Multiple Sclerosis – Treatment to Reduce Symptoms and Modify course of Disease

Multiple sclerosis is an autoimmune disease wherein the patient produces ‘antibodies’ or proteins that damage the covering of nerve fibers. This is followed by damage to the nerve itself. Thus the nerve is not able to function properly leading to symptoms like decreased sensations, inability to move some muscles or balance depending on the nerve involved. The condition may progress to such an extent that the patient may be totally disabled and need complete care.

Medications used in multiple sclerosis include:

Drugs that modify the course of the disease: 

Drugs that act on the immune system help to modify the course of the disease.  The preferred drugs are beta – interferon and glatiramer acetate. These drugs reduce the relapses of multiple sclerosis. Other drugs are also available but they can cause serious side effects. They are used only if the above two drugs are not effective or if they cause side effects. These second-line drugs are mitoxantrone and natalizumab. Mitoxantrone causes side effects like damage to the heart, leukemia, low white blood cell counts, infections, problems with menstruation and infertility.  Natalizumab can cause progressive multifocal leucoencephalopathy, a condition that affects the brain and can result in death or disability. Natalizumab was voluntarily withdrawn by its manufacturer due to this side effect but was later reintroduced since some multiple sclerosis patients were willing to take the risk.

Drugs that suppress immunity:

These drugs include azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil and corticosteroids. They reduce immunity, thus reducing the damage on the nerves and nerve coverings.

Drugs that reduce symptoms:

Drugs used to reduce the symptoms of multiple sclerosis are:

Corticosteroids reduce inflammation and flare ups of the disease

Muscle relaxants such as baclofen and tizanidine reduce muscle spasms

Amantadine, modanafil, aspirin are useful in fatigue caused by multiple sclerosis

Tolterodine – helps to control urinary symptoms such as frequency and urgency

Antidepressants help to control depression associated with the disease

Gabapentine is useful for burning feet.

Vitamin D has also been found to have a protective effect in multiple sclerosis

Besides drugs, physiotherapy, occupational therapy, avoiding extreme heat and a well balanced diet are also important in the treatment of multiple sclerosis. Patients with severe disease not responding to steroids may undergo a procedure called plasmapheresis in which the antibodies are filtered out from the blood.