depression by improving transmission of signals between neurons. And, they’ve also been shown to curb inflammation by slowing the production of immune cells and causing them to die off sooner than normal. Treating depression with medication may also help with other symptoms associated with MS. That’s because many drugs for depression treat MS-related fatigue and chronic pain, too.

These are some of the medications your doctor may prescribe for depression:

• Fluoxetine (Prozac)

• Sertraline (Zoloft)

• Paroxetine (Paxil)

• Escitalopram (Lexapro)

• Citalopram (Celexa)

• Venlafaxine (Effexor)

• Duloxetine (Cymbalta)

• Desvenlafaxine (Pristiq)

• Amitriptyline (Elavil)

• Imipramine (Tofranil)

• Nortriptyline (Pamelor)

• Bupropion (Wellbutrin)

• Mirtazapine (Remeron)

• Trazodone (Desyrel)

• Phenelzine (Nardil)

• Tranylcypromine (Parnate)

Incontinence

Incontinence happens in MS when nerves that control the bladder, bowels, or pelvic floor become damaged.

When that happens, the bladder sometimes squeezes and forces urine out. Two drugs used to treat this are:

• Oxytrol (oxybutinin): This antispasmadic drugs may help the bladder relax to produce fewer squeezes.

• Botox (botulinim toxin): These injections can help block nerve signals to the bladder, which have become erratic due to damage from MS, and improve symptoms.

For bowel incontinence, most healthcare providers recommend lifestyle treatments to keep you “regular,” such as a high-fiber diet, physical activity, and plenty of fluids. Additional treatments you can explore with your doctor include biofeedback training, which help you become more aware of when you have to go, as well as transanal irrigation, which helps flush stool out. We know, no one wants to even think about this problem, but just remember that there are treatments.

Insomnia

Insomnia can have a lot of possible causes when you have MS, such as:

• Side effects of medication

• Napping during the day due to fatigue

• Chronic pain or uncomfortable spasticity

• Depression

That means you’ll need a multipronged approach to deal with insomnia. Start with healthy sleep hygiene (more on this in the very next section). And be sure to seek treatment for other MS symptoms, such as depression and pain, that may be stealing your snooze time.

If you’re still not getting the sleep that you need talk to your doctor, who might suggest you try:

• Melatonin supplements, which are made from a natural hormone in the brain that helps prepare you for sleep.

• Antihistamines like Benadryl (diphenhydramine HCI), which can make you drowsy.

• Sleep medications like Ambien (zolpidem)—but do make sure your doctor is aware of all other current medications to avoid a negative interaction.

Side Effects of MS Treatments

The side effects of multiple sclerosis treatments can vary depending on the specific medication or therapy being used. Here is a bulleted list of potential side effects associated with some common MS treatments:

Disease-Modifying Therapies (DMTs):

• Flu-like symptoms (e.g., fever, chills, muscle aches) with interferon-beta and some other DMTs.

• Injection site reactions, including pain, redness, or swelling.

• Fatigue and weakness.

• Liver function abnormalities in some cases.

• Gastrointestinal symptoms (e.g., nausea, diarrhea).

• Headaches.

• Elevated risk of infections due to suppressed immune function with certain DMTs.

• Cardiac issues or blood disorders in rare cases with some DMTs.

Corticosteroids:

• Increased appetite and weight gain.

• Mood swings and emotional changes.

• Insomnia.

• Elevated blood pressure and blood sugar levels.

• Gastrointestinal symptoms (e.g., stomach irritation).

Hematopoietic Stem Cell Transplantation (HSCT):

• High-dose chemotherapy-related side effects, including nausea, vomiting, hair loss, and increased infection risk.

• Potential long-term risks such as infertility, organ damage, and secondary autoimmune disorders.

• Fatigue and weakness during the recovery period.

Spasticity Medications:

• Drowsiness and dizziness.

• Muscle weakness.

• Dry mouth.

• Low blood pressure (orthostatic hypotension) with some medications.

Systemic Treatments:

• Gastrointestinal upset (e.g., constipation) with pain medications.

• Drowsiness or dizziness with some medications.

• Potential for dependence or addiction with opioids used for pain management.

• Cognitive impairment (memory and attention) with certain medications used for fatigue.

Takeaways

If you have MS, there are many ways to treat it. Medication is likely an essential part of your path forward, as are complementary techniques. Stress management is an important part of managing your disease. Talk with your family, friends or a counselor, join a support group, learn to manage your anger and fears through stress-busting mindfulness and meditation, and consider exercising more, which has been shown to reduce feeling of stress, so you can keep living fully with MS.