Top Treatments for Multiple Sclerosis Diagnosis

Multiple Sclerosis (MS) is a chronic, unpredictable, and often debilitating autoimmune disease that attacks the central nervous system. It can lead to a wide range of symptoms, including muscle weakness, fatigue, vision problems, and cognitive impairment, profoundly impacting the lives of those affected. According to a 2019 prevalence study funded by the National MS Society, approximately 1 million people in the United States live with multiple sclerosis.

Managing the complex and varying symptoms of Multiple Sclerosis can be a significant challenge, leaving patients and their healthcare providers searching for effective treatment options that can provide relief and slow disease progression.

Fortunately, the medical community has made substantial advancements in understanding and managing Multiple Sclerosis, offering a range of treatments and therapies that can help alleviate symptoms, modify the course of the disease, and improve the quality of life for those living with this condition.

This article explores the top treatments for Multiple Sclerosis, from corticosteroids and plasmapheresis to the latest disease-modifying therapies and emerging treatments, providing a roadmap for navigating the complex landscape of Multiple Sclerosis management.

1. Corticosteroids

Source: HSS

Corticosteroids such as oral prednisone and intravenous methylprednisolone are prescribed primarily to reduce nerve inflammation, which is a key factor in exacerbating symptoms during Multiple Sclerosis flare-ups. These medications dampen the immune response, reducing inflammation, and helping speed recovery from attacks.

However, while corticosteroids are effective in managing acute relapses of Multiple Sclerosis, they come with potential side effects. These include:

• Insomnia
• Increased blood pressure
• Higher blood glucose levels
• Mood swings
• Fluid retention
• Weight gain
• Bone weakening (osteoporosis)

Due to these side effects, their use is limited to short courses during acute relapses to minimize potential risks.

2. Plasmapheresis

Source: Howstuffworks

Plasma exchange, also known as plasmapheresis, is a procedure particularly used in severe cases where symptoms do not respond adequately to steroids. During plasma exchange, the liquid portion of the blood (plasma) is separated from blood cells. The blood cells are then mixed with a protein solution (albumin) and returned to the body. This process helps to remove harmful substances, including antibodies that contribute to the immune system's attack on the nervous system.

Plasma exchange can be critical for patients experiencing new, severe symptoms that respond poorly to other treatments. However, plasmapheresis has risks and potential side effects due to its invasive nature, such as temporary:

• Low blood pressure
• Bleeding
• Infection

3. Disease-modifying therapies (DMTs)

Several disease-modifying therapies (DMTs) are employed to modify the progression of Multiple Sclerosis, particularly in its relapsing-remitting form. These treatments for Multiple Sclerosis are critical for reducing the frequency and severity of relapses, slowing the formation of new lesions in the central nervous system, and potentially reducing the risk of disability progression.

One category of DMTs includes injectable treatments such as:

• Interferon beta medications: These were among the first DMTs used for Multiple Sclerosis. They help by modulating the immune system, reducing inflammation, and potentially promoting nerve growth. Interferons are injected under the skin or into muscle and can help decrease the number and severity of relapses. However, side effects like flu-like symptoms, injection-site reactions, and potential liver damage are common, requiring regular monitoring of liver enzymes.
• Glatiramer acetate (Copaxone, Glatopa): This drug blocks the immune system's attack on myelin, the protective covering of nerves, which is often targeted in Multiple Sclerosis. It is administered via subcutaneous injections and is generally well-tolerated, although injection-site reactions and lipoatrophy (fat loss from the injection site) can occur.

Source: Copaxone

Another category within DMTs is monoclonal antibodies. Ofatumumab (Kesimpta, Arzerra) is a medication that targets B cells, which are implicated in the pathophysiology of MS. Given as a subcutaneous injection, it can reduce the number of brain lesions and exacerbations of the disease. Common side effects include injection site reactions and the risk of infections.

