Managing Relapses

The unpredictability of multiple sclerosis makes it a difficult disease to manage. However, for many, it is possible to develop a treatment regimen that keeps the condition in check and slows or prevents relapses. Doctors treat MS by focusing on three specific areas: symptoms, acute flare-ups, and slowing the progression of MS with medication.

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Depending on the type of MS you have you may experience gradually worsening symptoms or acute attacks followed by remissions. Here are some frequently asked questions:

How do I know when I’m experiencing a relapse?

In some instances, you may feel a bit more tired or wobbly. Other times, you may notice a sudden onset of more severe symptoms, including vision or speech problems, tingling, shakiness, or an inability to use a limb normally. A doctor will conduct a neurological exam or order an MRI with gadolinium to detect active lesions. He or she may may conduct a Kurtzke Expanded Disability Status Scale (EDSS) assessment to quantitatively assess disability.  A relapse episode must last at least 24 hours and most last days to weeks. Some may last months.

How are steroids typically used?

For years, doctors used steroids to treat MS relapses. However, there is no evidence that steroids slow the progression of the disease or prevent relapses. These drugs are still widely used to reduce inflammation. They include orally administered prednisone and intravenously (IV) administered methylprednisolone (Solu-Medrol) and dexamethasone (Decadron). Another drug that is sometimes used is ACTH (adrenocorticotropic hormone), which is administered by injection. In most cases, doctors use a three to five day course of high dosage treatments. This approach produces maximum results with minimal side effects. Some doctors also use pulse steroids, which typically use a one-day-a-month dose of intravenous methylprednisolone. Among the side effects from steroids: stomach irritation, elevated blood sugar, water retention, restlessness, insomnia, and mood swings.

How should I determine whether to take a disease-modifying MS drug?

It’s critical to understand the benefits and risks associated with any medication. It’s important to spend adequate time with a doctor, discussing the type of MS you have, the course of the disease, how you’re affected by it, your lifestyle, possible risks and side effects, and which, if any, drugs are suitable. These FDA-approved drugs—Avonex , Betaseron, Copaxone, Rebif, Gilenya, Tysabri, Novantrone and Extavia —have been proven to slow the progression of MS and minimize relapses.

How effective are these drugs in preventing relapses?

These medications have all demonstrated an ability to control or reduce the number of lesions and relapses. For example, only one-third of patients using Copaxone—which has been in use for over 15 years—experience disease progression, and 57 percent have experienced stable or improved EDSS scores. Gilenya, which was approved by the FDA in November 2010, shows a 60 percent reduction in annualized relapse rate. Each drug works differently—and they produce different side effects—so it’s important to carefully weigh the various options before choosing a therapy.

Should I consider alternative therapies?

Exercise, dietary supplements, stress management strategies, biofeedback, and acupuncture may all aid in the management of MS. However, these alternative approaches are not well studied and may or may not help you. Approximately 75 percent of MS patients use complementary and alternative medicine techniques (CAM), according to the National Multiple Sclerosis Society. When these techniques are used with a conventional medical treatment they are considered complementary. When they’re used outside of conventional medicine they’re considered alternative. If you’re considering a CAM therapy, keep your doctor informed about what you’re taking, don’t abandon conventional therapy and document your experiences. NMSS has a form you can use to assist with documentation.

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