<P> As of 2011, only one medication, mitoxantrone, has been approved for secondary progressive MS . In this population tentative evidence supports mitoxantrone moderately slowing the progression of the disease and decreasing rates of relapses over two years . </P> <P> The disease - modifying treatments have several adverse effects . One of the most common is irritation at the injection site for glatiramer acetate and the interferons (up to 90% with subcutaneous injections and 33% with intramuscular injections). Over time, a visible dent at the injection site, due to the local destruction of fat tissue, known as lipoatrophy, may develop . Interferons may produce flu - like symptoms; some people taking glatiramer experience a post-injection reaction with flushing, chest tightness, heart palpitations, and anxiety, which usually lasts less than thirty minutes . More dangerous but much less common are liver damage from interferons, systolic dysfunction (12%), infertility, and acute myeloid leukemia (0.8%) from mitoxantrone, and progressive multifocal leukoencephalopathy occurring with natalizumab (occurring in 1 in 600 people treated). </P> <P> Fingolimod may give rise to hypertension and slowed heart rate, macular edema, elevated liver enzymes or a reduction in lymphocyte levels . Tentative evidence supports the short - term safety of teriflunomide, with common side effects including: headaches, fatigue, nausea, hair loss, and limb pain . There have also been reports of liver failure and PML with its use and it is dangerous for fetal development . Most common side effects of dimethyl fumarate are flushing and gastrointestinal problems . While dimethyl fumarate may lead to a reduction in the white blood cell count there were no reported cases of opportunistic infections during trials . </P> <P> Both medications and neurorehabilitation have been shown to improve some symptoms, though neither changes the course of the disease . Some symptoms have a good response to medication, such as an unstable bladder and spasticity, while others are little changed . For neurologic problems, 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 . Multidisciplinary rehabilitation programs increase activity and participation of people with MS but do not influence impairment level . There is limited evidence for the overall efficacy of individual therapeutic disciplines, though there is good evidence that specific approaches, such as exercise, and psychology therapies, in particular cognitive behavioral approaches are effective . </P>

When was the first case of ms diagnosed