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Currently there is no cure for multiple
sclerosis (MS), but there are facets of the disease that have recognized treatments and
which can be very effective:
Exacerbations (also called flare-ups, attacks or relapses):
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 favored steroid regimen is methyl-prednisone administered intravenously in high doses for
three to five days with, perhaps, subsequent tapering lower oral doses of prednisone for
one to two weeks. The use of steroids is not believed to have any effect on the long-term
course of the disease. Corticosteroids are also used to treat MS exacerbations.
Symptoms of multiple sclerosis, such as fatigue, spasticity (muscles stiffness/spasms), bladder
problems, tremor, visual problems and emotional disorders, can often be markedly improved with
appropriate medications and therapy. The following summaries common treatments for MS symptoms:
| Symptom |
Affected
MS Patients |
Possible
Treatments |
| Fatigue |
50% |
amantadine
(Symmetrel)
pemoline (Cylert) |
| Spasticity |
60% |
exercise for mild
cases
baclofen (Lioresal)
tizanidine (Zanaflex)
diazepam (Valium) |
| Bladder problems
(urgency, incontinence) |
67% |
bromine
(Pro-Banthine)
oxybutynin (Ditropan)
Desmopresson (DDAVP)
Maprotiline (Ludiomil) |
| Tremor |
70% |
weight applied to
affected limb
carbamazepine (Atreol, Tegretol) |
| Visual problems
(optic neuritis—inflammation of nerves, uncontrolled eye motions, double vision) |
50% |
methylprednisolone
(Medrol) for optic neuritis
clonazepam (Klonopin) for uncontrolled motion |
| Emotional disorders
(depression, mood swings) |
25-50% |
amitriptyline
(Elavil)
desipramine (Norparmin, Pertofrane) imipramine (Tofranil) |
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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 magnetic resonance imaging.The effect
on progression of disability remains unclear.
Interferon Beta: at this time interferon
beta is considered effective only in relapsing-remitting MS. Clinical trials are currently
being carried out to assess the effectiveness of the drug in the progressive type of MS.
Three types of beta interferon are available:
- Interferon beta 1b (Trade Names:
Betaseron, Betaferon, Pharmaceutical Company: Berlex in North America, Schering AG in
Europe and rest of world)
- Interferon beta 1a (Trade Name: Avonex,
Pharmaceutical Company: Biogen)
- Interferon beta 1a (Trade Name: Rebif,
Pharmaceutical Company: Ares Serono)
Results of long-term clinical trials
have been published for Betaseron and Avonex. Betaseron is approved for use in the U.S.,
Canada, Australia, U.K. and many European countries. Avonex is now approved in the U.S. and is
awaiting European approval. Rebif is still undergoing clinical trials but is available in
Switzerland, U.K., Canada, and Australia.
Copolymer 1 (Trade Name: Copaxone,
Pharmaceutical Company: Teva Pharmaceuticals)
Results of clinical trials with Copaxone
have been published with a reported reduction in relapse rate. Copaxone has been available
for some years in Israel.
How are these drugs
administered?
- Betaseron and Rebif are administered by
subcutaneous self-injection every alternate day
- Avonex is given intramuscularly every
week
- Copaxone is administered by subcutaneous
self-injection every day
Avonex is in various phases of clinical
trials for treating MS in other stages including monosymptomatic MS, mutlidose treatment
of MS, open label MS, secondary progressive MS, and primary progressive MS. Biogen, Inc.
maintains a Web site that details the use, benefits and risks of the multiple sclerosis
treatment Avonex. The site also has a detailed section with information on multiple
sclerosis and question and answer section about Avonex and MS. http://www.avonex.com
While it may not be possible to improve
all lost function, people with MS should try to optimize 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
program 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 counseling. There may be the need for both
social and occupational lifestyle changes.
The following may help people with MS to alleviate some of their symptoms and enjoy a better quality of life:
- Reduce stress (relaxation or meditation exercises may be helpful)
- Exercise (water aerobics may be particularly helpful)
- Avoid extreme changes in temperature
- Seek support with counseling, support groups, etc.
Updated: March 2007
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