Symptomatic treatment often requires artful and carefully-regulated use of polypharmacy and interventions by hands-on therapists. In terms of preventive treatment, alternatives have been developed in the past few years which are being subjected to further refinement, testing, and modification. As these and subsequent therapies are made available, the decision regarding their use in specific patients – both alone and in novel combinations – will be an increasingly more complex process. In this challenging endeavor, intensive follow-up and monitoring of treatment effects, compliance and disease course by experienced personnel will have a profound impact on patient care. We are familiar with the full spectrum of treatment strategies, many of which are off-label. We also have expertise in multi-drug interaction, adjunctive medications to ease side effects, and alternatives to treatment failure. Choosing and maintaining compliance on a regime of single or multiple prophylactic medications is one of the biggest challenges in treating the MS patient. The staff of the MS Center monitors our clients closely, helping them through education, choice and treatment modification to ensure their comfort with the therapy and maximizing benefit. This includes training and learning sessions, altering dosages and frequency, use of adjuvant medications as necessary, and follow-up by phone, internet and clinic visits.