Symptomatic treatment of multiple sclerosis: a systematic review

Živilė Vaičekauskytė 1, Augustė Juknelytė 1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Multiple sclerosis (MS) – chronic demyelinating central nervous system (CNS) disease that is the most common reason for disability after trauma. The disease usually affects young people and people of working age, women more commonly than men. The disease is the most common in developed and developing countries. The main mechanisms of pathogenesis are demyelination and neurodegeneration, but the reason that initiates pathogenesis remains unknown. Symptoms of disease depend on MS form and lesions in the CNS. The disease usually manifests as acute optic neuritis, double vision, reduced sensitization of face, partial myelitis, paraparesis, hemiparesis, ataxia or in rare cases vision defects or dementia.  Patients with MS complain not only about neurological dysfunction but also complain about somatic symptoms that reduce the quality of life, disturb daily activity and enhance the appearance of complications. The most common symptoms of MS patients are urinary disorders, spasticity, fatigue, pain, tremor and ataxia, depression, thermoregulatory dysfunctions, and defecation disorders. Patients can experience a few of the symptoms at the same time. Therefore, it is a significant part of treatment to control all the symptoms. Patients get empiric treatment of medications that are used in the general population for specific symptoms according to good medical practice and experience because there is no evidence-based efficient treatment for MS symptoms. Neurosurgical interventions are involved in treatment more often. Deep brain stimulation and surgeries with gamma knife can be effective to control symptoms that cause disability when other treatment possibilities are not effective or their impact is too low. Rehabilitation can impact significantly in reducing motoric symptoms, but its‘ effectiveness is not proven by clinical studies. Psychotherapy is a combination of pharmacotherapy that can be efficient to treat emotional disorders. It is very important to educate patients and their family members about the disease because they need to fight with disease all life long. Appropriate care can assure a better quality of life. Meanwhile, the most attention is paid for disease-modifying treatment but for MS patients it is very important to manage symptoms that are experienced in daily life.

Keywords: multiple sclerosis, demyelinating disease, symptoms, symptomatic treatment