Multiple sclerosis and its treatment options
What is multiple sclerosis?
Multiple Sclerosis also referred to as MS is a disabling disease that needs immediate attention once it’s discovered. How would you know that you have MS? Well, lets briefly define what MS is a bit further. MS is a disease that attacks the spinal chord or the central nervous system and the brain.
MS directly hits myelin which is a protective sheath that protects the nerves. MS then causes communication breakdown between your body and your brain, leading to deterioration of the nerves which eventually become permanently damaged.
What signs should I look out for?
Signs of multiple sclerosis differs from one person to the next, and it also depends on the extent to which the disease has spread on the nerve fiber that has been affected. But generally, you should look for the following signs:
- Prolonged double vision
- Weakness or numbness in your limbs that may occur alternatively on the sides of the body, or your torso or legs.
- Body pains
- Complete or partial loss of sight, occasionally from one eye to the next as you experience pain when moving the eyes.
- Fatigue
- Slurred speech
- Bladder and bowel malfunction
- Unsteady gait
- Shock sensations when moving the neck
- Dizziness
Course of the disease
Most people experience a relapsing-remitting course. Periods of relapses develop over a few days or weeks, and they improve in part or in full. Quiet periods of MS remission follows, and they can last for several months to years.
Increase in body temperature can worsen the symptoms of MS. When the symptoms worsen; they can cause gait or mobility issues to patients. The rate at which sign progression occurs varies between people who have secondary-progressive MS.
Diagnosis
There are no known specific tests for MS; a diagnosis usually depends on eliminating symptoms and signs. This method is commonly known as the differential diagnosis.
The following diagnosis is likely to be recommended by your doctor after taking your medical examination after a look at your medical history.
MR: this test is taken to reveal the lesion areas on your spine and brain. A contrast material intravenous injection may be administered to highlight these areas.
Blood tests: this test will help in eliminating other diseases that have similar symptoms to MS. There is an ongoing test to identify biomarkers related to MS, and they will help in the diagnosis of MS.
Spinal tap (Lumbar puncture): in this test, a sample of the spinal canal fluid is removed for analysis. The lab test will indicate antibody abnormalities that are related to MS. Lumbar puncture can help eliminate infections that have similar signs to MS.
Evoked potential tests: these test records the nervous system’s electrical signals when a stimulus is triggered. This may be administered through electrical or visual stimuli where a moving visual pattern is observed. Short electric impulses are also administered the nerves located on the arms or legs.
Treatment options available for MS
We don’t have a cure for multiple sclerosis. The treatment options available are used to speed the recovery, slowing down the disease propagation and managing the symptoms shown by MS. There are cases where patients have mild MS that does not require treatment.
Treatment of MS attacks
Introduction of Corticosteroids like intravenous methylprednisolone or oral prednisone is prescribed for the reduction of inflammations that affect the nerve. There are side effects that are associated with this form of treatment, they include:
- High blood pressure
- Insomnia
- Fluid retention
- Mood swings
Plasma exchange: the plasma, which is the liquid part of the blood is separated from the blood cells. A protein solution called albumin is mixed with the blood cells, and it is induced back to the body.
If you have relatively severe new symptoms which are tolerant to steroids, plasma exchange or plasmapheresis is done.
Progression modification treatments
Ocrevus or ocrelizumab is the primary FDA approved modification therapy for primary progressive MS. The purpose of this therapy is to reduce disability formations on patients who are affected by this variation of MS.
For patients who have relapsing-remitting MS, there are some therapies available involved with disease-modification.
In MS, most of the immune response happens during the early stages. When an aggressive treatment is administered, it can lower the relapse rate and in turn lower new lesion formation.
Most of the MS disease-modifying therapies are risky. Choosing the right therapy will depend on several factors, including disease severity, duration, previous MS treatment effect, cost, other health concerns and the ability to get children.
Relapse-remitting treatment options include:
Mitoxantrone: this drug which is an immunosuppressant can cause heart problems, and it is also associated with blood cancer development. These concerns have made this drug limited in MS treatments. It has only been used in treating extreme cases of advanced MS.
