Treatment options for multiple sclerosis
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Every person with multiple sclerosis (MS) will have a different experience with the disease — meaning that treatment also will be unique. This is because the disease can affect different parts of the central nervous system and induce a wide range of symptoms with varying severity. The different types of MS also play a role in this variability.
Is there a treatment for MS?
Although no treatment exists yet that can cure the disease, research has led to major advances in therapies and in treatment strategies for MS. A considerable number of treatment options are available, especially for the most common form of the disease — relapsing-remitting MS (RRMS).
MS treatments can be classified into three main categories:
- disease-modifying therapies
- relapse management therapies
- symptomatic treatments
A safe treatment plan should be discussed between the patient and healthcare providers based on the individual’s symptoms, needs, MS type, and preferences. The goal is a tailored therapeutic approach that helps manage each MS case individually and ultimately enhances each patient’s quality of life.
The National MS Society recommends a comprehensive care approach involving several healthcare specialties, including primary care, neurology, urology, mental health, and rehabilitation.
When to start MS treatment
Even in the earliest stages of MS, when patients experience few and mild symptoms, the immune system can be continuously damaging nerve cells in the brain and spinal cord.
For this reason, early treatment is usually the best therapeutic option and is believed to improve long-term clinical outcomes and patients’ well-being.
There is increasing consensus in the medical and scientific community, according to a 2018 study, on the importance of early therapeutic intervention to prevent or slow damage to the brain, so as to maximize lifelong brain health. The underlying idea is to act before MS causes irreparable damage, and before the brain’s limited repair mechanisms become impaired or insufficient.
The American Academy of Neurology (AAN) released guidelines in 2018, which were reviewed and confirmed in 2021, stating that, in most MS cases, it is better to receive treatment early on than to let the disease run its course without treatment. These guidelines were endorsed by the Consortium of Multiple Sclerosis Centers, the Multiple Sclerosis Association of America, and the National MS Society.
When to stop MS treatment
According to AAN guidelines, stopping treatment is risky as it may lead to an increase in disease activity, including new or worsening symptoms.
However, not all medications work for everyone, meaning that stopping one treatment to switch to another might be necessary. Some medications also may need to be stopped due to serious side effects, or because a more appropriate treatment becomes available.
Furthermore, some MS therapies must be interrupted or adapted during specific life events, such as pregnancy or breastfeeding.
Another reason that can lead patients to consider stopping a treatment is when they feel their disease has stabilized and they are experiencing no signs of disease activity.
Importantly, any decision related to stopping or starting a treatment should be discussed between the patient and the healthcare team. The potential benefits and risks of such decisions must be carefully assessed to ensure the best care for the patient.
MS treatment options
Several approved MS treatments are currently available to help manage the disease, and various other experimental MS therapies are being developed. These treatment options range from therapies designed to modify or slow the disease course, to medications used to control disease relapses, to other approaches that help with specific symptoms of MS.
| Therapy | Purpose |
|---|---|
| Disease-modifying therapies | Prevent relapses and slow the accumulation of disability |
| Relapse management therapies | Shorten the duration and reduce the severity of acute disease exacerbations |
| Symptomatic treatments | Treat specific symptoms of MS, such as pain or fatigue |
Treatments to modify disease progression
MS treatments that can alter the course of the disease are referred to as disease-modifying therapies (DMTs). Most of these therapies seek to suppress or modulate the immune system and reduce inflammation, slowing disease progression and helping prevent relapses.
DMTs approved by the U.S. Food and Drug Administration (FDA) have been proven to reduce the frequency and severity of MS relapses. Some also can have a preventive effect, lessening the development of new lesions (regions of damage) in the central nervous system and/or slowing the progression of disability.
As there is no consensus regarding the choice of one DMT versus another, patient education and shared decision-making are important when establishing the best treatment plan for each individual. Healthcare professionals should inform patients about the potential benefits and risks of individual DMTs. Then, based on AAN guidelines, patient preferences should be taken into account in choosing a DMT, which also may improve treatment acceptance and adherence.
Information about DMTs currently available in the U.S. can be found in an updated list from the National MS Society.
In some cases, healthcare providers may choose to treat the disease with therapies that are approved for indications other than MS — this is called “off-label” use. Rituximab, approved for treating blood cancers, is an example of a medication that is commonly used off-label in MS patients.
| DMTs by Method of Administration | |
|---|---|
| Injectable | Avonex, Betaseron, Copaxone, Extavia, Kesimpta, Plegridy, Rebif |
| Oral | Aubagio, Bafiertam, Gilenya, Mavenclad, Mayzent, Ponvory, Tecfidera, Vumerity, Zeposia |
| Intravenous infusion | Briumvi, Lemtrada, mitoxantrone, Ocrevus, Tysabri |
Treatments for MS attacks
An MS attack, also referred to as a disease relapse or flare-up, is an episode in which new symptoms arise or existing symptoms worsen. A flare-up occurs due to active inflammation in the central nervous system. These attacks can vary in severity, and not all require specific treatment; therefore, treatment decisions are made based on each patient’s particular case.
The most common treatments used to manage relapses, also called abortive therapies, are:
- corticosteroids, including glucocorticoids such as prednisone and methylprednisolone. These therapies are considered the first line of treatment for severe relapses. They mimic the naturally occurring glucocorticoid hormone, cortisol, thereby reducing inflammation and accelerating a person’s recovery from a relapse.
- products containing a purified form of the adrenocorticotropic hormone (ACTH). This treatment can be used as an alternative relapse management approach for patients who do not respond well to corticosteroids or are unable to tolerate such medications. ACTH products can reduce inflammation and accelerate relapse recovery by stimulating the production of cortisol and other adrenocortical hormones.
