Symptomatic and Complementary Treatments

Abstract As most patients with multiple sclerosis (MS), despite the use of disease-modifying agents, suffer from a variety of often disabling neurological deficits, mitigation of these symptoms remains an essential part of comprehensive MS care. The interest in pharmacological symptomatic therapies has increased in recent years, and today randomized controlled trials have demonstrated beneficial effects on many MS-related symptoms. In this chapter we review the evidence of efficacy of therapies directed against gait disturbances, spasticity, bladder dysfunction, pain, cognitive dysfunction, and fatigue, as well as an assessment of vitamin D as nutritional supplement and of some complementary and alternative therapies. Effective therapies that alleviate gait disturbances, spasticity, and bladder dysfunction have been documented in well-designed, often large randomized placebo-controlled trials, while the evidence of therapeutic interventions against pain, fatigue, and cognitive dysfunction rest on open-label studies or clinical trials with small numbers of patients.