Best medications for MS symptoms



in this video I'm gonna share with you my personal opinions on my favorite medicines to manage common MS symptoms tune in because I'm gonna start right now learn about MS with be Erin boss tur I started this channel to help my own MS clinic patients learn between visits and it's my hope that through these videos I can help you learn to I use easy-to-understand language to bring you accurate and approachable multiple sclerosis education so if you are impacted by MS and you end up your game subscribe to the channel right now and please ring that notifications bell so that you're alerted to all of my upcoming educational content I divided the management of multiple sclerosis into three separate categories the first is managing acute MS attacks the second is disease modification slowing the disease down the third is managing chronic symptoms now allow me to explain when someone with multiple sclerosis suffers a clinical attack we give them medicines to help them recover unfortunately they don't always fully recover and they can be left with a residual deficit I'll use an example of an attack that results in left leg burning in this example we give the person steroids and they recover 80% they're left with a residual burning sensation in their leg which now becomes a chronic and bothersome symptom symptoms in ms can you Road the quality of our lives they can impact our daily functioning our performance at work and our ability to enjoy ourselves and we must if we're going to do the best job possible address chronic symptoms now I have made several videos on behavioral measures to improve a myriad of symptoms but what I have not done very much is talk about medicines I'm an allopathic doctor an MD and I use lotions and potions to help people feel better I have to throw out a couple disclaimers in this video I'm going to be talking to you about my personal opinions on my favorite medicines to manage common MS symptoms I am NOT providing you with medical advice this video is intended to be a form of medical education I'm not talking about how well the drugs work and the risks associated with them or the monitoring that's necessary for them or anything like that that's a conversation that you have to have with your medical provider and this video certainly doesn't replace that so let's get started the first symptom I wish to tackle is spasticity which manifests clinically as limbs that are very hard to bend spasms and bouncing of limbs and painful cramps now in order to properly manage spasticity we have to have a multi-modal approach we do multiple things at once exercise stretching heating the limbs staying adequately hydrated all of these things are critically important and I've talked about them in other videos today I want to focus on medications in my favorite medicine when managing mild plasticity is oral baclofen oral baclofen is one of many anti-spasmodics and it's my favorite for a couple reasons reason number one I find it to be the least sedating of all of those medications this is a medicine that oftentimes people have to take during the work day and I can't have them feeling groggy and sleepy number two it's easy to titrate I can start people at five milligrams a day which is a pretty low dose and I can slowly over multiple weeks increase them and I tend to go up on baclofen very slowly like five milligrams a day for a week and then five milligrams twice a day for a week and so on and so forth until we get up to a therapeutic level that works for that patient baclofen can be taken to mirror the needs of the patient and so if they only needed a night they can take it at night some of my patients actually have to take baclofen four times a day right when they wake up around lunchtime around dinner time and then before bed and this is a medicine with which we can do that and so I find that very helpful now let's turn our attention to depression depression is exceedingly common in multiple sclerosis it's actually twice as likely to occur in people with MS as compared to the general population on this YouTube channel I have multiple videos talking about different tricks and tips to optimize people with depression and if you haven't seen those I recommend that you check them out when it comes to medication management for depression I like wellbutrin the best it's my favorite antidepressant and I want to explain why number one it's not sedating many of the other antidepressants I find can cause some degree of sedation which is just not very tolerated and people that are trying to live active lives number two it does not cause weight gain many of the antidepressants can and people with MS are at risk of having difficulties maintaining their weight and so I don't want to give them a medicine which could contribute to that in fact sometimes wellbutrin is known to curb your appetite and so in some ways it can kind of help with the weight management number three it can be used to help decrease the desire to smoke cigarettes as many of you who follow my channel know smoking is a no-no in the setting of MS and using wellbutrin can actually be very helpful in moving towards quitting smoking number four wellbutrin can be taken with an extended-release dosing so you only have to take it in the morning and that's kind of lovely because that way you're not being asked to remember to take it multiple times a day number five wellbutrin does not worsen sexual function it's my opinion that if you're depressed and I give you an antidepressant which makes you have trouble with sex you're going to be more depressed and so wellbutrin is one of the only antidepressants that doesn't tend to worsen sexual function now wellbutrin is not for everyone if you have a seizure disorder wellbutrin is a no-no and sometimes wellbutrin can worsen anxiety and so obviously this is not a medicine for everyone but if given the opportunity this is my go-to medicine when treating depression in multiple sclerosis heat sensitivity and motor fatigue are very very problematic for many people with multiple sclerosis it's kind of a unique symptom in the setting of MS where someone starts walking and as their body heats up from the exercise they short-circuit and their legs become weak in the can't keep going or in the setting of August in Ohio when it's really hot outside they have cognitive and pathologic fatigue to the extent where they really can't function heat sensitivity is a problem and there's one medicine which has been fda-approved to help with heat sensitivity and I really like it it's called ampere or for amino pyridine and period is it twice a day medicine which only seems to help about 1/3 to maybe 1/2 of people with MS now we're not smart enough to figure out ahead of time which people with MS will respond in which people don't and so oftentimes I have to put someone on it for about a month taken twice a day before we can really determine if it helps or not I'll share with you anecdotally that in my experience using impurity one of two responses after a month on drug I either see what I call a Lazarus effect which is a wow this is really awesome or I see it yeah and if I give it and then it didn't really work and we have to take the person off of this now amperi is not okay for everyone and if you have problems with kidney function or if you haven't known seizure disorder this drug is a no-no what about neurogenic bladder I'm talking about urinary urgency we have to sprint to the bathroom for fear that you won't make it in time and urinary frequency where you feel like you're getting up and going way more often than you need to and maybe sometimes getting up multiple times at night and urinary accidents so what do we do about that my favorite medicine to manage this is a drug called century century XL is a once-a-day pill