Various aggressive immunosuppressive therapies have been tried, but most have been abandoned because of lack of efficacy, excessive side effects, or both. Cyclophosphamide, cladribine, methotrexate, azathioprine, and monthly high-dose corticosteroid treatment all have been advocated as treatment, but Symptomatic therapy Several of the common symptoms of MS respond to pharmacological treatment. Prominent among the most frequent symptoms of MS are depression and fatigue. Depression occurs in about 20 percent of MS patients, probably About 50 percent of patients with MS obtain at least partial relief by treatment with amantadine, but dosing late in the day, which may induce insomnia, should be avoided. When amantadine fails, pemoline, methylphenidate hydrochloride, or selective serotonin reuptake inhibitors may be useful.
Spasticity is another common symptom that is amenable to treatment.
The increased extensor tone in the lower extremities can to some extent compensate for associated weakness, but excessive spasticity is counterproductive to a fluid gait and may result in painful spasms or joint contracture. Often, it is secondary to unusual mechanical stress resulting from asymmetric weakness or spasticity. Appropriate orthotics, antispasmolytics, and self-performed exercise routines, supplemented by simple analgesics, are helpful. Paroxysmal pain syndromes, typified by trigeminal neuralgia, usually respond to low doses of carbamazepine or other antiepileptic drugs, particularly gabapentin. Distal dysesthetic sensations may also respond to these drugs.