Treatment
Overview
| Diagnosis | Symptoms
| Treatment
There is no known cure for multiple sclerosis, but there
are many types of treatments. The interventions prescribed
by your physician and other health care professionals are
not designed to make MS disappear. Instead, the various
treatments, including medications, exercises, adaptive aides,
and self-care strategies are designed to help manage symptoms,
prevent unnecessary complications, control disease progression,
and minimize disability. The medical management of your
MS involves an ongoing collaboration between you and your
health care team. Decisions about treatment must be made
on an individual basis.
The treatment of MS can be grouped into three categories:
management of acute attacks, disease-modifying treatments,
and management of symptoms.
Management of Acute Attacks
The onset of symptoms over several days or weeks,
involving either the development of new symptoms or the
worsening of old ones, may indicate an attack or exacerbation
of the disease. An attack is usually accompanied by inflammation
or demyelination in the central nervous system, either in
new sites or old ones. Treatment may be recommended if the
symptoms are severe or worsen. The swelling and inflammation
of demyelination may be reduced by high doses of an intravenous
corticosteroids [Solu-Medrol (methylprednisolone)]. Corticosteroids
are used in MS for the management of acut attacks or exacerbations
because they have the ability to close the blood-brain barrier
and reduce inflammation in the central nerouvs system.
Disease-Modifying Treatments
Only recently have there been treatments that hold
promise for reducing the course of MS. A number of new drugs
have been shown to modify the course of the disease –
Betaseron® (interferon beta-1b), Avonex® (interferon
beta-1a), Copaxone® (glatiramer acetate), Rebif®
(interferon beta-1a) and Novantrone® (mitoxantrone).
These drugs do not cure MS, but they have shown a reduction
in the frequency and severity of attacks, reduction in brain
lesion development, and a slowing of disease progression
with reduction in future disability level. Clinical trials
have shown that these drugs can improve the quality of life
for many people with MS. Therefore it is suggested that
treatment with one of these disease-modifying drugs be initiated
as soon as possible. Talk with your physician about what
treatment may be right for you.
The decision concerning whether or when to begin treatment
with one of these drugs is best made by you and your doctor.
Factors that should be considered include potential side
effects, benefits, frequency, method of drug delivery, and
your personal concerns, priorities, and lifestyle. The most
important goal is to find a treatment you can use comfortably
and consistently.
Each drug company offers customer support and may also
provide some financial assistance for qualifying individuals
without prescription drug coverage.
How do these drugs work?
All of these drugs work by altering or suppressing the
activity of the body's immune system. These drugs are based
on the theory that MS is possibly a result of an adnormal
response of the body's immune system that causes it to attack
the myelin surrounding the nerves.
The interferon drugs resemble the interferons the body
produces during a response by the immune system. It is thought that the interferons reduce nervous system inflammation by inhibiting inflammatory cells from entering into the system.
Copaxone, the only non-interferon medication, is an artifically
made protein that resembles a protein that is part of the
myelin that surrounds the nerves. Copaxone is thought to reduce nervous system inflammation by restoring cytokine balance by stimulating anti-inflammatory cells that can enter the nervous system.
Novantrone is an immune suppressing medication. It is used
for individuals who are considered to have a worsening of
the disease or secondary progressive MS.
Comparing the Disease Modifying Drugs
| Name |
Avonex
(interferon
beta-1a) |
Betaseron
(interferon
beta-1b) |
Rebif
(interferon
beta-1a) |
Copaxone
(glatiramer
acetate) |
Novantrone
(mitoxantrone) |
 |
| Mode of Delivery |
Intramuscular
Injection |
Subcutaneous Injection |
Subcutaneous
Injection |
Subcutaneous Injection |
Intravenous Infusion |
|
| Frequency |
Weekly |
Every other day |
3 times a week |
Daily |
Every 3 months |
|
| Side Effects |
Mild flu-like
symptoms |
Mild flu-like
symptoms
Possible injection
site reactions |
Mild flu-like
symptoms
Possible
injection site reactions |
Injection site reactions
Chest pain
Flushing |
Heart Damage (limit
doses of drug is recommended)
Nausea
Increased risk of infection |
|
Management of Symptoms
There are many effective treatments for the symptoms
that develop with MS. Many symptoms can be lessened or even
reversed with medical approaches. Drugs can help with many
of the chronic symptoms that appear, while modifications
in diet or lifestyle may help to eliminate or manage symptoms.
Most of the symptoms of MS can be minimized or corrected
with appropriate drug treatment, environmental modifications,
or physical therapy. To properly care for your disease,
routine follow-up visits with your health care team are
essential.
Other Treatments
Physical Therapy can be helpful
for MS patients at any stage of the disease. A physical
therapist can teach you exercises you can use to strengthen
and loosen muscles. The goal of physical therapy is to improve
your independence and quality of life by improving movement
and function.
Occupational Therapy teaches
people new ways to function at their highest level possible.
The goals of occupational therapy include: restore or improve
physical abilities, adapt patients’ surroundings, promote
behavioral changes, and teach new skills.
Counseling is beneficial
to patients from as early as the first diagnosis. Being
diagnosed with MS and dealing with the changes that accompany
all aspects of the disease can be stressful. Counseling
can help patients and family members cope with stress, depression
and anxiety.
Complementary and Alternative
Medicine (CAM)
Alternative medicine includes everything from drugs and
diet to supplements and lifestyle changes. CAM therapies
come from a variety of disciplines and traditions, each
with their own beliefs. Some CAM therapies include yoga,
guided imagery, relaxation techniques, massage therapy,
herbal therapies and many others. Before starting on any
CAM therapy it is important to do your homework. Investigate
the background of any CAM provider and talk with others
who have usde the treatment. You should talk with your physician
before starting any CAM therapy and let your physician know
if you are currently on any CAM therapy including vitamin
& mineral supplements.
Complementary and Alternative Medicine
Websites
www.ms-cam.org - Rocky
Mountain MS Center CAM website
www.nccam.nih.gov
- National Center for Complementary and Alternative Medicine
External Link Disclaimer
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