and that's awesome so you're not being asked to take pills multiple times a day in the reason that I like Centura as opposed to other common medicines like ditropan and detrol is because of cognition this class of medication risks clouding cognition and creating COG fog which is something that many people with MS struggle with and we don't want to give a medicine that worsens it the reason that Santeria is my favorite is it has the least number of cognitive side effects now staying on the theme of bladder what about urinary retention I'm talking about where you need to go and you go to the toilet and nothing happens and you sit there and strain and push on your bladder and maybe a little comes out you finish going to the bathroom and as soon as you step away you gotta go again urinary hesitancy and other symptoms of retention are very common in multiple sclerosis and so from a pharmacologic standpoint I have great success using flomax now flomax was invented to help men with enlarged prostates because it can open up the bladder neck and allow them to get the urine out in men and women with multiple sclerosis flomax can have an excellent benefit in opening up the bladder neck to allow them to empty air and all the way it's a medicine that I often times ask people to take before bed because it can cause a side effect of lightheadedness and so if you're asleep than you're not bothered by that the other option in managing bad urinary retention is a urinary catheter which actually is an awesome option but many people are reluctant to go there right away and so I like to start with flomax neuropathic pain is unfortunately all too common in the setting of multiple sclerosis it's one of these invisible symptoms which can literally erode the quality of someone's life and we use off-label medicines that stabilize cell membranes typically we're using anti-seizure medicines and antidepressants for their effects on pain now there's no one-size-fits-all but if I had to pick one medicine that I like the best it would probably be gabapentin or neurontin gabapentin was invented to treat seizures and it stabilizes cell membranes in the brain to stop seizures it can also stabilize cell membranes to decrease abnormal firing that causes neuropathic pain and it can be quite successful why do I like neurontin well number one it comes in lots of different doses so I can use a very small amount if I need it or I can use real big pills and use a large amount if I need it and I have a lot of room to titrate number two it's well tolerated by most people most of the patients that I put on the lots and don't suffer from a lot of side effects and so I really like because the goal of giving them the medicine is to make them more functional not sleepy and tired and dizzy which would be in counterpoint to that I also like neurontin because I can dose it as frequently as I need to I can give it just before better just upon waking or up to four times a day now neurontin is not the only medicine and just to share a little bit there are many times where I might reach for another one for example if I have a patient that's suffering from neuropathic pain and depression I really like using a medicine called cymbalta because it can treat both if I have someone that has really bad insomnia and they're having neuropathic pain I like to use a tricyclic antidepressant such as elavil or pamel or because it's somewhat sedating and it can help them fall asleep at night in patients with neuropathic pain that are struggling with weight gain I sometimes reach for a medicine called topamax because one of the side effects of topamax is it can cause weight loss my point here is that treating neuropathic pain pharmacologically is very involved and we have to consider the whole human being but if I was to reach for one medicine it would probably be neurontin what about a rectal dysfunction unfortunately some men with MS can suffer from erectile dysfunction and given that sex is a massively important aspect in quality of life if a man is bothered by that I want to give them a little blue after-dinner mint to improve Friday night I'm talking about viagra now there are many medicines in this class and they're outstanding to be blunt I have the most experience using Viagra and I find that it can be very very helpful I also like the fact that nowadays there's generic viagra and so sometimes we can get it at a lower cost point many people with MS suffer from constipation this is a terrible symptom and we don't talk about it enough I have a video on this channel talking about many different ways of managing constipation and I do not recommend starting with medicines only but that's what this video is about now what's my fave miralax now I don't start with me relax I oftentimes will have people use suppositories and other things but if we're really struggling me relaxes my go-to it's a liquid that doesn't have a taste and I like to recommend that patients mix a half a cap in with their morning coffee and I have them take a half a cap or a full cap every morning until they can start to become regular now a tip about me relax you can't keep taking it if you continually take me relaxed without stopping you're gonna have what my wife refers to as blood but fatigue is a monster in multiple sclerosis it is the most common symptom of MS and one of the two major reasons that people with multiple sclerosis leave the workforce fatigue presents in many different ways this can be a pathologic fatigue where you literally are trying desperately to stay awake it can also be a cognitive fatigue making it harder to process and think as the day goes on I have many videos on tricks and tips to improve fatigue and today I want to talk about my favorite medicine provigil it's not a traditional stimulant but it can be remarkable in its ability to help people with on a stay awake and to stay thinking clearly it doesn't have the same dependence and the same tolerance that I see with traditional stimulants like adderall and it can be used with a half a pill in the morning if necessary it can be reduced around noon now provigil like all medicines has side effects and we have to worry about insomnia and anxiety and high blood pressure but provigil has helped many of my patients continue to stay working and continue to stay active one last tip about provigil I find that if you take a drug holiday one day or two days a week it tends to work better what about insomnia I'll share with you my own personal opinion that I don't like sleeper agents I sort of think it's like Bugs Bunny coming up and hitting you on the head of the hammer and that can cause a lot of different problems one of my biggest gripes with sleeper agents is that patients literally become dependent upon them so after you've taken them for a while if you don't take them it's really really hard to regulate your sleep I also find that sometimes peep wake up groggy when I give them a sleeper agent and so I don't like that what do I like melatonin now Lehtonen is a natural substance is actually the way your brain tells you that it's time to go night-night I find that taking a decent dose of melatonin right before bed can be very helpful along with behavioral measures in trying to induce a natural and healthy form of sleep there you have it my own personal opinions about my favorite medicines to manage common MS symptoms again we don't only take care of people with a pill it requires a multiple modality approach in order to be successful and managing chronic symptoms I hope that this video gave you some insights into how we might apply pharmacology as one of the many tools to improve function optimize people's lives and make them the most awesome version of them possible thanks for learning about ms with me Erin boster and until my next video take care