- plasmapheresis, or plasma exchange. This is a procedure that involves removing and replacing a person’s plasma – the liquid portion of blood. It eliminates antibodies and other proteins that could be contributing to MS-related inflammation. This therapy also is sometimes considered when patients fail to adequately respond to corticosteroid therapy.
Treatments for MS symptoms
MS causes a variety of symptoms, including spasticity and gait problems, that can be burdensome for patients. Thus, treatment plans for patients often include therapies that help to manage MS symptoms. Of note, DMTs do not generally alleviate everyday symptoms.
Several therapies are available for the treatment of specific MS symptoms. Importantly, apart from pharmaceutical interventions, symptom management also can be achieved through rehabilitation approaches — including physical and occupational therapy — and lifestyle changes.
| Symptom | Treatment options |
|---|---|
| Spasticity (muscle stiffness or spasms) | Muscle relaxants such as baclofen or tizanidine; botulinum toxin products such as Botox (onabotulinumtoxin A) or Dysport (abobotulinumtoxinA); physical therapy and range-of-motion exercises. |
| Gait and mobility issues | Medication such as dalfampridine; physical therapy with stretching and strengthening exercises; use of mobility aids; home adaptations. |
| Fatigue | Medications such as amantadine and methylphenidate; physical activity programs; stress management; sleep improvement strategies; avoiding heat, and taking short breaks. |
| Nerve pain | Anti-epileptic medications; opioids. |
| Mental health | Medications such as antidepressants or anxiolytics; professional counseling; lifestyle changes. |
| Visual problems | Anti-inflammatory medications like corticosteroids; certain anti-seizure therapies for eye movement problems. |
Are complementary therapies for MS helpful?
Treatment approaches for MS include not only pharmaceutical interventions for controlling the disease and associated symptoms, but also therapies for other areas of care. These include physical therapy, exercise, acupuncture, rehabilitation focused on function, emotional support, and healthier nutrition.
Physical therapy
Physical therapy focused on exercises that strengthen muscles and improve gait, balance, and coordination can be of benefit to MS patients. The main goal of physical therapy is to help patients to maintain a certain level of function. This type of rehabilitation is important not only for mobility, but also for swallowing difficulties. It also can help with any issues with daily activities, including dressing and personal care.
Exercise
Regular exercise is recommended for MS patients as it can ease fatigue and help manage other disease symptoms. Exercise also can help improve a patient’s cardiovascular fitness, overall strength, and bladder and bowel function, as well as mood and well-being. Exercise programs for MS patients should be tailored according to each individual’s needs and capabilities. Swimming/water exercises, yoga, Pilates, and adaptive tai chi all are activities that can be of benefit.
Diet
There currently is not enough robust evidence to recommend any type of special diet for MS patients. Proper nutrition, however, is important, and patients are advised to maintain a healthy diet. This could be achieved by giving preference to a variety of fruits and vegetables, lean proteins, beans, nuts, and whole grains. Meanwhile, patients can limit their consumption of highly refined foods, as well as products rich in sugar, salt, and saturated fats.
Is stem cell therapy approved by the FDA for MS?
Stem cell therapy is currently not approved by the FDA and is considered an experimental treatment for MS. However, the medications and protocols used in autologous hematopoietic stem cell transplant (aHSCT) — a particular form of transplant that uses a patient’s own stem cells — are already approved by the regulatory agency.
The goal of aHSCT is to reset a patient’s immune system to eliminate those cells that drive MS inflammation. The procedure involves first harvesting stem cells from the patient’s bone marrow or blood. These cells are able to grow and differentiate into all kinds of blood cells. The patient is then given an aggressive course of chemotherapy to effectively wipe out the immune system, after which the collected stem cells are administered back into the patient via an infusion.
The approach results in the formation of new immune cells that are not primed to cause damage to the central nervous system, which, in theory, can reduce disease activity and prevent relapses. Some promising results with HSCT have been reported in MS patients, particularly in those with early disease.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about MS treatment options
There currently is no MS cure, but several treatments are available to help manage the disease. Some of these therapies are designed to control the immune system, reduce inflammation, and delay long-term disability progression. Others are used to address specific symptoms associated with the disease. The goal of any MS treatment plan is to slow progression of the disease, help accelerate recovery from relapses, and ultimately enhance patients’ quality of life and ability to function in activities of daily living.
Yes. Three main categories of medications are used in MS: disease-modifying therapies, to prevent disease relapses and slow disability accumulation; relapse management therapies, to reduce the duration and severity of acute relapses; and symptomatic treatments, to manage specific symptoms associated with the disease, such as fatigue and spasticity.
Because each MS patient experiences the disease differently, it is difficult to predict how a person will respond to a given treatment. Selecting an optimal treatment plan should be a joint effort between the patient and the healthcare team, based on the individual’s symptoms, MS type, disease severity, needs, and preferences. The potential risks and benefits of each therapy also should be carefully assessed.
Yes, MS treatment is covered by health insurance. Each state, however, follows different rules and laws; thus, the costs of therapy might differ. Due to the Affordable Care Act, denials or restrictions in health insurance, or higher premium rates because of a preexisting condition such as MS, are prohibited.
MS is a lifelong, chronic disease with no cure. Some forms of the disease can, however, progress very slowly over the years. These cases are sometimes referred to as inactive or “benign” MS and are characterized by at least 15 years of disease duration with few symptoms and little disability accumulation.
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