Many people find it challenging to decide when to begin treatment for multiple sclerosis (MS). Faced with few symptoms and the prospect of side effects from medication, many people choose to delay medical intervention. But MS is a lifelong condition. Starting treatment early can have a positive impact by potentially slowing the progression of the disease. Discuss the issue with your doctor to arrive at the best plan for your short-term and long-term well-being.
The benefits of early treatment
It’s easier to understand why early intervention may help MS when you consider how MS affects the body. Our nerves are protected by a fatty substance called myelin. These nerves are vital for all parts of the body to communicate with the brain. MS is characterized in part by the immune system’s attack on myelin. As the myelin degrades, the nerves are vulnerable to damage. Scarring, or lesions, can appear on the brain and spinal cord. Over time, communication between the brain and the body breaks down.
About 85 percent of people with MS have relapse-remitting MS (RRMS). These individuals experience attacks of MS symptoms followed by a period of remission. Several years after diagnosis, RRMS can turn into secondary progressive MS, which doesn’t have periods of remission.
The medications that treat RRMS are disease-modifying therapies (DMTs) that reduce the severity and frequency of attacks. They do this by acting on the body’s immune system, which attacks the myelin during an MS relapse. In turn, these medications reduce the amount of neurological damage from MS.
DMTs are not effective on secondary progressive MS. For that reason, your doctor may recommend starting DMT treatment early, when these medications can have a notable effect. A 2009 study in the Journal of Managed Care Medicine estimated that for every MS attack that causes symptoms, 10 attacks happen below the individual’s level of awareness.
Although potentially effective, DMTs come with side effects and risks. These can range from relatively mild flu-like symptoms and irritation at the injection site to a greater risk of cancer. It’s important to discuss these risks with your doctor to fully understand and weigh your options.
Complications of untreated MS
Left untreated, MS causes substantial disability in 80 to 90 percent of people after 20 to 25 years of the disease. Since diagnosis typically occurs between the ages of 20 and 50, many people have a lot of time left. It’s important to consider if making the most of that time means treating the disease and stopping its activity as early as possible.
Treatment options are limited for those with advanced or progressive MS. DMTs are FDA-approved for the treatment of RRMS. Only one drug, ocrelizumab (Ocrevus), is approved for primary progressive MS. However, there is no medication that can repair the damage already caused by MS.
A 2017 article in the Journal of Neurology, Neurosurgery and Psychiatry noted that many people do not have access to DMTs until several years after diagnosis. This group of people delay treatment, which has negative consequences for their brain health. If a person becomes disabled, it’s very challenging, or may be impossible, to recover the abilities they’ve lost.
Starting treatment early generally provides the best chance at slowing the progression of MS. It reduces the inflammation and damage to the nerve cells, which cause your disease to worsen. Early treatment with DMTs and other therapies for symptom management may also reduce pain and help you better manage your condition. Speak with your doctor to learn more about the benefits of early treatment for you.