Multiple Sclerosis medications & treatments
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Multiple sclerosis (MS) is a chronic autoimmune disease that can affect your brain and spinal cord. It affects almost 3 million people worldwide. A study by the National MS Society has estimated that nearly 1 million people are living with MS in the United States. Most people experience their first symptoms of MS between the ages of 20 and 40. Geographically, it tends to affect people who live in milder climates than those who live in hot areas near the equator or cold areas near the north or south poles. MS can be a serious condition and it produces significant physical disability within 20–25 years in more than 30% of patients.
What is multiple sclerosis?
Multiple sclerosis (MS) is a potentially debilitating autoimmune disease that affects your central nervous system (CNS). In the case of MS, your immune system attacks its own healthy tissue, including the protective sheath (myelin) that covers nerve fibers. The resulting damage leaves lesions or scars, which can disrupt communication between your brain and other parts of your body.
While the disease progression will vary between cases, 4 basic courses or types of MS have been defined, including:
- Clinically isolated syndrome (CIS). This type is typically characterized by 1 episode of symptoms lasting at least 24 hours. CIS is caused by inflammation or demyelination (loss of myelin covering) in the central nervous system (CNS). The episode does not typically involve fever or infection and it will be followed by a partial or complete recovery. People who experience may or may not develop MS.
- Relapsing-remitting MS (RRMS). RRMS is the most common form of MS and accounts for almost 85% of cases. It involves flare-ups (exacerbation) of new or worsening symptoms followed by periods of remission (no symptoms present).
- Primary progressive MS (PPMS). In PPMS, your symptoms will slowly worsen from the time they start, without any early relapses or remissions.
- Secondary progressive MS (SPMS). SPMS typically follows a course of RRMS. This second phase of MS is by nerve damage or loss. It is estimated that 50 percent of people diagnosed with RRMS would progress to SPMS within 10 years, and 90 percent would transition within 25 years.
Multiple sclerosis causes
While there is not typically a single, definitive cause of MS, these risk factors may increase the likelihood of you developing MS:
- Age. MS can affect people of any age, but you typically experience your first symptoms between the ages of 20 and 40.
- Gender. Women are 2 to 3 times more likely than men to develop RRMS.
- Family history. Having a parent or sibling with MS increases your risk of developing it as well.
- Environmental factors. MS occurs more frequently in areas that are farther from the equator. Other factors include exposure to air pollution and organic solvents.
- Viral infections. Research has shown that some viruses can increase your risk of developing MS. Some of these include Epstein-Barr virus (mononucleosis), varicella zoster virus (chickenpox), and measles.
- Low vitamin D levels. Low exposure to sunlight and low vitamin D levels can increase your risk of MS.
- Smoking. Smoking can double your chances of being diagnosed with MS. You are also more likely to develop PPMS.
- Autoimmune diseases. If you have certain autoimmune disorders such as inflammatory bowel disease, thyroid disease, and type 1 diabetes, you are at a higher risk of developing MS.
- Obesity. Studies have shown that obesity in childhood and adolescence can increase the risk of developing MS.
How is multiple sclerosis diagnosed?
For a diagnosis of MS, a healthcare professional, often a neurologist, will look at your symptoms, review your medical history, perform a comprehensive neurological exam, and run some diagnostic tests.
Multiple sclerosis symptoms
Symptoms of multiple sclerosis can vary between people and throughout the disease. Symptoms will also depend on the location of the damaged nerve fibers. Some common symptoms of MS include:
- Vision problems such as double vision, optic neuritis (blurry vision and pain in one eye), and partial or complete loss of vision.
- Fatigue (80% of people with MS report this symptom, according to the National Multiple Sclerosis Society)
- Slurred speech
- Changes in gait (the way you walk)
- Muscle spasms
- Muscle weakness
- Tingling or numbness, especially in your legs or arms
- Memory and concentration issues
- Bladder control problems
In many cases, your doctor can make an MS diagnosis based on your medical history and neurologic exam. They may run additional tests to confirm the diagnosis or rule out other possible causes of your symptoms. These tests may include:
- Blood tests. Blood tests are used to rule out other conditions that have some of the same symptoms as MS, including lupus, some infections, and vitamin and mineral deficiencies.
