Articles

Multiple Sclerosis Treatments

By Brock Smith, R.Ph.

Multiple Sclerosis (MS) is a disease that affects the central nervous system, which includes the brain, spinal cord, and optic nerves. It generally shows up between the ages of 20 and 50 years old. It results from the inflammatory, demyelination process in the central nervous system. MS is characterized by the formation of lesions along the nerve fibers in the brain and spinal cord.

MS is an autoimmune disease but what causes the immune system to attack the body is not clear. Some hypothesize that it may be viruses or environmental factors. MS occurs with more frequency in cooler climates (further from the equator) and most definitely has a genetic link.

A diagnosis of MS is a clinical one based on a thorough history and neurological examination, and one supported by MRI and other diagnostic tests. Diagnosis of MS can also be aided by lumbar puncture, enhancing and non-enhancing lesion detection, Visual evoked potentials (VEP), and magnetization transfer ratio (MTR). Management of the disease falls into three general categories: acute treatment of relapses, prevention of progression or reduction in the frequency of relapses, and control of symptoms.

Those with MS can experience many symptoms, some of the most common include:

• Issues with walking
  
• Visual problems
  
• Bowel and bladder disturbances
  
• Changes in cognitive function, problems with memory, attention, and problem solving.
  
• Sensations such as numbness or "pins and needles"
  
• Changes in sexual function
  
• Pain
  
• Depression and mood swings
  

• Tremor
  
• Poor coordination
  
• Speech and swallowing problems
  
• Impaired hearing
  

Along with these primary symptoms secondary symptoms will present themselves. Bladder infections, loss of muscle tone, poor body alignment, decreased bone density and poor breathing. These symptoms can be controlled but the hope is to avoid them by treating the primary symptoms.

Following an MS diagnosis, a wide array of medical professionals will work together to help manage symptoms for the lifetime of the patient. MS is unpredictable and variable day-to-day and on an individual basis. Because of the unpredictability of the condition, patients should consider the following when choosing an MS treatment:

• Effectiveness
  How well does the therapy slow the progression of physical disability? Does it decrease the number of relapses? Preventing or postponing long-term disability should be the main goal of any MS treatment.

• Safety
  All medications have some risks. It’s important to weigh those with the potential benefits of therapy, as well as consider the impact of side effects. Talk to your doctor and pharmacist. They can provide important safety information to help you make your decision.

• Convenience
  Therapy won't do much good if it is inconsistently. During the treatment consideration process, think about the quantity of medication and the number of doses per day. Also consider the treatment itself -- whether it is injection therapy or infusion therapy. Choose a treatment that fits well with your lifestyle.

• Side effects
  All MS treatments have the risk of developing side effects. When beginning a treatment, it is important to consider both the benefits and the possible risks, and discuss any concerns with your healthcare providers. Talk to your doctor and pharmacist about potential side effects and what MS treatment is right for you.
  

Some studies have shown 4-AP to provide temporary improvement in symptoms such as weakness, imbalance and decreased vision. A larger study showed 27% of patients reported improvement in symptoms while taking 4-AP and only 2% of the placebo group showed an improvement.

Side effects can include dizziness, numbness and tingling, and instability while walking. Less common side effects may include nausea, vomiting, and abdominal pain. Serious effects may include generalized convulsions and confusion.

Of course, there are many medications used to treat the various forms of MS. A compounded medication that has shown some improvement in MS symptoms is Estriol. MS patients that become pregnant experience a significant decrease in relapses that may be mediated by a shift in immune response from T helper 1 to T helper 2.

The following list is a snapshot of drugs for demonstration only. Multiple drugs exist with the same indications listed under various trade names.

• Cymbalta-depression and neuropathic pain
  
• DDAVP nasal spray-Urinary frequency
  
• Dantrium-spasticity
  
• Antibiotics (for infections)
  
• OTC laxatives and stool softeners for constipation
  
• Steroids
  
• Ditropan (XL)-bladder dysfunction
  
• Baclofen- spasticity
  
• Novantrone- disease modifying agent
  
• Viagra- sexual dysfunction
  
• Zanaflex- spasticity
  

Helpful websites include:
www.msactivesource.com/msavProject/msas.portal
www.nationalmssociety.org
www.msfocus.org

Treatment of MS with pregnancy hormone estriol. Department of Neurology, Reed Neurological Research Center, University of California Los Angeles, LA, CA. 90095