Beta interferons: these drugs are injected into the muscle or under the skin to reduce the severity and frequency of the relapse. They are the most commonly MS prescribed medications.
- Side effects of Beta interferons
- Reactions on injection-site
- Flu
Blood tests will also be done to monitor the liver because of the medication which can cause damage to the liver. Neutralizing antibodies can be developed in people who are using this drug, resulting in ineffective drugs.
Lemtradea (Alemtuzumab): this drug helps in suppressing MS relapse, by depleting white blood cells by targeting a protein that is found on the immune cell’s surface. Potential nerve damage that is caused by white blood cells is limited by this effect, but also increases the risk of autoimmune disorders and infections.
Drug infusion that is carried out in five consecutive days is the kind of treatment alemtuzumab is involved with, followed by infusions done three days after a year of the five-day infusion.
There are infusion reactions assimilated with alemtuzumab, registered providers are the only ones who stock this treatment, and patients have to be registered to take this treatment program.
Ocrevus (Ocrelizumab): this medication is comprised of a humanized immunoglobin antibody that is approved by the FDA for progressive forms of MS and relapses. The drug has been tested and proved to reduce the rate of relapse and in reducing disability in both variations of the disease.
Ocrevus is induced by intravenous infusion. The side effects include:
- Irritation in injection-site
- Low blood pressure
- Nausea
- Fever
- Risk of breast cancer
- Aubagio(Teriflunomide): relapse rate can be reduced by daily medication of this drug.
Side effects
- It can cause liver damage
- It can also cause hair loss
- It is harmful to a pregnant woman and its fetus
Copaxone (Glatiramer acetate): This medication is injected under the skin. It is helpful in blocking myelin attack that arises from the immune system.
Side effects
- Irritation on injected-site
Gilenya (Fingolimod): this daily medication helps to reduce the rate of relapse. As you take this medication, ensure that you have a regular check on your heart rate especially after the fast does, because there is a possibility of heart rate reduction.
- Side effects
- High blood pressure
- A headache
- Blurred vision
Tecfidera (Dimethyl fumarate): this is an oral medication that is taken twice a day to reduce relapses.
Side effects
- Diarrhea
- Flushing
- Low white blood cell count
Other treatments for symptoms of MS
Muscle relaxants: You are going to experience frequent muscle stiffness or muscle spasms that are very painful. Muscle relaxants such as Zanaflex (tizanidine) and (Lioresal) baclofen come in handy.
Physical therapy: a physiotherapist can teach you stretching exercises and muscle strengthening exercises to strengthen your body so that it is easier for you to carry out your daily undertakings.
When you infuse mobility aid to physical therapy, it can help you to manage many weaknesses experienced on the legs that are associated with MS.
Alternative medications: there are other medications that may be administered for pain, depression, sexual dysfunction, bowel and bladder malfunction associated with MS.
Alternative medicine
Activities such as meditation, massage, yoga, healthy diets, relaxation techniques like acupuncture can boost the overall physical and mental well being of a patient who suffers from MS.
Oral cannabis extract has been recommended by the American Academy of Neurology for muscle pains and spasticity. Other forms of cannabis have not been recommended.
The institute has not recommended the use of Ginkgo biloba and herbal supplements, magnetic therapy or bee venom for MS medication.
Home remedies and lifestyle
Relieve stress: symptoms can be triggered by stress levels. Tai chi, yoga, meditation, massage and deep breathing exercises may also help.
Get enough rest
Cool down your temperature: symptoms of MS can become extreme when the body temperature rises. It is recommended to use cooling vests or scarves as you avoid heat exposures.
You can also perform MS physical therapies at home every day.
Support
It is difficult to live with chronic illnesses. To manage the stress that is associated with MS, there are several techniques that can be used:
- Perform your daily duties the best way you can
- Be in touch with family and friends
- Pursue your hobbies so that you enjoy yourself as much as possible
- Reach out to a support group
- Share out your feelings and issues with your therapist or clinical doctor