4. Oral treatments

Oral treatments for Multiple Sclerosis offer convenience and an alternative to injectable medications, broadening the spectrum of disease management options for patients. Here are some of the key oral medications used to treat Multiple Sclerosis:

• Teriflunomide (Aubagio): This medication, which is taken once daily, reduces the rate of relapse. It works by inhibiting a specific enzyme necessary for the proliferation of activated immune cells, thus reducing their ability to attack the nervous system. Common side effects include liver damage and hair loss, and the drug carries a risk of birth defects, necessitating the use of contraception for both men and women during treatment and for a period afterward.
• Dimethyl fumarate (Tecfidera): Taken twice daily, this drug also reduces relapse rates. It is believed to modulate the immune response and provide antioxidant effects to protect against damage to nerve cells. Side effects may include flushing, gastrointestinal discomfort, and a reduction in white blood cell count, which necessitates regular blood monitoring.
• Diroximel fumarate (Vumerity): Similar to dimethyl fumarate but generally associated with fewer gastrointestinal side effects, this medication is also taken twice daily and offers a similar mechanism and efficacy profile.
• Monomethyl fumarate (Bafiertam): Recently approved, this medication is a delayed-release formulation that aims to offer benefits similar to dimethyl fumarate with potentially fewer side effects.
• Fingolimod (Gilenya): This once-daily pill was the first oral medication approved for Multiple Sclerosis. It works by trapping immune cells in lymph nodes, preventing them from reaching and damaging the central nervous system. Monitoring is required for the first dose due to potential heart rate effects, and there are other side effects including the risk of serious infections.
• Siponimod (Mayzent): Specially approved for secondary-progressive Multiple Sclerosis, this medication is similar to fingolimod but specifically targets certain types of immune cells. It requires heart rate and blood pressure monitoring similar to fingolimod and carries similar risks and side effects.
• Ozanimod (Zeposia): This is another sphingosine 1-phosphate receptor modulator like fingolimod and siponimod but with a potentially better side effect profile. It is also taken once daily and is effective in reducing relapse rates.
• Ponesimod (Ponvory): Approved for the treatment of relapsing forms of Multiple Sclerosis, including clinically isolated syndrome, relapsing-remitting Multiple Sclerosis, and active secondary progressive Multiple Sclerosis, this drug is taken once daily with a titration period to mitigate heart-related side effects.
• Cladribine (Mavenclad): Reserved for active relapsing Multiple Sclerosis and for cases not responsive to other treatments, this drug involves a short course of pills taken for a few days over two years and requires monitoring for side effects like infections and potential cancer risks.

5. Infusion Treatments

Infusion treatments for Multiple Sclerosis represent a significant approach for managing both relapsing and progressive forms of the disease. These treatments deliver medication directly into the bloodstream, allowing for targeted and often potent therapeutic effects. Here are the primary infusion treatments used in Multiple Sclerosis management:

• Natalizumab (Tysabri): This monoclonal antibody is highly effective at reducing relapse rates and slowing disability progression in relapsing forms of Multiple Sclerosis. It works by blocking the movement of potentially damaging immune cells from the bloodstream into the brain and spinal cord. Natalizumab is typically considered for use in individuals with highly active or rapidly evolving severe relapsing-remitting Multiple Sclerosis. The major concern with natalizumab is the risk of progressive multifocal leukoencephalopathy (PML), a rare but potentially fatal brain infection, particularly in patients who are positive for JC virus antibodies.
• Ocrelizumab (Ocrevus): This is the only drug approved for both primary progressive Multiple Sclerosis and relapsing forms of the disease. Ocrelizumab targets CD20-positive B cells, which are believed to play a role in the pathological processes of Multiple Sclerosis. It has been shown to reduce relapse rates and slow the progression of disability. The infusion is given every six months after the initial doses, and while generally well-tolerated, it can increase the risk of infections and possibly cancers, including breast cancer.
• Alemtuzumab (Lemtrada): This drug is used for active relapsing-remitting MS, generally after other treatments have failed. Alemtuzumab targets CD52, an antigen present on the surface of T and B lymphocytes, leading to the depletion of these cells. Treatment involves receiving an infusion for five consecutive days, followed by another three days of infusion one year later. While highly effective, alemtuzumab carries significant risks, including autoimmune disorders and infections, and requires a comprehensive monitoring program to manage these risks.
• Rituximab (Rituxan): Although not officially approved for Multiple Sclerosis in many countries, rituximab is commonly used off-label for both relapsing and progressive forms of Multiple Sclerosis, especially in cases where other treatments have failed. Like ocrelizumab, it targets CD20-positive B cells. The risks include infusion reactions and increased susceptibility to infections.

