MS Treatment
Diagnosing MS
How is MS diagnosed?
There is no single test used to diagnose MS and doctors use a number of tests to rule out or confirm the diagnosis. Diagnosis is made when there is clinical evidence that at least two different areas of the CNS area affected. Also, when magnetic resonance imaging (MRI) shows involvement of two CNS areas that have appeared at different times, with the second are being a new one. There are some MS patients, however, who do not have visible lesions on an MRI. Early in the disease course, scans may be normal because the lesions are not yet large enough to be visualized on MRI. Therefore, a detailed medical history and various neurological and blood tests are also part of determining a diagnosis of MS.
What is the prognosis of the disease?
Most patients with clinically evident MS ultimately experience progressive neurological disability; however, the rate of progression differs from one person to another. There is no way to predict at the beginning how a person’s MS will progress. However, there are some factors that may identify patients with MS with a higher risk of relapses and/or disability progression. These include patients who have frequent attacks in the first few years after diagnosis with incomplete recoveries, rapid accrual of disability, more lesions on MRI early on, or symptoms of tremor, in-coordination, difficulty in walking at the disease onset. Men have a worse prognosis than women and patients who are diagnosed after age 40 tend to do worse than people diagnosed before age 40.
DMDs have significantly improved the long-term prognosis of MS.
Treating MS
Treatment
The first step in treating multiple sclerosis (MS) effectively is to learn as much as possible about the illness. This way, people impacted by MS can start to build a picture of the changes that may take place in both the short and long-term future. Disease Modifying Therapies (DMT’s) help to improve the lives of those affected by MS by delaying the progression of the disease.
What are my choices?
The medication used in treating MS can be divided into three groups:
- Medicines that treat an acute attack improve symptoms but neither change the mechanisms that caused the MS nor the course of the disease; these medicines are usually referred to as corticosteroids, which are a form of steroids.
- Medicines that alter the course of the disease (Disease Modifying Therapy) by reducing the effects on disordered immune processes. Immunomodulatory and immunosuppressive medicines fall into this category. These act by reducing the immune system cell activity that causes the body to attack its own central nervous system.
- Medicines that treat specific symptoms. This is known as symptomatic therapy.
Corticosteroids
Treatment of an acute multiple sclerosis attack is carried out with strong anti-inflammatory medicines known as corticosteroids. Corticosteroids are steroid hormones that contain cortisone and are administered orally or intravenously (injected). Continuous treatment over several months using low doses of a cortisone preparation is not generally recommended. This is because continuous therapy will not result in any long-term influence on the illness. In addition, long-term cortisone therapy can result in severe side effects.
Possible corticosteroid side effects include:
- Premature bone decalcification
- Abnormal development of body fat
- Cloudiness of the eye lens
- High blood pressure
- Diabetes
- Acne
- Psychological disturbances
3 important treatment goals
Starting therapy is an important step in doing something about your MS. When it comes to treating your MS, your doctor will most likely have 3 key treatment goals in mind: slowing disability progression, reducing the frequency of relapses and reducing or preventing the damage MS causes that can only be seen on an MRI, while minimising the risk of unwanted side effects.
Disability progression
Relapsing MS affects everyone differently. Over time, MS can often lead to worsening of a person’s mobility (movement and walking ability). Eventually, some people may develop other physical disabilities.
Relapses
A relapse, also called a flare-up, is when 1 or more relapsing MS symptoms worsen or new ones appear for at least 24 hours.
MRI lesions
Lesions are abnormalities in the brain or spinal cord. Healthcare providers use 2 kinds of MRI scans to see the lesions that are caused by MS. Monitoring disease activity through MRI scans helps to determine whether treatment is working.
Staying with or switching MS treatments
More than 30% of patients switch DMTs for reasons ranging from treatment expectations to side effects to financial concerns. You should keep taking your DMT as prescribed, unless your healthcare provider tells you to stop. This could be due to:
- The side effects make you feel worse than the disease
- Your healthcare provider determines that your medication is not working
- You’re having trouble taking your treatment
Always consult your healthcare provider about starting or stopping your MS treatment.
