What is multiple sclerosis?
Multiple sclerosis (MS) is a chronic condition that attacks the central nervous system (CNS) and often causes disability. The CNS includes the optic nerve, the spinal cord, and the brain. Nerve cells are like wires that conduct electrical impulses from one cell to another. These signals allow the nerves to communicate. Like wires, nerve cells need to be wrapped in a form of insulation to function correctly. Nerve cell insulation is called myelin.
MS involves gradual, unpredictable damage to the myelin of the CNS. This damage causes nerve signals to slow down, stutter, and distort. The nerves themselves may also suffer damage. This can cause MS symptoms such as numbness, loss of vision, difficultly speaking, slow thinking, or even inability to move (paralysis).
Your doctor will likely want to start treatment right after you’re diagnosed. Learn more about what to consider when you evaluate your MS treatment plan.
Every case of MS is different. For this reason, treatment plans are designed to fit individual needs. Symptoms may come and go, gradually worsen, and sometimes the major symptoms disappear. It’s important to regularly communicate with your doctor, especially when symptoms change.
Treatments focus on slowing the damage caused by the immune system’s attacks on myelin. Once a nerve itself is damaged, however, it can’t be repaired. Other treatment approaches are targeted at providing symptom relief, managing flare-ups, and helping you cope with physical challenges.
Doctors are now encouraging MS patients to take a more active role in selecting their treatment. To do this, you’ll need to become more health literate and consider a variety of factors based on your preferences and overall treatment goals.
As you begin your research, it’s critical to think about the factors that are most important to you. Ask yourself the following questions:
- What are your treatment goals and expectations?
- Are you comfortable with giving yourself injections at home?
- Would you rather get an infusion at a licensed clinic?
- Could you remember to administer an injection or take oral medication daily, or would you rather take a medication with less frequent dosing?
- What side effects can you live with? What side effects will be most difficult for you to cope with?
- Can you manage the need to schedule regular liver and blood tests?
- Will your travel or work schedule affect your ability to take your medications on time?
- Will you be able to store your medications safely and out of reach of children if you need to?
- Are you pregnant or planning to become pregnant?
- Are you already taking any medications or supplements?
- Which medications are covered by your particular insurance plan?
Once you’ve answered these questions on your own, openly and honestly discuss all concerns with your doctor.
Knowing what treatment options are available to you is the first step in making a decision about your MS treatment plan.
During MS attacks, the disease actively causes physical symptoms. Your doctor may prescribe a corticosteroid drug during an attack. Corticosteroids are a type of drug that helps reduce inflammation. Examples of corticosteroids include:
- prednisone (taken by mouth)
- methylprednisolone (given intravenously)
The main goal of treatment is to slow progression of the disease. It’s important to treat MS even during remission, when there are no obvious signs of illness. While MS can’t be cured, it can be managed. Strategies to slow the progression of MS include a number of different drugs. These drugs work in different ways to slow myelin damage. Most are classified as disease-modifying therapies (DMTs). They have been developed specifically to interfere with the immune system’s ability to destroy myelin.
When researching DMTs for MS, it’s important to consider whether they are injected, infused, or taken by mouth.
- beta interferons (Avonex, Rebif, Betaseron, Extavia)
- glatiramer acetate (Copaxone, Glatopa)
- peginterferon beta-1a (Plegridy)
The following drugs are taken orally as a pill, either once or twice a day:
- fingolimod (Gilenya)
- teriflunomide (Aubagio)
- dimethyl fumarate (Tecfidera)
These DMTs must be given as an infusion at a licensed clinic:
- natalizumab (Tysabri)
- alemtuzumab (Lemtrada)
- ocrelizumab (Ocrevus)
The cost of MS treatment can be a source of stress for you and your family. MS requires lifelong treatment. While insurance companies will cover most options to some degree, copayments and coinsurances can add up over time.
Before starting a particular drug, check with your insurance to learn how much of the cost you’ll be responsible for. There may be less expensive treatment options available that your insurance company needs you to try before you can try a more expensive option. Some MS drugs have recently gone off-patent, which means that inexpensive generic options may be available.
Certain pharmaceutical drug manufacturers may offer copayment assistance programs and help navigating insurance plans. When researching treatment options for MS, it may be beneficial to contact the pharmaceutical company’s patient support program. These programs often include nurse ambassadors, phone hotlines, support groups, and patient ambassadors. The National Multiple Sclerosis Society has a list of available programs.
A social worker may also be able to help you navigate the costs of treatment. Your doctor can refer you to one.
In an ideal situation, you can find a balance between MS symptoms and side effects of your medications. Some drugs may affect liver function, requiring regular blood tests to ensure your liver isn’t sustaining any damage. Other drugs may increase the risk of certain infections.
Corticosteroids can cause the following side effects:
- weight gain
- mood swings
- unexpected or persistent infections
Since most DMTs affect immune system function on some level, it’s important to monitor any side effects. The most common side effects of disease-modifying agents include:
- flu-like symptoms
- increased risk of infection
- hair loss
- redness, swelling, or pain at the injection site
A lot of these side effects will dissipate over the course of several weeks. You can also manage them with over-the-counter medications.
Always keep your healthcare provider in the loop regarding any side effects that you experience. Your doctor might need to adjust your dose or switch you to a new medication depending on the severity of your side effects.
Certain medications can cause birth defects, so it’s important not to take these drugs if you’re pregnant. Inform your doctor right away if you become pregnant during treatment.
There are many lifestyle factors to consider when choosing between oral, injectable, and infused medications. For example, oral medications usually have to be taken every day, while injections and infusions are given less frequently, even as little as every six months.
Some medications can be taken at home, while others require a visit to a clinic. If you choose to take a self-injectable medication, a healthcare professional will teach you how to inject yourself safely.
You may have to plan your lifestyle around your medications. Several medications require frequent lab monitoring and visits to your doctor.
To manage your MS symptoms and any possible side effects of treatment, you must become an active participant in your treatment plan. Follow advice, take your medications correctly, eat a healthy diet, and take care of your general health. Staying physically active also helps.
Recent research found that patients who exercise regularly may be able to slow some of the effects of the disease, such as a declining ability to think clearly. Ask your doctor if exercise therapy is right for you.
You may also benefit from rehabilitation. Rehab can involve occupational therapy, speech therapy, physical therapy, and cognitive or vocational rehabilitation. These programs are designed to treat specific aspects of your disease that may affect your ability to function.
Recent advances in treatments have allowed most MS patients to live relatively normal lives. Some approved treatments are undergoing further clinical trials, and new drugs are constantly making their way through the clinical pipeline. Drugs that may encourage the regeneration of damaged myelin are presently under investigation. Stem cell therapies are also a possibility in the near future.
These new treatments wouldn’t be possible without participants in clinical trials. Ask your doctor if you’re a candidate for a clinical trial in your area.
Most MS patients can expect to take DMTs indefinitely. But recent research suggests it may be possible to discontinue drug therapy in special cases. If your disease has remained in remission for at least five years, ask your doctor if discontinuing drugs may be possible.
Keep in mind that it may take six months to a year for a medication to truly start working. MS drugs are designed to manage flare-ups and slow down damage to your nervous system. Medications won’t cure the disease, so you may not notice any major changes other than that your MS isn’t getting worse.
Although there is currently no cure for MS, there are many treatment options available. Designing a treatment plan that works best for you will involve close collaboration with your doctors. They must weigh numerous factors when evaluating treatment options. Consider getting a second opinion if you’re not satisfied with what your doctor has offered.