Editing Multiple sclerosis (section)

=== Associated symptoms ===
Both medications and neurorehabilitation have been shown to improve some symptoms, though neither changes the course of the disease.<ref name="pmid16168933">{{cite journal | vauthors = Kesselring J, Beer S | title = Symptomatic therapy and neurorehabilitation in multiple sclerosis | journal = The Lancet. Neurology | volume = 4 | issue = 10 | pages = 643–52 | date = October 2005 | pmid = 16168933 | doi = 10.1016/S1474-4422(05)70193-9 | s2cid = 28253186 }}</ref> Some symptoms have a good response to medication, such as bladder [[spasticity]], while others are little changed.<ref name="pmid1897097722"/> Equipment such as [[catheter]]s for [[neurogenic bladder dysfunction]] or mobility aids can help improve functional status.

A [[multidisciplinary]] approach is important for improving quality of life; however, it is difficult to specify a 'core team' as many health services may be needed at different points in time.<ref name="pmid1897097722"/> Multidisciplinary rehabilitation programs increase activity and participation of people with MS but do not influence impairment level.<ref name="pmid17443610">{{cite journal | vauthors = Khan F, Turner-Stokes L, Ng L, Kilpatrick T | title = Multidisciplinary rehabilitation for adults with multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD006036 | date = April 2007 | volume = 2011 | pmid = 17443610 | doi = 10.1002/14651858.CD006036.pub2 | pmc = 8992048 | veditors = Khan F }}</ref> Studies investigating information provision in support of patient understanding and participation suggest that while interventions (written information, decision aids, coaching, educational programmes) may increase knowledge, the evidence of an effect on decision making and quality of life is mixed and low certainty.<ref>{{cite journal | vauthors = Köpke S, Solari A, Rahn A, Khan F, Heesen C, Giordano A | title = Information provision for people with multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD008757 | date = October 2018 | issue = 10 | pmid = 30317542 | pmc = 6517040 | doi = 10.1002/14651858.CD008757.pub3 }}</ref> There is limited evidence for the overall efficacy of individual therapeutic disciplines,<ref name="pmid15859525">{{cite journal | vauthors = Steultjens EM, Dekker J, Bouter LM, Leemrijse CJ, van den Ende CH | title = Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews | journal = Clinical Rehabilitation | volume = 19 | issue = 3 | pages = 247–54 | date = May 2005 | pmid = 15859525 | doi = 10.1191/0269215505cr870oa | hdl = 1871/26505 | url = https://research.vu.nl/en/publications/6f3a1a11-d73e-42e6-a372-79aa1a265df3 }}</ref><ref name="pmid12917976">{{cite journal | vauthors = Steultjens EM, Dekker J, Bouter LM, Cardol M, Van de Nes JC, Van den Ende CH | title = Occupational therapy for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003608 | year = 2003 | volume = 2010 | pmid = 12917976 | doi = 10.1002/14651858.CD003608 | pmc = 9022193 | veditors = Steultjens EE }}</ref> though there is good evidence that specific approaches, such as exercise,<ref>{{cite journal | vauthors = Amatya B, Khan F, Galea M | title = Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD012732 | date = January 2019 | issue = 1 | pmid = 30637728 | pmc = 6353175 | doi = 10.1002/14651858.CD012732.pub2 }}</ref><ref>{{cite journal | vauthors = Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G | title = Exercise therapy for fatigue in multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD009956 | date = September 2015 | volume = 2015 | pmid = 26358158 | doi = 10.1002/14651858.CD009956.pub2 | pmc = 9554249 }}</ref><ref name="pmid17482708">{{cite journal | vauthors = Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A | title = Physical training and multiple sclerosis | journal = Annales de Réadaptation et de Médecine Physique | volume = 50 | issue = 6 | pages = 373–6, 369–72 | date = July 2007 | pmid = 17482708 | doi = 10.1016/j.annrmp.2007.04.004 }}</ref><ref>{{cite journal | vauthors = Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G | title = Exercise therapy for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD003980 | date = January 2005 | volume = 2005 | pmid = 15674920 | pmc = 6485797 | doi = 10.1002/14651858.CD003980.pub2 | veditors = Kwakkel G }}</ref> and psychological therapies are effective.<ref>{{cite journal | vauthors = Thomas PW, Thomas S, Hillier C, Galvin K, Baker R | title = Psychological interventions for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD004431 | date = January 2006 | volume = 2010 | pmid = 16437487 | doi = 10.1002/14651858.CD004431.pub2 | veditors = Thomas PW | pmc = 8406851 }}</ref> Cognitive training, alone or combined with other neuropsychological interventions, may show positive effects for memory and attention though firm conclusions are not possible given small sample numbers, variable methodology, interventions and outcome measures.<ref>{{cite journal | vauthors = Rosti-Otajärvi EM, Hämäläinen PI | title = Neuropsychological rehabilitation for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD009131 | date = February 2014 | volume = 2014 | pmid = 24515630 | doi = 10.1002/14651858.CD009131.pub3 | pmc = 10966661 }}</ref> The effectiveness of [[Palliative care|palliative approaches]] in addition to standard care is uncertain, due to lack of evidence.<ref>{{cite journal | vauthors = Latorraca CO, Martimbianco AL, Pachito DV, Torloni MR, Pacheco RL, Pereira JG, Riera R | title = Palliative care interventions for people with multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD012936 | date = October 2019 | issue = 10 | pmid = 31637711 | pmc = 6803560 | doi = 10.1002/14651858.CD012936.pub2 }}</ref> The effectiveness of interventions, including exercise, specifically for the prevention of falls in people with MS is uncertain, while there is some evidence of an effect on balance function and mobility.<ref>{{cite journal | vauthors = Hayes S, Galvin R, Kennedy C, Finlayson M, McGuigan C, Walsh CD, Coote S | title = Interventions for preventing falls in people with multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD012475 | date = November 2019 | issue = 11 | pmid = 31778221 | pmc = 6953359 | doi = 10.1002/14651858.CD012475.pub2 }}</ref> [[Cognitive behavioral therapy]] has shown to be moderately effective for reducing MS fatigue.<ref>{{cite journal | vauthors = van den Akker LE, Beckerman H, Collette EH, Eijssen IC, Dekker J, de Groot V | title = Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis | journal = Journal of Psychosomatic Research | volume = 90 | pages = 33–42 | date = November 2016 | pmid = 27772557 | doi = 10.1016/j.jpsychores.2016.09.002 }}</ref> The evidence for the effectiveness of non-pharmacological interventions for chronic pain is insufficient to recommend such interventions alone, however their use in combination with medications may be reasonable.<ref>{{cite journal | vauthors = Amatya B, Young J, Khan F | title = Non-pharmacological interventions for chronic pain in multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | pages = CD012622 | date = December 2018 | issue = 12 | pmid = 30567012 | pmc = 6516893 | doi = 10.1002/14651858.CD012622.pub2 | doi-access = free }}</ref>