Multiple Sclerosis Treatment

Multiple Sclerosis Treatment

Summary

Multiple sclerosis (MS) is a progressively debilitating disease that is believed to be caused by the body’s immune system attacking its own nerve cells (neurons). The resulting damage prevents communication between the brain and nerve cells, and may lead to weakness, vision loss, spasticity and paralysis.

Treatment of MS focuses on maintaining the patient’s mobility and independence for as long as possible. It does this by slowing or temporarily halting the progress of the disease, reducing the frequency and severity of attacks, and treating the symptoms when they occur. There is no cure for MS.

Many of the medications used to treat MS are called disease modifying medications (or immunosuppressants), which act to reduce the immune system’s attacks on the nerve cells. Interferon beta-1b and interferon beta-1a are some of the most frequently prescribed MS medications. They slow the progression of the disease and reduce the length of relapses.

Glatiramer acetate is a MS medication that blocks the destruction of myelin, a fatty substance that helps conduct nerve signals. Mitoxantrone is typically used for the treatment of cancer, but it also reduces the number of relapses that some MS patients experience. It may cause severe side effects and it is usually only used for two to three years.

In 2006, monoclonal antibodies were re-approved by the U.S. Food and Drug Administration (FDA) for the treatment of MS. They help block the nerve damage caused by the disease, but have also been associated with the occurrence of a rare brain disease.

Additional medications are available to treat the symptoms of MS. Corticosteroids reduce nerve inflammation during relapses, limiting their length and severity. Medications may also be prescribed to treat individual symptoms, such as pain, fatigue, tremors and urinary tract infections.

When medications are unable to treat the symptoms of MS, surgery may be necessary. There are several devices that may be implanted into the body that provide relief from symptoms. Symptoms that can be improved with implanted devices include tremors, spasticity, incontinence and urine retention. Having the devices may help patients regain some degree of control over many body functions.

Patients with MS may also go through rehabilitation to regain and maintain mobility and independence. Physical therapy helps patients maintain strength and flexibility and reduces fatigue, pain and spasticity. Occupational therapy aims to improve MS patients’ fine motor skills so they can perform daily activities like dressing and bathing. MS patients and their loved ones may also benefit from counseling and education to help them cope with the disease and the changes in lifestyle it causes.

About multiple sclerosis treatment

Multiple sclerosis (MS) is a neurological disease that can become debilitating. Eventually, it may lead to paralysis. There is no cure for the disease, but treatments are available that slow the progression of the disease and may temporarily reduce the severity of some symptoms.

MS is an autoimmune disorder that disrupts communication between the brain and muscles. The patient’s immune system attacks myelin, a fatty substance that surrounds the nerve fibers of the central nervous system and helps conduct nervous signals. The damaged myelin is replaced with scar tissue that slows, distorts or blocks communication. Without the ability to communicate, muscles do not respond to brain commands to move. This may lead to a range of symptoms, including spasticity, vision loss, numbness, lack of coordination, fatigue and paralysis.

There are several forms of MS. Relapsing-remitting MS is the most common. Patients experience attacks, or relapses, of symptoms that are separated by periods of remission with no or few symptoms. Patients with the relapsing-remitting form may eventually develop secondary-progressive MS. This type is characterized by constant symptoms that get more severe with time and do not have periods of remission. Some patients have primary-progressive MS, which is similar to the secondary-progressive form, but is not preceded by the relapse-remitting form. The fourth form of MS is progressive-relapsing, where patients experience symptoms that are constant, become progressively more severe and also worsen during periodic attacks.

Treatment for MS does not cure the disease. Instead it aims to increase the amount of time before the patient becomes debilitated. The goals of treatment include:

  • Slowing the progression of MS
  • Reducing the frequency, length and severity of relapses
  • Treating and reducing the severity of symptoms

Treatment options vary greatly from patient to patient. In some cases, patients may experience an attack of MS symptoms once with no further occurrences and no need for treatment. Other patients will require more intensive treatment based on their form of MS and the course of the disease.

Patients who are pregnant or nursing may require specific treatment methods. Certain medications, such as disease modifying medications, may increase the risk of birth defects or miscarriage in women who are pregnant. Additionally, some medications may be transmitted in breast milk and are potentially unsafe for the infant. Women with MS who are pregnant or who wish to become pregnant should consult their physician as soon as possible about how best to manage their MS while pregnant.

Medications for multiple sclerosis treatment

There are multiple medications available to multiple sclerosis (MS) patients. They work in various ways to help the patient cope with the disease.

