Treatment for Multiple Sclerosis
The main goal of multiple sclerosis treatment is to help a person be as independent as possible while also dealing with the emotions (such as anxiety, anger, depression, or fear) that can accompany this disease. Medications, physical and occupational therapy, and emotional support may all be part of a person's treatment plan for MS.
At this time, there is no cure for MS. However, researchers continue to make great advancements in the understanding and treatment of this disease.
Current treatment for multiple sclerosis focuses on controlling the immune system and managing the symptoms of multiple sclerosis. It is important for people to work with their healthcare providers to find the best approach to address multiple sclerosis symptoms such as extreme fatigue, bladder problems, and spasticity (muscle tightness and stiffness).
Specific MS treatments can include:
- Physical or occupational therapy
- Emotional support.
There are three basic goals when using medications as a multiple sclerosis treatment:
- Manage the exacerbations or relapses of MS, which are the attacks where new symptoms appear or the old symptoms get worse
- Modify the disease itself
- Manage MS-related symptoms.
Treatment That Modifies the Disease
Four forms of beta interferon (Avonex®, Betaseron®, Extavia®, and Rebif®) have now been approved by the Food and Drug Administration (FDA) for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow down the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.
The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone®), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one-third.
An immunosuppressant treatment for multiple sclerosis, Novantrone® (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS. Another disease-modifying MS drug, Tysabri® (natalizumab), is available only through a restricted-access program for people who have found other MS drugs to be ineffective or intolerable, since it can cause very dangerous side effects.
There are two disease-modifying drugs that are taken by mouth rather than injection. The first oral disease modifying MS drug to be approved was Gilenya™ (fingolimod), which is classified as a "sphingosine 1-phosphate receptor modulator."
This medication binds to certain receptors in the body and prevents lymphocytes from leaving the lymph nodes. This decreases the number of lymphocytes in the bloodstream. Lymphocytes, a type of white blood cell, play an important role in the immune system.
The second oral disease-modifying MS medication is Aubagio® (teriflunomide), a pyrimidine synthesis inhibitor. Lymphocytes need pyrimidines to divide and reproduce. By preventing the body from making pyrimidines, Aubagio reduces the number of lymphocytes in the body, which may be the reason it works to prevent MS relapses. Aubagio can cause liver problems and suppression of the immune system and cannot be taken by pregnant women.
Treatment That Manages Symptoms
Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers, such as:
If psychological symptoms of fatigue, such as depression or apathy, are evident, antidepressant medications may help. Another drug that may reduce fatigue in some, but not all, patients is amantadine (Symmetrel®).
Although improvement of visual problems usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol®) followed by treatment with oral steroids is sometimes used.