Fast Five Quiz: Key Aspects of Multiple Sclerosis Treatment

Michelle H. Cameron, MD, PT, MCR

Disclosures

December 06, 2018

Oral, sustained-release dalfampridine has been shown to improve walking in patients with MS. This was demonstrated by an increase in walking speed. It is the only medication approved by the FDA for this indication for patients with MS.

Cognitive dysfunction is a major problem that affects quality of life, family and social relationships, and employment. Cognitive dysfunction also can affect memory, comprehension, problem-solving, and speech. Treatment for cognitive dysfunction in patients with MS should include supportive therapy provided by speech pathologists or occupational therapists. In addition, depression may contribute to cognitive dysfunction and should be treated if it is diagnosed. No pharmacologic therapy has been shown clearly to improve cognitive impairment in MS. For example, a multicenter randomized clinical trial in patients with MS who had memory impairment found that donepezil was no better than placebo for improving memory.

SSRIs are the preferred medication class for treating depressive symptoms in patients with MS. Second-line treatment options include tricyclic antidepressants.

Pharmacologic treatment of spasticity includes baclofen, which is particularly useful for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity in patients with MS who have reversible spasticity. Baclofen is effective in most cases, is inexpensive, and is titrated easily from 10 mg/day to 140 mg/day in divided doses. Adverse effects include fatigue and weakness. Dantrolene sodium acts directly on skeletal muscle to decrease spasticity in patients with MS. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions.

For more on symptomatic treatment of MS, read here.

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