- Spinal tap (lumbar puncture). Your doctor may remove a small sample of cerebrospinal fluid using a spinal tap to look for the presence of oligoclonal bands (OCBs), which can be used to diagnose MS. It can also rule out possible infectious causes.
- MRI scan. An MRI with contrast dye is used to look for active and inactive lesions (areas of damage) in the brain or spinal cord.
- Evoked potential tests. These tests analyze the electrical activity in your brain and spinal cord in response to visual or electrical stimuli.
What are some multiple sclerosis treatment options?
There is currently no cure available for MS and many MS patients do well without any therapy. For those that need it, several MS treatment options can decrease attack frequency and severity, treat MS relapses, or delay the progression of the disease.
- Disease-modifying therapy (DMTs). DMTs slow down disease progression and reduce the number of relapses you have. They are available in oral, injectable, or intravenous (IV) dosage forms. Self-injectable DMTs include Copaxone (glatiramer acetate), Avonex (interferon beta 1a), and Kesimpta (ofatumumab). Oral medications include Mayzent (siponimod), Gilenya (fingolimod), and Aubagio (teriflunomide). Infused medications include Lemtrada (alemtuzumab), Novantrone (mitoxantrone), and Ocrevus (ocrelizumab).
- Corticosteroids. Medications such as oral Deltasone (prednisone) and IV Medrol (methylprednisolone), are given to reduce nerve inflammation and damage to the myelin sheath.
- Symptom management medications. Your doctor may also prescribe other medications to ease specific symptoms which help improve your quality of life. These medications are aimed at symptoms such as bladder and bowel dysfunction, fatigue, pain, and muscle stiffness or spasticity.
If steroids don’t work or you can’t tolerate them, your doctor may recommend plasma exchange (plasmapheresis). This procedure involves removing your blood, then separating the plasma from your blood cells. The plasma is then replaced with a protein solution (albumin), mixed back in with your blood cells, and then re-infused back into your body.
A physical or occupational therapist can teach you exercises to help strengthen your muscles to help you stay active and mobile. They can also show you how to use assistive devices that will help you get around and perform daily tasks.
What is the best medication for multiple sclerosis?
The best medication for the treatment of multiple sclerosis will depend on the individual’s specific medical multiple sclerosis, medical history, medications that the individual is already taking that may potentially interact with multiple sclerosis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter multiple sclerosis medications approved by the Food and Drug Administration (FDA).
Best medications for multiple sclerosis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Avonex (interferon beta-1a)||Immunomodulator||Injection||30mcg into the muscle once a week.||Injection site reactions, headache, flu-like syndrome, muscle ache, nausea, infection, fever|
|Plegridy (peginterferon beta-1a)||Immunomodulator||Injection||125mcg under the skin or into the muscle every 14 days.||Injection site reactions, chills, headache, pain, fever, weakness|
|Copaxone (glatiramer acetate)||Immunomodulator||Injection||20mg under the skin once daily or 40mg under the skin 3 times a week (at least 48 hours apart).||Injection site reactions, weakness, pain, joint pain, anxiety, nausea, flu-like syndrome|
|Kesimpta (ofatumumab)||Monoclonal antibody||Injection||20mg under the skin at weeks 0, 1, and 2, then 20mg once a month starting at week 4.||Injection site reactions, headache, infection, back pain|
|Tysabri (natalizumab)||Monoclonal antibody||Injection||300mg via IV infusion every 4 weeks.||Fatigue, diarrhea, infection, joint pain, cough, urinary urgency/frequency|
|Ocrevus (ocrelizumab)||Monoclonal antibody||Injection||300mg via IV infusion, repeat 2 weeks later, then 600mg via IV infusion every 6 months thereafter.||Infusion-related reactions, infection, depression, cough, back pain, diarrhea|