37 comments

  1. Can you advise on medications that don't mess with the stomach or GI system? I need help with pain due to neuropathy and spasticity, but I have gastroparesis and gastritis…. Any recommendations?

  2. Hi Dr Boster, I've recently been prescribed 100mg "Amantadine" for fatigue; what are your views on this drug? I also have a serious Hyperhydrosis issue & have been prescribed Pro-Banthine to try & combat that I've only just started taking them both, alongside my MS DMT "Tecfidera" which I've been taking for a few years now & appears to be doing the job, for the most part, stable MRI's with no new lesions and no major relapses. I would greatly appreciate any advice or thoughts on the Amantadine as I've read & heard many positive but also negative reviews? Kind regards, Gerald.

  3. Dr Boster,
    I have told you in person but I will say it again. Your videos are wonderful! You bring a passion and personality to a disease that often makes us feel the opposite. My question is about melatonin. I have seen information warning that it can cause relapses in people with MS. My previous MS physician told me that there was not enough research to show one way or the other. Do you have an opinion on this? Thanks again for the videos. I think that you have made a great impact on not only your patients, but many others as well.

  4. I had a rare reaction to Baclofen, it made the spasms worse and the tremors worse but helped with the pain, switched to tinazidine , but it doesn’t help the pain , spasms as well ,what do you recommend? The muscle spasms in the quads are so so bad I can see the muscles lumped up. In a bunch. Pain in spine like someone shoving a pole in the middle of the spine, tight tight muscles on either side and left breast.

  5. LEARNED A LOT OF INFO IN THIS VIDEO DOC, YOU VERY WELL EDUCATED WITH FULL DETAILED SUBJECTS TOO. MY LADY TAKES BACLOFEN NOT FOR M.S FOR ANOTHER MEDICAL ISSUE, BUT GOOD MEDICATION TOO. THANK YOU FOR BEING HONEST IN MULTIPLE SCLEROSIS.

  6. Hi Dr Aaron, your videos are super helpful. I am from India and would like to share my case with you and get your thoughts. Would be extremely grateful if you could give your opinion on my condition. Happy to pay online for the services too. Can I get your email?

  7. By the way lazarbeam is actually a 40 year old woman from Canada Ontario lazarbeam is my son he just he's a funny guy anyway

  8. What about Copaxone has MS treatment?
    Also Cymbalta I use up for my depression what is that your thoughts on that?

