By Dr Ananya Mandal, MD
There is no cure for Multiple Sclerosis (MS). Treatment aims at delaying disease progression and preventing symptom relapse.
Management of MS involves of a number of healthcare professionals from different specializations who work as a team to help patients with this complex disorder. Some examples of the professionals involved in treating individuals with MS include neurologists, urologists, physiotherapists, occupational therapists, speech therapists, psychologists, social workers and nurses.
The treatment of MS is divided into three broad categories:
The management of specific symptoms of the disease
The treatment of MS attacks
Disease-modifying treatments to slow disease progression and prevent symptoms
Specific symptom management
This involves the prescription of treatments for specific symptoms such as:
Glasses to aid individuals with visual disturbances. People with jerky eye movements (nystagmus) may be prescribed a drug called gabapentin.
Muscle stiffness, spasm and tightness may be relieved with physiotherapy. In addition, muscle relaxants such as baclofen, tizanidine, diazepam, dantrolene or botox may be beneficial. Splints and braces may also be used for the correction of muscle spasm. Muscle spasm and pain may cause problems with manoeuvrability which can be improved with physiotherapy, exercise, splints and movement aids.
Nerve pain can be another major problem in MS and can be treated using carbamazepine, amitriptylline or gabapentin.
Psychological problems such as depression and anxiety are treated using appropriate medications and psychological therapy.
Bladder incontinence is treated using anti-cholinergic medicines such as oxybutynin or tolterodine. Mild to moderate constipation may be treated with dietary changes and laxatives.
These are the main agents used to treat MS relapse. They reduce the inflammation that occurs during an attack and shorten the length of the relapse. They are usually administered intravenously and examples include methlprednisolone and prednisone.
Plasma exchange or plasmapheresis
This procedure may be used if a person is nonresponsive to steroids. In plasmapheresis, the blood cells are separated from plasma, mixed with a replacement solution and returned to the blood.
Disease modifying medications
Interferon beta agents are used to slow disease progression in MS and reduce the length and severity of attacks. Examples include avonex, betaseron and rebif.
This drug is given as injections. Glatiramer acetate is thought to block the immune attack of myelin and is administered subcutaneously once a day.
This agent prevents the migration across the bood–brain barrier of certain immune cells that may damage the brain and spinal cord. Natalizumab is given as a monthly injection.
Reviewed by Sally Robertson, BSc