What can be expected with end-stage multiple sclerosis?

Swallowing and eating

Swallowing problems are uncommon in the early stages of MS, but in late stages, as many as one third of people with MS have trouble swallowing. They also may have eating difficulties as a result of hand tremors and muscle spasms. Some people in the late stages of MS show signs of declining mental processes. As a result, they may be unaware of the act of eating or of the need to swallow when being fed. It’s helpful for caregivers, patients and health care providers to talk about how food and fluids will be provided in the advanced stages of illness.


Speech difficulties may require assessment by a speech-language pathologist (SLP). An SLP also can suggest ways to handle feeding and swallowing problems.


People with advanced MS may have pain caused by muscle spasms, neuropathic (nerve) pain, and pain caused by immobility. Neuropathic pain and pain from spasms can be challenging to treat. Medications for neuropathic pain include anticonvulsants and antidepressants. If tricyclic antidepressants are used, be aware that urinary retention can be a side effect. Cannabinoids may help relieve neuropathic pain related to MS. Muscle spasms are often treated with muscle relaxants. Physiotherapy to improve range of motion may help with muscle spasms and spasticity.

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