  9. AAA AAA
    I’ve had ms for 9 years, I’m jc positive had to get off tecfidera as it worked great but my titre got to dangerous, I went back to copaxone now I’m going through the worst relapse I have ever been through where I can’t feel my legs and had to be infused with steroids now I’m tapering off. I have a decision to make coming up, they found new legions in my brain and spine. In this scenario I’ve marked it down to ocrevus or aubagio? U think aubagio might work better then copaxone before deciding to do ocrevus???? Helpppp

  10. I cannot describe how depressing this is. And my heart goes out to those who suffered MS before science knew what it was. I cannot imagine the angst of a farmer in the Middle Ages who felt a burning sensation in his arms and started to lose mobility. The self-hatred for losing energy and motor function, or the superstitious fears that came from convulsions and exhaustion. Whew, I guess I shouldn't complain.

  11. Thank you so much for this video. I have just been diagnosed with MS last August at the age of 69. My sister at 63 has had MS for years and years. She is having trouble with spastic legs. I will pass along the knowledge.

  12. Thank you for this wonderful insight. As always, I appreciate your effort and generosity in helping us. I am so grateful to have the added support, education, guidance, and encouragement you provide us.

    Dr. Aaron Boster, You are moving mountains within the MS community worldwide!

  13. i had dyplopia they gave me cortisone it went away and it attacked me on the neck and spine is there any relief for that?

  14. I am replying in this thread about MS medications . I have a question about a medication and it relates to having MS . I'm not certain what the risk is of someone acquiring the flu while they have MS . But I also can't seem to find an answer for if it is safe to take over-the-counter medications for flu symptoms . And I'm not certain if having the flu with MS put you at a higher risk for the illness to be bigger than usual . But since I live in an area that is caught up in the present flu season. I'm a little curious if I do acquire the flu can I take an over-the-counter medication safely to deal with the symptoms .

  15. Thank you, this is a very good video! I'm now worried about the options available when the time comes but now I know better, thank you Doctor

  16. How am I gong to tell my new nero all my systems lol. I received word that my first nero from another province is now here in mine and I get him back. yaaaaa me. My systems are all over the place since the summer and I do not know is some are MS or my body getting old. I always feel like Im over reacting when I am with him and end up not telling everything. I wonder if its fear of being not believed like I felt for so long with others.

  17. Finding your channel has been a god send for me. Thank you thank you thank you! I live in the U.P. and sure wish I was close to your clinic.

  18. Hi Dr. Aaron. Am from India aged 56 years and diagnosed with MS though atypical of age.(Second opinion has flatly denied this ) As per the radiology report the lesions are inactive and no medication is suggested except for 5 doses of methyl prednisone. Having severe imbalance problem and fatigue. Inflammation at optic chiasma is there. Could you please suggest the way forward. Thank you.

  19. Thks again for sharing this information, you r awesome!!! Dr. Booster I have a question I'm on Ampyra but just this month they changed it to the Generic my insurance won't pay ? I've been on this for yrs an I'm afraid to take it , because I'm allergic to alot of meds that I wasn't 15 to 20 yrs ago from which I was diagnosed 20 yrs ago , this is why I'm afraid to even try taking Dalfampridine 2 a day, an I've been on Ampyra for about 9 yrs sorry for the long story but the med has stayed the same with no change for about 4 yrs any suggestions on anything similar?

  20. Constipation, I noticed just before a major exacerbation so I make sure to prevent this by taking high doses of magnesium.

  21. Oh, I always swear by – and never at! – gabapentin (Neurontin) and Cymbalta, which very effectively delivers a double-punch with its painkilling and antidepressant features. No "mud butt" here (and kudos to your wife for her creativity, Dr. Boster!)… I only use Miralax intermittently. I was unable to take Provigil, though (I got hives). Instead, I'm on a 30-mg. dose of Vyvanse, and it's working perfectly.

  22. I’ve watched many of your videos and what always comes thru loud and clear is that you are so passionate about your “kids” meaning you speak to us as tho we are a family member who truly cares.

  23. I mentioned fatigue/lassitude and static drop foot / stiffness to my neurologist and she pretty much offered nothing! no tips blank 👀

  24. Dr. should be prescribing this channel to their patients with MS! I am on to my second team of doctors, now in Boston. I am now receiving excellent care, but even so, I don't always know enough about the disease to even ask the right questions. The information on this channel is incredibly helpful. Thank you.

  25. Great Channel Dr. Boster! Epocrates says that Sanctura XR has been discontinued in the US market. Trospium is the alternative listed. I take Toviaz and would like to try something different. I also use 5mg Cialis to help with stop/start the urine flow. Medical Marijuana has helped me come OFF Hydrocodone, Oxycontin, Lyrica, Topomax, Gabapentin, etc. All of which also constipated me. I find using Metamucil capsules is the solution for me for regularity. Metamucil also seems to encapsulate the bowel movement, making for a much cleaner #2.

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