Multiple sclerosis (MS) treatment

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from: Mayo Clinic

 

 

Treatment

 

 

Multiple sclerosis (MS) treatment involves managing the symptoms as well as treating the disease before permanent damage causes additional symptoms. Although there is no cure for MS, treatments may include medications, physical and occupational therapy and experimental therapies

 

 

 

Treatment for MS attacks

 

 

 

• Corticosteroids. Your doctor may prescribe oral or intravenous corticosteroids to reduce inflammation in nerve tissue and shorten the duration and severity of flare-ups. Prolonged use of these medications isn't recommended because evidence doesn't suggest long-term effectiveness. Prolonged use may cause side effects such (as osteoporosis and high blood pressure (hypertension
  

• Plasma exchange. In plasma exchange, your blood is removed, and a machine separates your blood cells from your blood fluid (plasma). After your blood cells are mixed with a replacement solution, typically albumin or a synthetic plasma-like fluid, the blood cells and solution are returned to your body
   
   
  

  Nearly 45 percent of people who don't get relief from corticosteroids benefit from plasma exchange. It's not clear why plasma exchange works, but doctors believe that replacing plasma may dilute the activity of the destructive factors in the immune system

  
   
   
   
  Plasma exchange is effective for people who have sudden, severe attacks of MS-related disability who don't benefit from high doses of corticosteroids. The treatment is most helpful in those who have a mild disability before the attack. Plasma exchange has no proven benefit beyond three months from the onset of neurologic symptoms
  

• Careful monitoring. If your attacks are mild or infrequent, your doctor may advise a wait-and-see approach, with counseling and close observation

  
  

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Medications to modify the course of MS

 

• Beta interferons. The U.S. Food and Drug Administration has approved beta interferons only for people who have relapsing forms of MS to reduce the frequency and severity of flare-ups. Beta interferons don't reverse damage and haven't been proven to prevent permanent disability. Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) are genetically engineered copies of proteins that occur naturally in the body. You may receive Betaseron and Rebif via injection under your skin (subcutaneous) and Avonex as an injection in a muscle (intramuscular

  
   
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  Mayo Clinic doctors generally recommend beta interferons for people who have more than one MS attack a year and for those who don't recover well from flare-ups. The treatment may also be used for people who have a significant buildup of new lesions as seen on an MRI scan, even without major new symptoms of disease activity

  
  

• Glatiramer (Copaxone). Glatiramer is an alternative to beta interferons and is effective in curbing MS attacks in people who have relapsing-remitting MS. Doctors believe that glatiramer blocks the immune system's attack on myelin. You take glatiramer as a subcutaneous injection once daily

  
  

• Natalizumab (Tysabri). This drug reduces the frequency of MS attacks by limiting the ability of immune cells to move from your bloodstream to your brain, and is given monthly. Your doctor may recommend natalizumab mainly if you don't benefit from or can't tolerate other MS medications because natalizumab can increase the risk of a serious brain infection

  
  

• Mitoxantrone (Novantrone). Your doctor may recommend mitoxantrone if you have very aggressive relapsing-remitting or secondary progressive MS. Generally, your doctor will consider it if you haven't benefited from beta interferons and glatiramer, continue to have relapses with stepwise worsening and your MRI scans show ongoing inflammation. You take mitoxantrone by IV every three months

  
  

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Medications that treat MS symptoms

 

 

A number of drugs are available to help relieve MS symptoms

• Medications to reduce stiffness and spasticity. Your doctor may prescribe the muscle relaxants tizanidine (Zanaflex) and baclofen (Lioresal) for muscle spasticity

  
  

• Medications to reduce fatigue. The antiviral drug amantadine (Symmetrel) and the stimulant modafinil (Provigil) may reduce your fatigue

  
  

• Other medications. Depending on your individual needs, your doctor may prescribe medications for depression, pain, and bladder or bowel control problems that may be associated with MS

  
  

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Physical and occupational therapy

 

Your doctor may recommend physical or occupational therapy to help you preserve your independence. You'll learn how to perform strengthening exercises and use devices that ease your daily tasks

Counseling

 

Individual or group therapy may help you and your family better cope with MS and relieve emotional stress