The purpose of many medications is to suppress the body’s immune system to reduce the attacks on the myelin sheath surrounding the central nervous system nerves. These drugs are called immunosuppressants. Medications that may be recommended for treating MS include:

  • Interferon. Antiviral proteins that modify the activity of the immune system and slow the destruction of myelin. These medications are recommended in patients with the relapsing forms of MS who can still walk. Interferon is injected by the patient several times a week. There are multiple types of interferon for treating MS and the injection frequency varies depending on the type.

    Interferon beta-1b
    (injected under the skin) is one of the most frequently prescribed medicines for MS. Patients taking this medication usually have a slower progression of disease and attacks that are shorter, less severe and less frequent. Interferon beta-1a (injected into the muscle) provides modest benefits to patients and reduces inflammation of nerves. Interferon medications are likely to produce side effects that are similar to flu symptoms and include fever, chills, sweating, muscle aches, fatigue and depression. Some patients may also experience anxiety or poor concentration.

  • Glatiramer acetate. An immune system modifier that blocks attacks on myelin. This medication may be recommended for patients with relapsing-remitting MS. Research indicates that glatiramer acetate reduces the frequency of MS-associated relapses. The medicine must be injected under the skin daily and may produce a localized reaction (e.g., swelling, redness, tenderness). Since it must be injected frequently, the patient’s physician will likely recommend rotating injection sites. Other side effects include flushing and shortness of breath.

  • Mitoxantrone. Medication typically used in chemotherapy for cancer. Mitoxantrone has been shown to reduce the number of relapses patients experience and reduce the number of brain lesions that occur. It is given intravenously in a medical facility to patients with progressive or relapsing-remitting MS when the patient has shown no response to other treatments. Patients can only take the medication for two to three years because of its potentially severe side effects, including heart damage. Other side effects include discolored urine (blue or green), fatigue, bruising, nausea and bladder infections.

  • Monoclonal antibodies. Medication that blocks the nerve-damaging activity of white blood cells in patients with relapsing forms of MS. The antibodies (natalizumab) are administered intravenously in a medical facility each month. The medication usually reduces attacks and the occurrence of new brain lesions. It is recommended that this therapy not be used with other medications. Side effects may be severe and are likely to include headache, fatigue, urinary tract infections, depression, respiratory infections and joint pain. The availability of this medication is limited because a small number of patients have developed a rare brain disease, known as progressive multifocal leukoencephalopathy, while on this medication. There is a registration program, called TOUCH, for physicians and patients to monitor the prescription of the medication and its effects on patients.

In most cases, physicians may recommend that one of these medications be started early after receiving a diagnosis of multiple sclerosis as they may temporarily halt the progression of the disease by slowing the damage to the nervous system. In many patients, the medications help reduce the occurrence of attacks of severe symptoms. However, over time, the medications may lose effectiveness and the disease may continue progressing.

Patients with MS are likely to be prescribed corticosteroids during relapses. These medications reduce nerve inflammation and provide short-term improvement in the severity of movement-related symptoms. Patients taking corticosteroids often also experience faster recovery from attacks, but the medication has shown no long-term benefit. Side effects of the medication may include weight gain, nausea, seizures and psychosis.

Medications are also available to treat individual symptoms of MS. These medications may include:

Medication ClassSymptoms Treated
AnalgesicMuscle pain, back pain, trigeminal neuralgia
AntibioticUrinary tract infections
AntidepressantFatigue, pain, depression
Erectile dysfunction medicationErectile dysfunction in men
LaxativeConstipation
Muscle relaxantSpasticity, tremors

Surgery for multiple sclerosis treatment

Surgery cannot cure multiple sclerosis (MS) but may be necessary when severe symptoms of the disease become debilitating and do not respond to oral or intravenous medications.

In some cases, tremors (involuntary muscle contractions that cause shaking) may become severe. Patients who experience this symptom may benefit from deep brain stimulation. This procedure involves implanting an electrode into the thalamus, a part of the brain that regulates nerve signal transmission. Sending an electrical charge to the electrode inactivates the thalamus and stops the nerve signals that are causing the muscle contractions. The electrical charges are controlled by the patient and can be activated and deactivated when necessary.

Patients with MS may also experience spasticity (uncontrollable limb movements). If these movements become severe, a spinal pump may be inserted. The pump is implanted under the skin near the spinal cord and delivers muscle relaxants to control the spasticity with generally fewer side effects than oral medication. After surgery, patients must consult a physician every one to three months to refill the pump. The device typically works for up to seven years before the battery dies and surgery is needed to replace it.

MS frequently causes bladder dysfunction. This may occur as a result of incontinence, frequent urinary tract infections or retention of urine. Urine retention may be treated with the insertion of a catheter, which is a tube into the urethra that allows urine to be drained. In addition, a bladder pacemaker may be implanted in patients who need help controlling the urge to urinate. This device regulates the nerve signals to the bladder and can be activated by the patient.

