What's the treatment for multiple sclerosis?
Because no known way to prevent or cure multiple sclerosis exists, the main focus of daily care is aimed at symptom management and efforts to stabilize progression of the disease. The treatment of multiple sclerosis mainly aims at decreasing the rate and severity of relapse, reducing the number of multiple sclerosis lesions, delaying the
progression of the disease, and providing symptomatic relief for the patient. Several different drugs have been developed to treat the symptoms of multiple sclerosis.
During an exacerbation, corticosteroids (such as prednisone or methylprednisolone) used at high dosages (500 mg–2 g per day intravenously for a course of 3 to 5 days) can accelerate regression of symptoms. Subsequent tapering with pills may be reasonable in certain cases. There is clear evidence that sole treatment with oral steroids at dosages of 100 mg per day or less and subsequent tapering is inferior to intravenous high dose treatment. In principle, steroid treatment during pregnancy is possible. There is no good evidence that corticosteroids influence longterm outcome.
Interferon beta is used to treat relapsing remitting multiple sclerosis, and it comes in two different injectable forms: interferon beta-1a (Avonex) and interferon beta-1b (Betaseron). Interferons are also made by the body, mainly to combat viral infections. Interferons have been shown to decrease the worsening or relapse of multiple sclerosis. Studies have shown that interferon beta-1a injections lower the rate of multiple sclerosis relapses by approximately 32 percent and also can lower the risk that multiple sclerosis disability will progress or become severe. In addition, interferon beta-1a may decrease the numbers of multiple sclerosis plaques seen on MRI scans. Interferon beta-1b can reduce the multiple sclerosis relapse rate by 31 percent annually and can decrease plaque formation seen on MRI, but it may not have as strong an affect on disability as interferon beta-1a.
Glatiramer acetate (Copaxone) is a mixture of amino acids used to treat multiple sclerosis. Glatiramer acetate has been shown to decrease the relapse rates of multiple sclerosis by 30% and appears to also have an effect on the overall disability of multiple sclerosis. Glatiramer acetate is better tolerated than the interferons and has fewer side effects. Concerning its therapeutic effect it is approximately comparable to Interferon-beta. Glatiramer acetate consists of synthetic peptides made of four different amino acids, which are basic modules of all proteins in the human body. Once per day must be injected into the skin. Attempts to develop pills containing glatiramer acetate have also been unsuccessful. Copaxone is effective in the treatment of relapsing remitting multiple sclerosis.
The currently most effective drug in the preventive treatment of multiple sclerosis is Mitoxantrone. It has been proven to be effective in relapsing remitting and in secondary progressive multiple sclerosis. In most cases it is administered every three months intravenously. Therapy with Mitoxantrone is generally well tolerated, however, since with ongoing therapy the risk for damage of the heart muscle increases, at an average Mitoxantrone can only be administered for 3 to 4 years. This is why Mitoxantrone is only used in cases of rapid disease progression. Mitoxantrone treatment requires monitoring of the heart function during therapy. Regular blood monitoring is required. With these precautions Mitoxantrone treatment is safe.
A recent study found that women who took vitamin D supplements were 40% less likely to develop multiple sclerosis than women who did not take supplements. However, this study does not allow to conclude that vitamin D has a beneficial influence on ongoing multiple sclerosis. Furthermore it could not distinguish between a beneficial effect of vitamin D and multivitamin drugs including vitamin E and various B vitamins which may also exert a protective effect.
A variety of medications are used to treat symptoms without influencing the inflammatory nature of the disease (symptomatic treatment). Baclofen and tizanidine can be useful against spasticity. There is no convincing evidence that cannabinoids (marijuana) can improve spasticity. The anticonvulsant drugs Gabapentin and Carbamazepine and the antidepressant amitriptyline can improve pain and tingling sensations in certain cases. SSRIs be used for depression, as well as for fatigue. Fatigue can also be influenced by amantadine and modafinil. There is also treatment for bladder disturbances available which is effective in many cases. Examples are oxybutynin and trospium chloride. Treatment with sildenafil (Viagra®) or similar substances can improve male erectile dysfunction in many cases.
multiple sclerosis causes a large variety of symptoms, and the treatments for these are equally diverse. Most symptoms can be treated and complications avoided with good care and attention from medical professionals. Good health and nutrition remain important preventive measures. Vaccination against influenza can prevent respiratory complications, and contrary to earlier concerns, is not associated with worsening of symptoms. Preventing complications such as pneumonia, bed sores, injuries from falls, or urinary infection requires attention to the primary problems which may cause them. Shortened life spans with multiple sclerosis are almost always due to complications rather than primary symptoms themselves.
Physical therapy helps the person with multiple sclerosis to strengthen and retrain affected muscles; to maintain range of motion to prevent muscle stiffening; to learn to use assistive devices such as canes and walkers; and to learn safer and more energy-efficient ways of moving, sitting, and transferring. Exercise and stretching programs are usually designed by the physical therapist and taught to the patient and caregivers for use at home. Exercise is an important part of maintaining function for the person with multiple sclerosis. Swimming is often recommended, not only for its low-impact workout, but also because it allows strenuous activity without overheating.
Occupational therapy helps the person with multiple sclerosis adapt to her environment and adapt the environment to her. The occupational therapist suggests alternate strategies and assistive devices for activities of daily living, such as dressing, feeding, and washing, and evaluates the home and work environment for safety and efficiency improvements that may be made.
Training in bowel and bladder care may be needed to prevent or compensate for incontinence. If the urge to urinate becomes great before the bladder is full, some drugs may be helpful, including propantheline bromide (Probanthine), oxybutynin chloride (Ditropan), or imipramine (Tofranil). Baclofen (Lioresal) may relax the sphincter muscle, allowing full emptying. Intermittent catheterization is effective in controlling bladder dysfunction. In this technique, a catheter is used to periodically empty the bladder.
Spasticity can be treated with oral medications, including baclofen and diazepam (Valium), or by injection with botulinum toxin (Botox). Spasticity relief may also bring relief from chronic pain. Other more acute types of pain may respond to carbamazepine (Tegretol) or diphenylhydantoin (Dilantin). Low back pain is common from increased use of the back muscles to compensate for weakened legs. Physical therapy and over-the-counter pain relievers may help.
Fatigue may be partially avoidable with changes in the daily routine to allow more frequent rests. Amantadine (Symmetrel) and pemoline (Cylert) may improve alertness and lessen fatigue. Visual disturbances often respond to corticosteroids. Other symptoms that may be treated with drugs include seizures, vertigo, and tremor.
Myloral, an oral preparation of bovine myelin, has recently been tested in clinical trials for its effectiveness in reducing the frequency and severity of relapses. Preliminary data indicate no difference between it and placebo.