Symptom	Pharmacologic	Nonpharmacologic
Bladder dysfunction	Detrusor spasm: imipramine, muscarinics, detrusor muscle onabotulinumtoxinA (Botox) injections Nocturia: intranasal desmopressin Outlet disorder: alpha adrenergic blockers, cannabinoids	Detrusor spasm: avoidance of spicy or acidic foods, caffeine, and alcohol; bladder training; sacral neuromodulation Outlet disorder: catheterization
Bowel dysfunction	Constipation: bisacodyl (Dulcolax), docusate sodium (Colace), enemas, lubiprostone (Amitiza), magnesium oxide, polyethylene glycol (Miralax), psyllium (Metamucil)	Abdominal massage, biofeedback, bowel timing (planning toileting times), electrostimulation of abdominal muscles, transanal irrigation
Cognitive impairment	Donepezil (Aricept) Amantadine, ginkgo, and rivastigmine (Exelon) were found to have no clear benefit	Neuropsychological rehabilitation, occupational therapy
Depression and emotional lability	Bupropion (Wellbutrin), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), venlafaxine	Cognitive behavior therapy, multidisciplinary rehabilitation, physical activity
Fatigue	Amantadine, dextroamphetamine, methylphenidate (Ritalin), modafinil (Provigil), selective serotonin reuptake inhibitors (fluoxetine)	Aerobic exercise; avoidance of heat, overexertion, and stress; cognitive behavior therapy; mindfulness training
Movement disorders	Ataxia: baclofen (Lioresal), cannabinoids, dantrolene (Dantrium), threonine, tizanidine (Zanaflex) Impaired ambulation: dalfampridine extended-release (Ampyra) Tremor: onabotulinumtoxinA for focal tremors, beta blockers, diazepam (Valium), isoniazid	Ataxia: deep brain stimulation, vestibular rehabilitation Impaired ambulation: behavior change therapy, physiotherapy, supervised resistance training programs
Pain	Neuropathic pain  First-line: amitriptyline, duloxetine, gabapentin (Neurontin), nortriptyline (Pamelor), pregabalin (Lyrica)  Second-line: capsaicin cream, venlafaxine Trigeminal neuralgia  First-line: carbamazepine (Tegretol), oxcarbazepine (Trileptal)  Second-line: baclofen, gabapentin, lamotrigine (Lamictal), pregabalin Musculoskeletal pain: analgesics, baclofen	Hydrotherapy, physiotherapy, surgical procedures for trigeminal neuralgia
Sexual dysfunction	Female: duloxetine Male  First-line: phosphodiesterase-5 inhibitors  Second-line: intercavernous vasodilators	Female: clitoral vibratory stimulation, vaginal lubrication Male: penile prostheses, vacuum appliances
Spasticity	Benzodiazepines, cannabinoids, dantrolene, gabapentin, intrathecal or oral baclofen, onabotulinumtoxinA, tizanidine	Electromagnetic therapy, physiotherapy, structured exercise program, transcranial magnetic stimulation, transcutaneous electrical nerve stimulation, whole body vibration
Vision problems (oscillopsia)	First-line: gabapentin Second-line: memantine (Namenda)	Vestibular rehabilitation