Symptomatic treatment for multiple sclerosis

Besides immunomodulation and immunosuppression, the symptomatic treatment of multiple sclerosis (MS) is another important part of the overall management of this chronic disease. Such treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of affected patients. Moreover, with symptomatic treatment, the development of secondary physical impairment due to existing symptoms (i.e. lumbar radiculopathy as a sequel of spasticity-related disturbed gait) may be avoided. A lot of different drugs are used for the treatment of MS symptoms, but only a few have been under investigation particularly for MS patients and are approved by national health authorities. Despite large lists of publications, only a small number of evidence-based studies exists, and consensus reports are very rare, too. Therefore it seemed necessary to develop a consensus statement on symptomatic MS treatment which comprises existing, evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. Thus, it should be possible to avoid that many obviously effective drug treatments are not being prescribed only because their effectiveness was not proven in sophisticated control led studies, resulting in an unacceptable restriction of treatment modalities. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination cranial nerve function, autonomic, cognitive, and psychological functions, MS-related pain syndromes, and epileptic seizures. The paper includes some proposals for rehabilitation and palliative care of the most severely affected patients. As in the formerly published consensus statements on immunomodulation and immunosuppression, an extensive MEDLINE search was performed; then the treatment studies found were evaluated using the criteria of Goodin and coworkers. Each chapter of our paper contains a short definition of the respective symptoms, some details of frequency, evaluation methods, and treatment goals, and a detailed description of treatment methods (non-drug-related, drug-related, invasive/operative) followed by a consensus proposal on pragmatic therapy.