Multiple sclerosis is a difficult disease to manage because there is no cure, and there’s never a way to predict when a relapse might occur. As the disease progresses, the relapses could be closer together as well as harsher on the body with greater difficulty in recovering.
Finding ways to help manage the disease and symptoms that can be debilitating is crucial to surviving and maintaining a high quality of life.
Treating MS with steroids
Sometimes, especially early on, flareups (or relapses) are not as debilitating. While there can be some issues with pain and mobility, flareups are more of a nuisance. In these cases, doctors may first prescribe a corticosteroid, which can be taken as a pill but is more effective as an injection or intravenous treatment. Steroids work as an anti-inflammatory agent, which can help ease the symptoms of MS that are caused by inflammation in the central nervous system (CNS) related to an MS relapse. An infusion treatment will last three to five days, determined by the individual and the specific relapse, while oral steroids are usually a ten-day prescription.
Beta interferon works as an anti-inflammatory and immunosuppressant, utilizing the immune system to reduce inflammation in the affected areas of the CNS. This particular drug increases the use of suppressor lymphocytes in the body, which are manufactured to stop the activation of other types of immune cells that harm the central nervous system. Because the antibodies that would attack the myelin coating on the CNS are not produced as frequently, beta interferon can keep relapses from occurring as frequently and keep the relapses more manageable. Unfortunately, they also leave the body more susceptible to other infections.
Another injectable medication is a synthetic protein called glatiramer acetate, which simulates the substance myelin. Myelin is the fat and protein coating that both protects the CNS fibers and enhances the electrical impulses that flow through it to create motion and other reactions. This is the substance the immune system attacks, creating the symptoms of MS. Researchers have not determined how glatiramer acetate works but do know that it seems to block the T cells from damaging myelin in some way, thereby reducing the effects of MS symptoms and helping to control relapses.
- Dimethyl fumarate
With teriflunomide, there is less risk of other infections than with a number of immunosuppressants, and it’s also taken as a pill rather than needing to see a physician or go to a clinic for an infusion. Certain T-cells that divide rapidly are believed to play a large part in the severity of MS and its relapses. Teriflunomide inhibits the activation of these cells, reducing the number of divisions and, therefore, the number of these immune cells. Physicians have found this to both help reduce the severity of symptoms and help reduce the frequency of relapses in relapsing-remitting multiple sclerosis patients.
Another daily pill that has shown great promise for those trying to manage multiple sclerosis is fingolimod. This particular drug literally traps the offensive lymphocyte cells (which produce the antibodies that go after the CNS) inside lymph nodes, disallowing them from proceeding to wreak havoc on the nerves and the myelin coating. Without as many of the offensive cells, autoimmune reactions are fewer and further apart, and they aren’t as strong. A two-year study shows that patients using fingolimod literally reduce the number of relapses by half.
Dimethyl fumarate can be delivered as an injection or orally and is used not only in the treatment of multiple sclerosis but also to treat plaque psoriasis. The method of action isn’t completely understood by researchers. However, the breakdown of dimethyl fumarate into another substance in the body seems to act in a way that reduces the number of offensive lymphocytes, which then reduces the amount of inflammation in the CNS. The biggest concern is that this has some negative gastrointestinal effects, though doctors tend to watch patients carefully, since there could potentially be liver damage.
More serious immunosuppressants
If a patient tries these treatments and sees no improvement, that doesn’t mean it’s time to give up. In fact, there are several other options available that doctors can prescribe, including infusions of immunosuppressants.
The two most common of these are both considered monoclonal antibody treatments and not chemotherapy. Natalizumab has been used for both multiple sclerosis and Crohn’s disease with promising results. The patient receives an infusion every four weeks for MS. While this particular immunosuppressant doesn’t stop the production of the immune cells that make antibodies against the myelin, it blocks those cells and antibodies from being able to breach either the blood-brain barrier or from being absorbed into the intestinal lining. By creating this blockage, inflammation in the central nervous system is reduced, as is the potential for relapse. And with fewer cells managing to get past, relapses tend to be much less severe.
Ocrelizumab works differently. It’s considered an anti-CD20 agent. CD20 is a marker found on the B lymphocytes that produce potentially harmful antibodies that increase the risk of MS flare ups. By targeting these cells and destroying them prior to the antibodies being formed, ocrelizumab decreases the likelihood of a relapse and even the amount of damage done to the CNS in an attack. This infusion therapy is received twice a year.
In some cases, none of these treatments are effective. If the patient is still experiencing too many problems based on MS and its symptoms, a doctor may prescribe a particular type of chemotherapy called alemtuzumab. The drug targets the B and T cells in the immune system that normally attack unwanted toxins like bacteria or viruses but have turned on the body and begun to attack the central nervous system and destroy myelin. Instead, this form of treatment kills the T and B cells, preventing the creation of those antibodies.
This is not a preferred method of treatment, if another can assist in reducing the effects of MS because it has several side effects that could potentially be very harmful, including extreme headache and migraine, rampant infections, and even the possibility of developing thyroid disease. However, the treatment does show a significantly larger reduction in relapses than beta interferon, and only two rounds of treatments are typically given, a year apart.