brain, spinal cord, and nerve disorders
Multiple Sclerosis (MS)
Treatment of Multiple Sclerosis
Corticosteroids Medications that help keep the immune system from attacking myelin sheaths Measures to control symptoms No treatment for multiple sclerosis is uniformly effective. For an acute attack, corticosteroids are most commonly used. They probably work by suppressing the immune system. They are given for short periods to relieve immediate symptoms (such as loss of vision, strength, or coordination) if the symptoms interfere with functioning. For example,prednisonemay be taken by mouth, ormethylprednisolonemay be given intravenously. Although corticosteroids may shorten relapses and slow the progression of multiple sclerosis, they do not stop its progression. Corticosteroids are rarely used for a long time because they can have many side effects, such as increased susceptibility to infection, diabetes, weight gain, fatigue, osteoporosis, and ulcers. Corticosteroids are started and stopped as needed. Medications that help keep the immune system from attacking myelin sheaths are usually also used. These medications help reduce the number of future relapses. They include the following: Interferon-beta injectionsreduce the frequency of relapses and may help delay disability. Glatirameracetate injectionsmay have similar benefits for people with early mild multiple sclerosis. is a Monoclonal Antibodies given intravenously as an infusion once a month. It is more effective than other medications in reducing the number of relapses and preventing further damage in the brain. However, Fingolimod,ozanimod,ponesimod,siponimod,teriflunomide,cladribine,dimethyl fumarate,monomethyl fumarate, anddiroximel fumaratemay be used to treat multiple sclerosis that occurs in relapsing patterns. These medications can be taken by mouth.Fingolimod,dimethyl fumarate,monomethyl fumarate, anddiroximel fumaratealso increase the risk of progressive multifocal leukoencephalopathy, although the risk is much less than withnatalizumab. Ocrelizumabis a monoclonal antibody used to treat multiple sclerosis that occurs in relapsing or primary progressive patterns. It is given as an infusion into a vein every 6 months. It can cause infusion reactions, which may include a rash, itching, difficulty breathing, swelling of the throat, dizziness, low blood pressure, and a fast heart rate. Alemtuzumab(used to treat leukemia), also a monoclonal antibody, is effective in treating multiple sclerosis that occurs in relapsing patterns (relapsing-remitting pattern and progressive relapsing pattern). It is given intravenously. However, it increases the risk of serious autoimmune disorders and certain cancers. Consequently,alemtuzumabis usually used only when treatment with two or more other medications has been ineffective. Ofatumumabis used to treat relapsing forms of multiple sclerosis and multiple sclerosis that is actively progressing. It is injected under the skin (subcutaneously). People with multiple sclerosis can be taught to administer it themselves. increases a person's susceptibility to infections (such as urinary tract infections, upper respiratory infections, and because it suppresses the immune system. Mitoxantrone,a chemotherapy medication, can reduce the frequency of relapses and slow the progression of the disorder. It is used only when other medications do not work and is typically given for only up to 2 years because it can eventually lead to heart damage. Immune globulin,given intravenously once a month, occasionally helps when other medications have been ineffective. Immune globulin consists of antibodies obtained from the blood of people with a normal immune system. Medications that increase the risk of progressive multifocal leukoencephalopathy (natalizumab,fingolimod, anddimethyl fumarate) are used only by specially trained doctors. Also, people who take them must be checked periodically for signs of progressive multifocal leukoencephalopathy. Blood tests for the JC virus, which causes progressive multifocal leukoencephalopathy, are done periodically. If a person takingnatalizumabdevelops progressive multifocal leukoencephalopathy, plasma exchange can be done to remove the medication quickly. Plateletpheresis (platelet donation) is recommended by some experts for severe relapses not controlled by corticosteroids. However, the benefits of plasma exchange have not been established. For this treatment, blood is withdrawn, abnormal antibodies are removed from it, and the blood is returned to the person. Stem Cell Transplantation , done at centers that specialize in stem cell transplantation, may be somewhat useful for severe, difficult-to-treat disease. Other medications can be used to relieve or control specific symptoms of multiple sclerosis: Muscle spasms:The muscle relaxantsbaclofenortizanidine Problems with walking:Dalfampridine, taken by mouth, to improve walking Pain due to abnormalities in nerves:Antiseizure medications (such asgabapentin,pregabalin, orcarbamazepine) or sometimes tricyclic antidepressants (such asamitriptyline) Tremors:Clonazepamorgabapentinor in severe cases, referral to a specialist who is experienced in injecting botulinum toxin (a bacterial toxin used to paralyze muscles or to treat wrinkles) Fatigue:Amantadine(used to treat Parkinson disease) or, less often, medications used to treat excessive sleepiness (such asmodafinil,armodafinil, oramphetamine) Depression:Antidepressants such assertralineoramitriptyline, counseling, or both , or Treatment , depending on the type of incontinence Constipation:Stool softeners or laxatives taken regularly People with urine retention can learn to catheterize themselves and thus empty their bladder. People with multiple sclerosis can often maintain an active lifestyle, although they may tire easily and may not be able to keep up with a demanding schedule. Encouragement and reassurance help. Regular exercise such as riding a stationary bicycle, walking, swimming, or stretching reduces spasticity and helps maintain cardiovascular, muscular, and psychologic health. Physical therapy can help with maintaining balance, the ability to walk, and range of motion and can help reduce spasticity and weakness. People should walk on their own for as long as possible. Doing so improves their quality of life and helps prevent depression. Avoiding high temperatures—for example, by not taking hot baths or showers—can help because heat can worsen symptoms. People who smoke should stop. may reduce the risk of developing Osteoporosis , doctors usually recommend that people take People who become weak and unable to move easily may develop Prevention , so they and their caregivers must take extra care to prevent the sores. If people are disabled, occupational, physical, and speech therapists can help with rehabilitation. They can help people learn to function despite disabilities caused by multiple sclerosis. Social workers can recommend and help arrange for needed services and equipment. 