Exacerbations of MS are usually treated with a high dose of adrenocortical steroids. These are customarily administered intravenously for 3 to 5 days, followed by a prednisone taper over approximately six weeks. It has been demonstrated that patients with monosymptomatic MS initially treated with methylprednisolone defer the development of more typical MS when they are treated with methylprednisolone. Development of two or more deficits, marked weakness and incoordination, and/or loss of sensation in both lower extremities are indications for treatment with adrenocortical steroids.
Prophylactic treatments include Interferon beta 1a and 1b which reduce lymphocytic invasion of the brain, induce a suppressor immune reaction, provide an antiviral action, reduce the number of exacerbations over time and preserve brain mass. Glatiramer (Copolymer I or Copaxone), a peptide consisting of 4 amino acids, glycine, alanine, lycine, and tyrosine, act by inducing immune tolerance to myelin basic protein. This is also effective in reducing the number of exacerbations and preserving brain mass over time. Chemotherapy such as methotrexate and Novantrone (mitoxantrone) are also recommended for patients with chronic progressive disease.
Symptomatic management includes the treatment of neurogenic bladder with anticholinergic medications such as Oxybutynin for urinary frequency and urgency. Regimens for treating constipation include psyllium preparations, laxatives, suppositories, and physical activity. Spasticity, particularly flexor and extensor spasms, is treated with either GABA-b-ergic compound (baclofen) that increases spinal inhibition or Tizanidine that increases supra-spinal inhibitors of spinal reflex activities.