Although there is no cure for multiple sclerosis (MS), there are many effective ways of managing the disease. Treating MS primarily focuses on developing strategies to manage symptoms. Because symptoms range greatly from patient to patient, it is essential that you work with your doctor or healthcare provider to develop a treatment plan that is right for you.
Disease Modification Drugs
There are currently a number of drugs approved by the Food and Drug Administration to help modify the course of relapsing MS. There are five injectable medications: Interferon B-1a (Avonex), Interferon B-1b (Betaseron), Glatiramer Acetate (Copaxone), Interferon beta-1b (Extavia), and Interferon B-1b (Rebif). There are also two infusion therapy (intravenous therapy) medications, Natalizumab (Tysabri) and Mitoxantrone (Novantrone), and three oral treatments, Teriflunomide (Aubagio), Fingolimod (Gilenya), and Dimethyl Fumarate (Tecfidera).
Treating Physical Symptoms
Drugs & Medications to Treat MS Symptoms
Inflammation is very typical of MS relapses, and it can lead to many of the secondary symptoms associated with MS. Corticosteroids are often used to ease inflammation and reduce the severity of attacks are one of the most common MS treatment options. Corticosteroids used to treat MS include:
- dexamethasone (intravenous)
- methylprednisolone (intravenous)
- prednisone (oral)
Muscle relaxants are also very commonly administered to MS patients to ease suffering due to painful muscle stiffness or muscle spasms. Commonly prescribed drugs to treat spasticity include:
- baclofen (Lioresal)
- cyclobenzaprine (Flexeril)
- diazepam (Valium)
- tizanidine (Zanaflex)
Other drugs may be prescribed to reduce fatigue, treat depression, pain, bladder problems, bowel control issues, or any other symptoms associated with multiple sclerosis. Teriflunomide (Aubagio) is a newer drug that helps treat relapsing forms of MS.
Rehabilitation and Physical Therapy
The delivery of rehabilitation services can be done in many venues: at home, in outpatient facilities, in inpatient programs, in health clubs and gyms, and at MS treatment centers. The approach to MS rehabilitation, however, must be quite different from how an orthopedic patient with a fracture or a spinal cord-injured person receives care. The issue of fatigue affects the pace of rehabilitation. Many people with other diseases can tolerate two to four hours of rehabilitation. People with MS may have problems dealing with that type of schedule. It is very important to establish an appropriate exercise and conditioning program that will not allow fatigue to interfere with function. Teaching energy conservation and pacing early on becomes very valuable.
When is rehabilitation indicated in MS? Certainly, it is appropriate during an acute exacerbation that has produced a significant change in functions such as walking, coordination, strength, or stamina. Rehabilitation in the context of an acute attack usually is time-limited and goal-oriented—the aim is to return to a prior level of function. Rehabilitation also is indicated during disease progression, when one is gradually losing function and is no longer able to move and transfer safely or be as mobile as in the past. A program at that time may consist of professional services, along with self-care activities such as a home exercise program, aquatherapy, or a personal fitness program at a gymnasium or health club. Studies have indicated that a targeted rehabilitation program can improve not only the strength of weakened muscles but also MS-related fatigue, depression, and social isolation.
It is important to remember that the duration of rehabilitation services will depend not only on available personnel and facilities but also on third-party reimbursement (insurance coverage). Most insurance carriers require that rehabilitation prescriptions contain information about desired outcomes—goals of therapy and specific benchmarks (i.e., ambulation with a walker, ability to walk 50 feet, safe transfers, etc.). Once these goals have been achieved, rehabilitation usually is terminated, with potential for reassessment once additional rehabilitation goals can be identified.
Treating Emotional Change
Emotional changes related to multiple sclerosis may encompass a wide variety of phenomena. They may include depression, grieving, reactions to stress, emotional lability (unstable moods), affective release (also known as pseudobulbar affect), euphoria, and anger. People who are diagnosed with multiple sclerosis are faced with a dynamic rather than a static illness. Problems confronted on one day may change the next. The disease itself may wax and wane; symptoms may come and go; function can be altered by environmental factors and personal symptoms such as fatigue.
Managing change in multiple sclerosis calls for creative solutions within a flexible and accepting environment. There's a need for adaptation over time so that management becomes the goal rather than the cure. In acknowledging this, principles of care must change from those of the acute medical model to one that is individualized and ongoing throughout a person's lifetime. The aims of emotional support are to support the person in accordance with his or her life goals with the preservation of autonomy and maintenance of a role in the family and society at large. This requires maintenance of emotional stability and positive interpersonal relationships.
Strategies to assist people manage change throughout the spectrum of the disease consist of education, individual, group, and family counseling, support groups, and networks of peers. The nature of multiple sclerosis challenges the people affected by the disease to seek appropriate support services with understanding professionals who can develop and implement individualized, culturally sensitive, and dynamic programs to meet the needs of all those affected by the disease throughout a lifetime.