Introduction

Although agents that have a partial benefit on relapses in multiple sclerosis (MS) are available, there is little to suggest that we are able to influence disease progression in any meaningful waythus the need to manage the accumulating impairments and disability that accompany progression actively. Attempting to evaluate and treat the wide range of fluctuating and interacting symptoms associated with MS can be frustrating and at times demoralising for patient and physician alike. Additionally, available drug treatment is limited both in its efficacy and in the evidence available to guide its use. Many agents are poorly tolerated, often because they will exacerbate co-existing symptoms.

Table Removed (Available Only in the Full Text)

Given the limitations of drug treatment both for symptom management and disease progression, it is essential that the neurologist is aware of other approaches to management, knows when and how to refer to other disciplines, and is able to explain the reasons for the referral. . . . [Full text of this article]