TREATMENT

There is currently no cure for MS, but drugs are available that can slow the course of the disease. Synthetic forms of interferon (a natural immune chemical that regulates immune responses) reduce the frequency and severity of relapses and slow the accumulation of disability over time. Glatiramer acetate is a mixture of synthetic polymers that may serve as a decoy for the immune system, reducing its attacks on myelin. This, in turn, can reduce the frequency of relapses, which may slow the progress of the disease.

There are also treatments for specific symptoms, including corticosteroids (often taken intravenously), that can shorten the duration of an MS attack. Several drugs can relieve spasticity, fatigue, and bladder problems. People with MS often find that nondrug treatments, such as regular exercise and adequate rest, can help them to maintain more active lives. Physical therapy and exercise can help strengthen weakened muscles and improve coordination. Occupational therapy can improve daily living skills by teaching people with MS how to function with reduced motility, and speech therapy can help with speaking and swallowing difficulties (see Speech and Speech Disorders: Speech Therapy).

Advances in treatment research are giving hope to those affected with MS, and their families. Current research is focusing on ways to specifically block only myelin-attacking immune cells, and how to harness natural growth factors that may stimulate the replacement of tissues destroyed in MS.

As yet there is no cure for MS but there are facets of the disease which have recognised treatments and which can be very effective.

Exacerbations

The standard treatment for significant acute exacerbations is the use of steroids, which exert powerful anti-inflammatory effects. Steroids reduce inflammation at the site of new demyelination, allowing return to normal function to occur more rapidly and reducing the duration of the exacerbation. The current favoured steroid regimen is methyl-prednisolone given intravenously in high doses for 3-5 days with, perhaps, subsequent tapering lower oral doses of prednisone for 1-2 weeks. The use of steroids are not thought to have any effect on the long-term course of the disease.

Altering the course of the disease

A number of new drugs have recently been approved for use in MS which have some effect on the frequency and severity of exacerbations and the number of lesions as seen on MRI, thought the effect on progression of disability remains unclear.

General Disease Modifying Therapies

Glatiramer acetate (Copaxone®)

Interferon beta-1a (Avonex®)

Interferon beta-1a (Rebif®)

Interferon beta-1b (Betaseron® or Betaferon®)

Mitoxantrone (Novantrone®)

Acute Exacerbations

Dexamethasone (Decadron®)

Methylprednisolone (Depo-Medrol®)

Prednisone (Deltasone®)

Symptom Specific Treatment

For many of the symptoms that occur in MS, effective treatments are available. It is important, however, that careful diagnosis and repeated symptom evaluation is undertaken together with a competent physician (GP, neurologist or other specialists such as urologists, gynaecologists etc). In "MS: The Guide to Treatment and Management" a great number of such therapies are listed and the evidence concerning their indications, applications and effectiveness are discussed in detail.

Spasticity

Baclofen (Lioresal®)

Clonazepam (Klonopin® or Rivotril ®)

Dantrolene (Dantrium®)

Diazepam (Valium®)

Gabapentin (Neurontin®)

Tizanidine (Zanaflex®)

Tremor

Clonazepam (Klonopin® or Rivotril ®)

Isoniazid (Laniazid®)

Fatigue

Amantadine

Fluoxetine (Prozac®)

Modafinil (Provigil®)

Pemoline (Cylert®)

Bladder Dysfunction

Ciprofloxacin (Cipro®)

Desmopressin (DDAVP Nasal Spray®)

Imipramine (Tofranil®)

Methenamine (Hiprex, Mandelamine®)

Nitrofurantoin (Macrodantin®)

Oxybutynin (Ditropan®)

Oxybutynin: extended release formula (Ditropan XL®)

Phenazopyridine (Pyridium®)

Propantheline bromide (Pro-Banthine®)

Sulfamethoxazole (Bactrim® or Septra®)

Tolterodine (Detrol®)

Bowel Dysfunction

Bisacodyl (Dulcolax®)

Docusate (Colace®)

Docusate mini enema (Therevac Plus®)

Glycerin (Sani-Supp supository ®)

Magnesium hydroxide (Phillips’ Milk of Magnesia®)

Mineral oil

Psyllium hydrophilic mucilloid1 (Metamucil®)

Sodium phosphate (Fleet Enema®)

Sexual Dysfunction

Alprostadil (Prostin VR®)

Alprostadil (MUSE®)

Papaverine

Sildenafil (Viagra®)

Pain

Amitriptyline (Elavil®)

Carbamazepine (Tegretol®)

Clonazepam (Klonopin® or Rivotril ®)

Gabapentin (Neurontin®)

Imipramine (Tofranil®)

Nortriptyline (Pamelor® or Aventyl ®)

Phenytoin (Dilantin®)

Cognitive, Psychiatric and Psychological Dysfunction

Bupropion (Wellbutrin®)

Fluoxetine (Prozac®)

Paroxetine (Paxil®)

Sertraline (Zoloft®)

Venlafaxine (Effexor®)

Vertigo & Dizziness

Meclizine (Antivert ® or Bonamine ®)

Temperature Sensitivity & Paroxysmal itching

Hydroxyzine (Atarax®)

Nausea; Vomiting

Meclizine (Antivert ® or Bonamine ®)

Rehabilitation and Management

While it may not be possible to improve all lost function, all people with MS should try to optimise their physical, mental and social condition. After an exacerbation there may be the need for restorative rehabilitation. During remission periods people with MS should participate in a maintenance therapy programme to achieve and sustain their optimum physical condition. This may involve physiotherapy, stretching, coordination exercises, speech and swallowing instruction. It may also include medication, good nutrition and counselling. There may be the need for lifestyle changes (both social and occupational).