|Lemtrada (alemtuzumab)||Monoclonal antibody||Injection||12mg/day via IV infusion for 5 consecutive days, then 12mg/day on 3 consecutive days.||Fever, chills, anemia, nausea, vomiting, rash, fatigue, cough, headache|
|Gilenya (fingolimod)||Immunomodulator||Oral||1 capsule (0.5mg) once daily.||Headache, elevated liver enzymes, nausea, infection, stomach pain, diarrhea, cough|
|Tecfidera (dimethyl fumarate)||Immunomodulator||Oral||1 capsule (120mg) twice daily for 7 days then increase to 1 capsule (240mg) twice daily thereafter.||Flushing, stomach pain, diarrhea, nausea, vomiting, rash, itching|
|Aubagio (teriflunomide)||Immunomodulator||Oral||1 tablet (7mg or 14mg) once daily.||Headache, diarrhea, hair loss, flu symptoms, nausea, tinging, infection|
|Mayzent (siponimod)||Immunomodulator||Oral||1 tablet (2mg) once daily.||Headache, high blood pressure, falls, swelling, nausea, dizziness, diarrhea|
|Ampyra (dalfampridine)||Potassium channel blocker||Oral||1 tablet twice daily with or without food.||Infection, headache, nausea, back pain, insomnia, dizziness|
|Solu-Medrol (methylprednisolone)||Corticosteroid||Injection||160mg via IV once daily for 1 week, then 64mg via IV every other day for a month.||Nausea, headache, weight gain, increased heart rate, dizziness|
|Lioresal (baclofen)||Muscle relaxant||Oral||1 tablet (5mg to 20mg) three times daily.||Drowsiness, dizziness, weakness, nausea, confusion, fatigue|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of multiple sclerosis medications?
As with all medicines, those used for multiple sclerosis will have some side effects, depending on the class you are taking:
- Injectable medications such as DMTs can commonly cause injection site reactions, flu-like syndrome, headache, muscle aches, pain, nausea, and infections.
- Oral immunomodulators can cause headaches, diarrhea, flu symptoms, nausea, infections, stomach pain, back pain, and vomiting.
What are some home remedies for multiple sclerosis?
While medications and physical therapy are important in the treatment of MS, there are some lifestyle changes and self-care measures you can do to help manage your condition:
- Eat a healthy diet. A healthy, well-balanced diet can improve your overall health. Studies have shown that vitamin D may have a protective effect and lower the risk of developing multiple sclerosis (MS).
- Exercise regularly. Regular exercise is important for your physical and mental health. With MS, it can improve your strength, muscle tone, balance, and coordination.
- Stop smoking. Smoking can double your chances of being diagnosed with MS and worsen symptoms if you already have MS.
- Stress management. Stress may trigger or make your MS symptoms worse, especially fatigue. Try meditation, yoga, tai chi, massage, or other complementary therapies to help reduce and manage your stress.
- Get plenty of rest. Try to set and maintain a good sleep schedule.
Frequently asked questions about multiple sclerosis
What is the life expectancy if you have MS?
Multiple sclerosis itself is rarely fatal but the life expectancy for people with MS is around 5 to 10 years lower than average.
What are some complications of MS?
MS affects everyone differently so you may not have any complications. However, some complications that are common in MS include:
- Bowel and bladder problems (constipation, diarrhea, incontinence)
- Depression and other mental health issues
- Vision changes
- Cognitive issues such as memory loss
- Speech or swallowing problems
Is MS genetic?
Genetics plays a role in MS. Research has shown that if you have a parent or sibling with MS, you are 30-40 times more likely to develop this condition.
Can I exercise with MS?
Exercise can provide a lot of benefits for someone with MS. It can build muscle strength and improve your flexibility. It also can reduce fatigue and depression, and help improve your memory and concentration. You should aim for 30 minutes of exercise 5 days a week.
Related resources for multiple sclerosis
- What is MS? National Multi Sclerosis Society
- Multiple sclerosis practice essentials. Medscape
- Multiple sclerosis overview. MayoClinic
- Multiple sclerosis: what research is being done? National Institute of Neurological Disorders and Stroke
- Disease-modifying therapies for adults with multiple sclerosis. Neurology.org