Treatment
Principles of Treating Multiple Sclerosis
Expert guidelines recommend that the treatment of MS should be approached in four different ways. Each of these approaches may be undertaken separately or in combination:
- Management of symptoms and disability with:
- speech therapy, physiotherapy and occupational therapy.
- pharmacological or other therapeutic agents. - Management of the emotional and social consequences of relapses and disability.
- Treatment of acute relapses with corticosteroids.
- Treatment with DMTs aimed at:
- reducing the severity and/or frequency of relapses.
- slowing the course of the disease.
At present, beta interferons and glatiramer acetate are the only disease-modifying treatments (DMTs) licensed for option 4 (refT1).Treatment of MS with DMTs and other agents is discussed elsewhere in this section of MSActiveSource. The rest of this page looks briefly at other ways to manage common MS symptoms.
There are many possible symptoms in MS.
An acute relapse may present as optic neuritis and is usually treated with corticosteroids (refT2).
Other symptoms involving problems with movement (eg balance/coordination) and muscles (eg incontinence, fatigue, loss of muscle strength) or sensory problems (eg pain, loss of sensation) require attention from the appropriate therapist or specialist.
A sudden increase in disability, or an increase in dependence on others, often requires referral to a specialist neurological service for assessment. Disability may develop as the consequence of a relapse, and support such as the provision of care may be required (refT2).
Depression is a common complaint in MS. Possible factors contributing to depression, including chronic pain, social isolation and psychological problems such as anxiety, need to be assessed and if possible eliminated or reduced. It is unclear whether depression in MS (as influenced by these specific factors) is different from depression in other people. Antidepressant medication or cognitive therapy may be used as part of a depression management programme.
People with MS may suffer from emotionalism (inappropriate crying or laughing), a condition that may be linked to depression. Poor control over one’s emotions (eg laughing for no reason) can have potentially distressing social consequences (refT2). Anyone with MS who appears to have little control over their emotions requires assistance and guidance from the appropriate healthcare professional. An antidepressant medication may also be required.
A Pathway Through MS: Understanding and Treating your MS
This is a video programme that has been developed to help people with MS better understand their condition and their treatment options. Separate parts of this video appear elsewhere in this website.
This part of the video focuses on injection and treatment-related side effects and includes advice on how to deal with them. It is divided into four sections: Injection Site Reactions; Treatment-Related Side-Effects; Unwanted Immune Reactions; and Relapses.
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Points covered in this part of the video:
1. Injection Site Reactions
- More common after subcutaneous injection.
- Usually appear as redness and swelling.
- If the skin becomes broken of painful, the patient should contact their MS Specialist Nurse or consultant neurologist.
2. Treatment-Related Side Effects
Interferon beta: flu-like symptoms:
- Frequently experienced by patients receiving interferon beta therapy, particularly during the initial stages.
- Tend to disappear with continued treatment.
Glatiramer acetate: chest-tightening and flushing:
- Can occur within minutes of injection.
- Last up to an hour.
3. Unwanted Immune Reactions (Patients may Develop Antibodies to All of the DMTs)
- Different interferon treatments produce different levels of antibodies.
- Antibodies are more common with interferon beta administered subcutaneously compared with intramuscular administration.
- Antibodies have been shown to reduce the effectiveness of treatment.
4. Relapses
- Treatment with a DMT can reduce the frequency and severity of relapses.
- A relapse can still occur when on treatment.
- Experiencing a relapse while on therapy does not necessarily mean that the treatment has stopped working.