6. Emerging Therapies And Treatments For Managing Symptoms

Emerging therapies and treatments for managing Multiple Sclerosis symptoms continue to develop, offering new hope and possibilities for those affected by this challenging disease. Here’s an overview of some recent developments and supportive treatments for symptom management:

Emerging Therapies for Multiple Sclerosis

Among these promising treatments are Bruton's Tyrosine Kinase (BTK) Inhibitors and Stem Cell Transplantation:

• Bruton's Tyrosine Kinase (BTK) Inhibitors: This is a new class of medication currently being studied for both relapsing-remitting and progressive forms of Multiple Sclerosis. BTK inhibitors work by modulating B cells, which are a type of immune cell involved in the inflammation that damages nerve cells in Multiple Sclerosis. These drugs aim to reduce inflammation and prevent further damage to the nervous system.
• Stem Cell Transplantation: Also known as hematopoietic stem cell transplantation, this treatment aims to "reset" the immune system. The process involves using chemotherapy to eliminate the existing immune system and then repopulating it with the patient’s own stem cells that have been harvested from their blood before the chemotherapy. While still under investigation, this treatment has shown promise in halting disease progression in some patients with aggressive forms of Multiple Sclerosis.

Treatments for Multiple Sclerosis Symptoms

Managing the symptoms of Multiple Sclerosis is crucial for improving quality of life. This involves a variety of approaches tailored to individual needs:

• Physical Therapy: Helps build muscle strength and improve mobility. Therapists work with Multiple Sclerosis patients to develop personalized exercises that maintain or improve coordination and balance.
• Muscle Relaxants: Drugs such as baclofen or tizanidine are used to manage muscle spasticity and stiffness, which are common in Multiple Sclerosis.
• Medications for Fatigue: This is one of the most common symptoms of Multiple Sclerosis. Drugs like amantadine, modafinil, and methylphenidate may be prescribed to reduce fatigue, although their effectiveness can vary.
• Medications to Improve Walking: Dalfampridine (Ampyra) can improve walking in some patients by aiding nerve function.
• Other Medications: These include treatments for bladder control, pain, depression, and other neurological symptoms that can be associated with Multiple Sclerosis.

Alternative and Complementary Therapies

Many patients turn to alternative treatments for Multiple Sclerosis to help manage symptoms:

• Diet: There is no specific diet for Multiple Sclerosis, but overall nutritional wellness and possibly high vitamin D intake may be beneficial.
• Exercise: Activities like yoga, swimming, and other low-impact exercises can help maintain body function and reduce symptom severity.
• Mind-Body Therapies: Meditation, yoga, and tai chi have been found helpful in managing stress and improving overall mental health.

Coping and Support

Living with Multiple Sclerosis requires a comprehensive approach to manage not only the physical symptoms but also the emotional and psychological challenges:

• Counseling and Support Groups: These can provide emotional support and practical advice to manage the day-to-day challenges of living with Multiple Sclerosis.
• Maintaining Social Connections and Activities: Engaging in hobbies and maintaining social interactions can help reduce the feelings of isolation and depression that may accompany Multiple Sclerosis.

Final Words

The treatment for multiple sclerosis has evolved significantly, offering patients and their healthcare providers a diverse arsenal of options to combat this complex and often debilitating condition. From the foundational use of corticosteroids and plasmapheresis to manage acute relapses, to the introduction of increasingly sophisticated disease-modifying therapies that can alter the course of Multiple Sclerosis, the medical community has made remarkable strides in providing effective ways to care for those living with this disease.

As new treatments continue to emerge, and our understanding of Multiple Sclerosis pathophysiology deepens, the future holds even greater promise for improving outcomes and quality of life. While managing Multiple Sclerosis requires a multifaceted approach, patients can take heart in knowing that there are ample resources and avenues for proactive care.

FAQs About Treatments for Multiple Sclerosis

What should I do if I experience a Multiple Sclerosis relapse?

It's recommended to contact your healthcare provider who may suggest a treatment such as oral steroids or plasmapheresis depending on the severity of the symptoms.

How can I choose the right treatment for Multiple Sclerosis?

Choosing the right treatment involves discussing the effectiveness, side effects, lifestyle impacts, and medication delivery methods (injections, oral medications, infusions) with your healthcare provider to find the best fit for your condition and lifestyle.

What is the role of diet and lifestyle in managing Multiple Sclerosis?

While no specific diet can cure MS, a healthy lifestyle including a balanced diet, regular exercise, and avoiding factors like smoking and obesity can help manage symptoms and potentially slow disease progression.

Is there a cure for Multiple Sclerosis?

Currently, there is no cure for Multiple Sclerosis, but treatments are available that help manage symptoms and slow the progression of the disease.