JEFFREY GREENSTEIN, MD: First of all, it's a very common problem in multiple sclerosis. It can be managed in part by trying to conserve energy, trying to use muscles so that you don't bring out spasticity, or alternatively, in some cases, loosening muscles up when spasticity is there. So there are a number of things that somebody can do without using medications.
However, medications are really a major part of controlling spasticity, and there are a number -- for example, baclofen, tizanidine, a drug called Neurontin or gabapentin, and all of these used, either singly or in combination, can be quite effective in controlling spasticity. Finally, for people with intractable spasticity, there's a technique called using the baclofen pump, which allows us to inject baclofen directly into the spinal fluid, and it acts directly on the spinal cord to reduce intractable spasms.
DAVID R. MARKS, MD: Rick, weakness and fatigue are another one of the symptom groups. I know you've suffered from that.
RICK SOMMERS: Right.
DAVID R. MARKS, MD: How do you manage that?
RICK SOMMERS: It's a question of knowing when to just quit and say, "I'm going," and put your arms up, and getting rest and knowing your limits, and being able to just shut down. The people around you have to know -- and this is a whole other subject I'm sure we could spend our time talking about -- but the people who are around you have to be aware of what you're going through and have to be accepting of the fact that if you're exhausted and you're dealing with spasticity and some of the other symptoms, that there are times you're just not going to be able to keep up.