Rehabilitation for multiple sclerosis treatment

Rehabilitation includes a mixture of therapies that help multiple sclerosis (MS) patients maintain mobility and independence. According to the National Multiple Sclerosis Society, patients who undergo rehabilitation as part of treatment have improved function over the course of the disease.

At the beginning of rehabilitation, patients are likely to be evaluated by a health professional, who will assess the patient’s mental and physical abilities, as well as therapy goals. A rehabilitation plan can then be developed to maintain and improve the patient’s existing abilities.

Physical therapy includes a mixture of exercises, massage and other treatments to maintain strength and flexibility. A physical therapist is likely to teach the patient exercises that can be performed at home to strengthen and retrain muscles. This helps patients improve balance and reduce fatigue, pain and spasticity. Additionally, physical therapy may include training in the use of assistive devices to improve mobility, such as canes, walkers or wheelchairs. A physical therapist may also recommend modifications like ramps and grab bars that can be installed in the patient’s home to make movement easier.

Occupational therapy is similar to physical therapy, but it focuses on improving patients’ fine motor skills so they can better accomplish daily activities, such as dressing and aspects of personal hygiene. Occupational therapy may also be able to help the patient develop ways to work more efficiently in order to reduce fatigue.

MS may involve difficulties with speech. Some patients may be too weak to speak at an audible volume, while others may have difficulty finding the right words, leading to frustration. These patients may benefit from speech and language therapy. This type of therapy may focus on retraining the patient’s speech skills. A speech and language therapist may also recommend voice amplifiers and similar devices.

Patients with MS and their family and friends may benefit from education and counseling on the disease. MS leads to major changes in lifestyle and an uncertain future. Discussing these topics with a professional counselor or in a support group often helps patients and their families cope with the disease and reduce emotional stress.

Ongoing research

Much of the research regarding multiple sclerosis (MS) is focused on new treatment options. Some scientists are using stem cell research to explore ways to repair or replace tissue that has been damaged by MS. Stem cells are special cells in the body that create other cells with specific purposes. For example, some stem cells are cardiac stem cells and will only make heart muscle cells. Other stem cells create brain tissue cells or lung tissue cells. MS researchers have discovered dormant neural stem cells in the brain that can create myelin-making cells called oligodendrocytes. Once oligodendrocytes are damaged, it is impossible for them to replicate and produce myelin. Scientists are trying to find a way to activate these neural stem cells so more oligodendrocytes can be created.

Stem cell research for MS is still in its early stages and trials have not yet taken place to test the suitability of stem cell therapy in humans with MS.

There is also significant research taking place on medications that could be used as possible therapy for MS. Some of these medications include:

  • 2-chlorodeoxyadenosine. Medication typically used to treat leukemia. To date, evidence indicates that it may slow the progression of the disease and improve the health of nerve cells. Side effects of the medication include back pain, respiratory infections and skin disorders.

  • Cyclophosphamide. An injected chemotherapy medication. It is believed to be most effective in reducing symptoms in patients younger than 40, but it is not useful against primary-progressive MS. It may cause severe side effects, including bladder cancer, nausea, infection, gonadal suppression, menstrual irregularities and premature menopause.

  • Plasma exchange or plasmapheresis. Removal and filtration of blood. Plasmapheresis removes the antibodies that attack the body’s nervous system. Patients who undergo the process have shown improvements for up to three months after treatment. This method may help patients who have not benefitted from corticosteroid treatment.

  • Cholinesterase inhibitors. Medications that are typically used to treat Alzheimer’s disease. The drugs target the neurotransmitter acetylcholine and help prevent it from breaking down. This may prove beneficial for patients experiencing cognitive symptoms such as dementia.

  • Vaccine. Injection of weakened myelin-attacking immune cells. Trial vaccines for MS have shown some benefit in patients with the relapsing-remitting form of the disease. To date, the vaccines must be developed for patients individually, making the development of a standardized vaccine difficult.

Questions for your doctor about MS treatment

Preparing questions in advance can help patients to have more meaningful discussions with physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to multiple sclerosis treatment:

  1. What’s the best way to treat my MS?
  2. What medications are available to treat multiple sclerosis and what are the side effects?
  3. How much will medications improve my symptoms?
  4. Will my symptoms get worse if I stop taking the medication?
  5. What should I do if I miss a dose of my medication?
  6. Can I take over-the-counter remedies for my symptoms?
  7. Would I benefit from surgery?
  8. Would I benefit from physical therapy? Can you recommend a physical therapist?
  9. What changes can I make at home to make living with multiple sclerosis easier?
  10. Can you recommend a support group?
  11. Will any of the research on MS affect my treatment options?
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