The advent of effective and highly effective therapies for multiple sclerosis (MS) is thankfully having a dramatic impact on the symptomatic burden of people with (MS). Fewer patients are developing severe relapses and the development of progressive disease is being delayed. However, there are still many people with MS who are troubled by ongoing symptoms either because they have forms of the disease that are less amenable to disease modifying therapy or have missed out on effective therapy because of unfortunate timing or other reasons. The commonest symptoms reported in MS are fatigue, sensory changes and pain, gait disturbance and ataxia, weakness and spasticity, bladder dysfunction, sexual dysfunction, depression and cognitive impairment. Other less common but potentially troublesome symptoms include trigeminal neuralgia, restless legs syndrome, seizures, nausea and vomiting, vertigo and opsoclonus.

The value of adopting a healthy lifestyle in improving symptom control cannot be over emphasised and should form an important part of patient education. Active treatment of new symptoms with anti-inflammatory therapy should always be considered even when the presentation is less dramatic (e.g. urinary urgency and frequency). There is a particularly close interplay between symptoms of fatigue, depression, cognitive impairment and sleep disturbance that requires considered assessment and specific treatment of underlying causes. Nocturia, obstructive sleep apnoea and restless legs syndrome are all more common in MS and are potentially treatable. Gait disturbance can be considerably improved in a proportion of patients with fampridine. The use of Botox injections at various sites in the lower urinary tract has revolutionised the treatment of bladder dysfunction. There are now many treatment options for the ongoing symptoms of MS and these will be outlined.