A cure for MS has yet to be discovered, and although recent efforts have brought advances in available treatments, substantial room for improvement remains. Presently, conventional medical treatment typically focuses on strategies to treat acute attacks, to slow the progression of the disease, and to treat symptoms.
Conventional Medical Treatments to Treat Acute Disease Flares
Corticosteroids. For acute MS flares, corticosteroids, such as methylprednisolone, are commonly administered in high doses to suppress the immune system and decrease the production of proinflammatory factors. These drugs are often prescribed for short periods and can be effective at alleviating the symptoms of MS. Corticosteroids should not be used for long-term therapy, however, because of their many side effects, including increased risk of infection, osteoporosis, high blood pressure, cataracts, elevated blood sugar, mood swings and weight gain. Also, while corticosteroids may reduce the symptoms of the disease, they have no effect on its progression.59
Plasma exchange (plasmapheresis). Plasmapheresis is a process in which whole blood is separated into blood cells and plasma, the liquid part of blood. In MS patients the plasma contains unusually high levels of antibodies and proinflammatory factors that exacerbate symptoms. Plasma exchange helps remove these factors quickly and is sometimes used to help combat severe symptoms of multiple sclerosis relapses in people who are not responding to intravenous steroids.
Conventional Medical Treatment to Modify the Course of the Disease
Beta interferons. Beta interferons (Avonex, Betaseron) reduce inflammation and slow progression of the disease, but like many medications used in conventional medical treatment of MS, the mechanism of action is poorly understood60,61 This specific treatment may be accompanied by adverse effects such as suicidal depression, liver damage, flu-like symptoms, and injection site reactions.62
Glatiramer acetate. Glatiramer acetate (Copaxone) is an MS treatment that yields fewer adverse side effects than beta interferon while still remaining clinically effective. Glatiramer has a chemical structure similar to the protective myelin sheath around nerves and serves as a decoy for antibodies that would otherwise attack this sheath.63 Side effects may include flushing, rapid heartbeat, nausea, shortness of breath after injection, and injection site reactions.64
Mitoxantrone and fingolimod. Mitoxantrone (Novantrone) and fingolimod (Gilenya) are immunosuppressants. Clinical data show these drugs can slow the rates at which disability progresses and the rate at which new lesions form in the brain and spinal cord. These therapies, however, are not used as a first-line treatment as they can cause severe side effects including heart disease, leukemia, decreased white blood cell counts, and increased rates of infection.65
Natalizumab. Natalizumab (Tysabri) is thought to block a protein that allows white blood cells to enter the brain and spinal cord and cause disease progression in MS. Due to an association with three cases of a potentially fatal infection of the CNS,66 this is a controversial drug that is only available for patients enrolled in the Tysabri Outreach Unified Commitment to Health (TOUCH) program.67 This medication is reserved for people who do not see results from other types of treatments.
Dalfampridine. Dalfampridine (Ampyra) is a medication approved in 2010 that increases the ability of nerve cells to conduct impulses.68 This drug represents a new class of therapies that is aimed at addressing neurologic deficits directly.
Medications to Treat Symptoms
Muscle relaxants. Multiple sclerosis patients may experience painful or uncontrollable muscle stiffness or spasms, particularly in the legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may improve muscle spasticity. However, baclofen may increase weakness in the legs, and tizanidine may cause drowsiness or a dry mouth.
Medications to reduce fatigue. Drugs such as amantadine (Symmetrel) may help reduce fatigue.
Other medications. Medications may also be prescribed for depression, pain and bladder or bowel control problems that may be associated with multiple sclerosis.
Medications on the Horizon
There are approximately 20 experimental therapies that are on the pathway to approval by the Food and Drug Administration's (FDA). Investigators are making progress toward developing treatments that may be capable of protecting the CNS as well as encouraging repair of brain and spinal cord lesions. Many of these drugs are potentially valuable as treatments for MS, but are months or years from traversing all phases of the FDA process.
Laquinimod. Laquinimodhas been shown to decrease proinflammatory factors and increase factors that promote nerve protection without increasing risk of infection. Laquinimod was well tolerated by most patients, with only a few reports of adverse effects.69
Alemtuzumab. Alemtuzumab (Campath) is an antibody specific for mature white blood cells that targets them for destruction by the immune system. This drug is approved for the treatment of certain types of lymphoma and leukemia. In one study, it was shown to be more effective than beta interferon in reducing disability progression and relapse rate, however, the trial was discontinued early due to serious side effects.70
Fumaric acid. Fumaric acid is a substance that has been used in the treatment of psoriasis and shows promise in MS to decrease white blood cell infiltration into the spinal cord.71
Therapy and Rehabilitation to Improve Quality of Life
In addition to one or more drug-based therapies, MS patients will often participate in rehabilitation programs intended to maintain or improve their ability to perform at home and at work. More specifically these programs focus on general fitness and aim to address problems related to mobility, speech and swallowing, and cognitive deficits.
Common rehabilitation strategies include:
- Physical therapy. Practices that aide mobility and functionality through structured physical activity on a scheduled basis.
- Occupational therapy. Skills aimed at using work, self-care, and leisure activities to foster development and limit disability.
- Speech therapy. Work with speech therapists can help MS patients overcome speech and language difficulties and help with troublesome swallowing.
- Cognitive rehabilitation. Assistance in managing difficulties with memory, high order thinking, and perception. A variety cognitive rehabilitation options are available. For example, playing chess regularly is a great way to promote neuronal function and communication; computer-based "brain training" programs are also helpful.
- Vocational rehabilitation. Support in making career plans, gaining job skills, and approaches to remaining gainfully employed.