Treating Multiple Sclerosis – What’s Multiple Sclerosis?
Multiple Sclerosis (MS) is a medical disorder caused by damaged nerves. Nerves are the electrical connections that signal among everything in our bodies. Since the nerves go everywhere, the symptoms can be almost anything depending on which nerves are damaged. See our main page on MS if you haven’t already. It’s also free. Treating multiple sclerosis aims to stop any worsening. When MS attacks occur, treatment is all about getting the attack to stop.
These Newer Medicines Are Effective for Treating Multiple Sclerosis
We now have medicines that work to treat MS, medicines developed through the past 20 years. They slow the worsening of MS. At times they slow MS progression to the point of almost stopping it. Concepts of MS nerve damage and ways to treat it continue to change, to improve, to generate ideas for new medicines. We now know so much more than we did even a few years ago about how these medicines work. But, while the current medicines are a great improvement over the past, none of them cure MS. We want a cure. Scientists and companies are working to find one.
The Choice of Doctor and His/Her Team Is Important
Not every doctor just down the street is an expert at treating MS. Medicine is a blend of art and science, and this is especially true when treating MS. The experience, skill, and training of the doctor and the treatment team are important. Super important. The medicines used, the close following of MS to see if it’s getting worse, getting repeated scans as time goes by, and everything in treating MS is specific for each person. It’s not “one-size-fits-all”. MS is not a medical condition for which you should get care from any random local GP doctor.
Physical Therapy Is Important – Treating Multiple Sclerosis
While the medicines for MS are the miracles, physical therapy remains really important in treating MS. The nerve damage of MS can cause some muscles and joints to be used too little. Sets of stretching exercises and muscle strengthening exercises work to keep everything flexible and strong. Then when the next remission comes, life can be much more normal. If muscles get weak and tendons and ligaments get stiff during a relapse, life remains more difficult during the next remission.
Start Treatment While You’re Still Well, Start Right Away, and Stay With It
For the best result in treating MS it’s important to start the medicine(s) and a physical exercise program as soon as you have the MS diagnosis. Then, once you start the treatment regimen, stay with it. Your medical treatment team has specific guidelines they follow on which medicines to start and when to start them, when to switch from one medicine to another, and when to stop a medicine. So it’s important for you to see your doctor often and carefully stay on track with the treatment plan if you want stay healthy. It used to be that people with MS would die younger than people in general. These days this is no longer always true. But to live a full life people with MS need to take better care of their health than the average person.
There Are Different Kinds of Medicines for Treating MS
Some of the MS medicines are oral meds, others are injections, and others are infusion medicines, dripped slowly directly into a vein over a period of time.
And, There Are Different Medicines for Different Types of MS
For Relapsing-Remitting MS
As we said on our main MS page, the most common type of MS is this relapsing-remitting MS, or RRMS. For RRMS there are several medicines that are called “disease-modifying”, meaning that they don’t just treat symptoms, they make a real difference. They change the illness itself. They’re medicines that must be injected under the skin or into muscle, not taken by mouth. There are 2 types of these medicines, the interferons and glatiramer. The 2 types work differently and both work well for MS. Several interferon brands are available. Which medicines to use when and what dose strength to use has to be an individual treatment plan for a specific person. These decisions are why you need an expert doctor to treat MS.
Oral Medicines for Relapsing-Remitting MS
There are also several medicines that can be taken by mouth for RRMS. As with injectible medicines, the choices must be individualized for a specific person. They are cladribine, dimethyl fumerate, diroximel fumerate, fingolimod, siponimod, and teriflunomide.
MS Medicines Given by Infusion
There are a few medicines used in special situations that must be given directly into a vein by a trained medical person. They are alemtuzumab, mitoxantrone, natalizumab, and ocrelizumab.
For Primary-Progressive MS
The 2nd type of MS that we list on our main MS page is Primary-Progressive MS or PPMS. This type happens in about 10% of new MS diagnoses. For this type, at least in terms of what is FDA-approved, there is one disease-modifying medicine, ocrelizumab.
Some MS Medicines Can Be Expensive
The newer medicines for treating MS can be expensive. Most offices and clinics that treat MS know about special programs to help with cost, how to apply to pay less, and can help you get the right medicines for less. One can also appeal directly to the pharmaceutical company that makes a medicine. The companies often help when they can.
There Are Times When a Rescue Medicine is Necessary
Let’s say that you and your doctor have found a set of medicines that’s working and your MS is not worsening at all or maybe worsening very slowly. Then it suddenly changes and gets worse quickly. Most of the time it will soon start to get better again without a rescue medicine. But not always. This is another important time when you need that expert doctor with experience. There are times when the MS gets much worst, too much so, and you need a rescue medicine. For example, if your eyesight deteriorates, or you become weak or off balance. Such an situation might be a time for a burst of a rescue steroid medicine.
Steroid Medicines for Rescue from MS Attacks
If an MS attack occurs and your doctor says you need a steroid rescue medicine, it means your nerves have become inflamed. Steroid medicines are great for stopping inflammation. The one usually used that you can take by mouth is prednisone. In situations where there is a more urgent need to stop the nerve inflammation a medicine might be used that is put directly into a vein. Intravenous methylprednisolone is one that is often used in these cases. While these steroid medicines are what’s needed they are not trouble free. They can interfere with your sleep, cause headaches, and make your muscles feel weak. Fluid retention is another side effect, and increased blood pressure. They can cause upsetting mood swings and make your blood sugar levels go up.
Plasma Exchange for Rescue from MS Attacks
There’s another approach for treating multiple sclerosis attacks. Sometimes an attack can come on new and become severe and steroids don’t seem to help. There is a treatment called “plasma exchange” or “plasmapheresis”. Some people think of it as a blood cleansing process. Blood is taken out and a machine separates the liquid part of your blood, the plasma, from the blood cells. The blood cells are then mixed with a solution with a protein called albumin in it. These cells and albumin are then put back into you. This takes out of the blood antibodies that might act to make the MS attack worse. The whole process takes at least 2 hours and maybe as long as 4 hours. Depending on the severity of the attack and the benefit from the plasma exchange, a person might have about 3 to 7 exchanges for an attack.
While Much Can Go Wrong, There Are Solutions
When you have MS many bad surprises can show up at any time. Fear not, your expert and experienced clinical team will have solutions. Here’s a short list, not meaning to scare you, but to let you know that if one of these happens it might be because of the MS.
- Bowel difficulties
- Bladder problems
- Walking problems
- Muscle spasms
- Sexual problems
- Feeling upset and emotional in a way that’s just not you
- Dizziness and/or vertigo
National Multiple Sclerosis Society Website
The National Multiple Sclerosis Society (NMSS) website is an important support site. The staff of the NMSS are dedicated individuals. The site tries to provide complete facts about what’s available.
We will do our best to get fresh information to you, and to keep you updated as companies launch new medicines or we find news of possible future medicines. The important thing here is our ability to gather expert opinions about which new medicines hold great promise, which will probably be somewhat helpful, and which are likely to be no help at all.
Check the ClinicalTrials.gov website for recruiting and not-yet-recruiting studies of MS.
National Multiple Sclerosis Society on Treating MS
e-medicine’s Medscape on Multiple Sclerosis Treatment & Management
The Mayo Clinic on Multiple Sclerosis Diagnosis and Treatment