Multiple Sclerosis Treatment: Medications, Therapies & Latest Options

Multiple sclerosis treatment usually combines medications with supportive therapies like physical therapy, occupational therapy, and regular movement. These approaches are especially important during relapses, when symptoms flare up again.

Multiple sclerosis is an autoimmune disease that often follows a relapse-remission pattern. This means symptoms can become more noticeable during flare-ups or as the disease gradually progresses.

Multiple sclerosis treatment is guided by a neurologist after a careful review of symptoms and overall health. The goal is to slow disease progression and reduce symptoms during relapses.

Main treatments

The main multiple sclerosis treatments are:

1. Medications for relapses

Treatment for multiple sclerosis relapses may include pulse therapy, which involves giving methylprednisolone (a corticosteroid) through an IV for a short period, usually 3 to 5 days.

According to the National Multiple Sclerosis Society, high-dose corticosteroids such as IV methylprednisolone are commonly used to treat MS relapses by shortening the relapse and speeding recovery.

After methylprednisolone, the doctor may recommend prednisone (another corticosteroid) by mouth for 3 to 5 days.

This treatment helps lower nerve inflammation, which can reduce how intense a relapse feels and how long it lasts, and may ease symptoms such as partial vision loss, reduced strength, or decreased coordination. 

However, it should only be used for short periods because corticosteroids can cause many side effects.

2. Disease-modifying therapies

Disease-modifying therapies (DMTs) help change how the immune system behaves in multiple sclerosis, lowering immune-driven damage to the brain and spinal cord. This can reduce relapses and, in many people, slow the buildup of disability over time.

Examples of DMTs include ofatumumab (Kesimpta), interferon beta, fingolimod, alemtuzumab, glatiramer acetate, dimethyl fumarate, teriflunomide, cladribine (Mavenclad), natalizumab, siponimod (Mayzent), and ocrelizumab.

In the United States, access to these medications typically depends on health insurance coverage and plan rules (such as prior authorization), as well as clinical criteria set by the prescribing neurologist.

Some immune-suppressing medications that may be used in select cases under specialist guidance, but are not FDA-approved specifically for multiple sclerosis, include azathioprine and cyclophosphamide.

3. Medications to control symptoms

Treatment for multiple sclerosis symptoms may include muscle relaxants, pain relievers, antidepressants, anticonvulsants, and medications targeting fatigue, urinary incontinence, erectile dysfunction, insomnia, or bowel control issues.

These medications should be prescribed on an individual basis, depending on the symptoms each person has.

4. Physical therapy

Physical therapy is recommended for people with multiple sclerosis to strengthen muscles, improve balance and coordination, prevent contractures, reduce numbness, and relieve pain.

It is typically recommended when MS symptoms worsen, such as arm or leg movement difficulties, reduced motor coordination, muscle weakness, or spasticity.

5. Respiratory therapy

In advanced stages of multiple sclerosis, when breathing becomes affected, respiratory therapy is typically recommended.

This therapy often involves small devices like a flutter valve to strengthen breathing muscles and loosen mucus. Breathing exercises are also key, as they improve breathing efficiency and may reduce choking risk.

6. Speech therapy

Speech therapy may be recommended to improve speech and communication and to address difficulty eating or swallowing, and it should be guided by a licensed speech-language pathologist.

7. Occupational therapy

Occupational therapy can help improve quality of life and support independence with daily activities at home, such as walking, brushing teeth, eating, or combing hair, for example.

During occupational therapy sessions, the professional can also help the person use assistive devices, such as adapted utensils, a walker, or a wheelchair, for example.

8. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) may be recommended by a doctor and is done with a psychologist. It is especially helpful for managing emotions across all stages of multiple sclerosis and for reducing anxiety and depression.

Cognitive behavioral therapy can also help build practical tools that support quality of life.

9. Regular physical activity

Staying active and exercising regularly can help slow disease progression or help prevent symptoms from appearing quickly.

Exercises a doctor may recommend include walking, Pilates, yoga, cycling, water aerobics, or swimming, for example.

These activities should be done in a calm setting with a comfortable temperature, since heat can increase sweating and may worsen multiple sclerosis symptoms.

It is important to avoid pushing the heart rate too high and to avoid raising body temperature during exercise.

If the person becomes short of breath, they should stop exercising right away and breathe slowly and deeply. The same guidance applies if the heart feels like it is racing, or if there is shortness of breath, fatigue, or heavy sweating.

10. Plasmapheresis

Plasmapheresis is a type of multiple sclerosis treatment in which the blood is filtered to help remove antibodies that attack nerve cells.

11. Stem cell transplant

Autologous stem cell transplantation is done by collecting the person’s own stem cells. Before the cells are given back, the person undergoes treatment with high-dose immunosuppressive medications to inactivate the immune system.

This type of treatment aims to “reset” the immune system, which is responsible for damaging the brain and spinal cord in multiple sclerosis.

It may be considered in severe, hard-to-treat cases, but it does not cure the disease. It is also a very delicate process and must be performed at specialized stem cell transplant centers.

Natural treatments

Some natural approaches may support multiple sclerosis treatment, such as following a balanced diet to help relieve constipation, increasing intake of foods high in vitamin D, or using therapies like acupuncture or acupressure.

However, these options do not replace medical treatment prescribed by a doctor and are meant to be used only as complementary support.

High-dose vitamin D has also been discussed as an option in multiple sclerosis, since some studies suggest higher vitamin D levels may be linked with fewer relapses, lower disease activity, and a lower risk of developing multiple sclerosis. Even so, high doses should only be used with medical guidance.

Is there a cure for multiple sclerosis?

According to the Multiple Sclerosis International Federation, there is currently no cure for multiple sclerosis (MS).

Management focuses on treating relapses, using disease-modifying therapies to reduce their frequency and slow disease progression, and addressing symptoms to support daily function. With appropriate treatment prescribed by a doctor, relapses can be managed and disease progression may be slowed.

Signs of improvement

Signs of improvement may appear when treatment is followed as directed and may include less intense symptoms, less fatigue, and improved coordination and muscle strength, making daily activities easier.

Improvement can begin after appropriate treatment starts, but the time it takes to notice symptom relief varies widely from person to person.

Signs of worsening

When treatment starts late or is not followed properly, signs of worsening may appear, including vision loss, paralysis, memory loss, or incontinence.

During worsening periods, treatment may need to be intensified, but this does not guarantee symptoms will be fully controlled. Even so, physical therapy can be a major support for improving quality of life.

Possible complications

The main complications of multiple sclerosis are:

• Reduced mobility;

• Brain lesions, which may lead to double vision;

• Chronic vertigo;

• Difficulty swallowing;

• Frequent urinary tract infections (UTIs) due to changes in bladder function;

• Chronic constipation;

• Erectile dysfunction in men;

• Mood disorders;

• Generalized fatigue;

• Cognitive problems, such as forgetfulness or memory loss.

In advanced stages of the disease, breathing complications may also occur and can sometimes be fatal due to weakened breathing muscles.

In addition, the buildup of secretions in the lungs may lead to conditions such as aspiration pneumonia, atelectasis, or respiratory failure.