Living with multiple sclerosis is difficult. Knowing that there is no cure and that relapses are unpredictable can be maddening, and many patients experience bouts of anxiety and depression, as well as feelings of hopelessness. However, this doesn’t have to be the case.
Treating basic flareups with steroids
In order to maintain quality of life during a flareup (or relapse) a patient may only need to manage some symptoms that shut down their ability to live normally for a few days at a time. This is especially true early on in relapsing-remitting multiple sclerosis, as symptoms come and go and often aren’t as bad as progressive types of MS. In these cases, a physician may simply order a round of strong corticosteroids, which are used to reduce inflammation and can help relieve symptoms and signs caused by inflammation in the brain and spinal cord. Steroids can be administered orally (usually over a longer period of time, up to two weeks) or as an injection (typically three to five days in a row, depending on the severity of the symptoms).
Many treatments to help manage multiple sclerosis signs and symptoms are types of immunotherapy. These treatments involve manipulating the immune system in some way to alter the body’s reaction so that it isn’t attacking the myelin – the coating of fat and protein that both protects the central nervous system (CNS) and helps to move electrical impulses faster through the system, which is the source of symptoms related to MS. Most of these are also considered DMTs – disease modifying therapies – because they modify the course of the disease. This means that, in most cases, these treatments help to reduce the frequency and severity of relapses, and in some cases, it helps to slow the progression of MS.
There are seven basic immunotherapy options that could help manage symptoms of MS.
- Beta interferon. The body actually manufactures beta interferon, but for MS patients, the additional quantity helps contain the autoimmune response that comes from the overreaction to myelin. It promotes the production of suppressor lymphocytes, which combat the creation of offensive immune cells that would harm the central nervous system. As an immunosuppressant, it works to reduce relapses and also has anti-inflammatory properties. This is taken as an injection, though the type prescribed dictates how frequently the patient will inject the medication.
- Glatiramer acetate. This particular treatment is harder to explain, since researchers have yet to identify the exact method by which it works. However, this DMT does work as an immunosuppressant in some way. It is a synthetic protein that simulates myelin, and it seems to block T-cells from damaging the nerves in the CNS, thereby keeping extensive damage from piling up and causing disability, as well as reducing the quantity and severity of relapses in MS patients. It, too, is an injectable substance that can be handled by the patient and is only subcutaneous (under the skin).
- Teriflunomide. One of several oral immunosuppressants, this is a viable option for patients who struggle with needles and don’t want to see their physicians every day. Teriflunomide works by staunching the immune system’s ability to activate a specific type of T-cell, which divides rapidly and floods the body. It’s this type of cell that is believed to be a large part of the attack on the central nervous system (CNS) in the course of MS, and this medication has worked well in reducing the frequency of relapses in RRMS relapsing-remitting multiple sclerosis).
- Fingolimod. This is a particularly effective – and strong – immunosuppressant that works a little differently in the course of managing MS signs and symptoms. Rather than attacking or reducing the production of the lymphocytes that destroy the CNS, fingolimod literally traps them in the lymph nodes where they can’t cause any damage. In doing so, this drug has proven to cut back the frequency of relapses in MS patients by half over two years.
- Dimethyl fumarate. This particular DMT is quite diverse, offered as injectable and oral treatment and used not only for MS but also for plaque psoriasis. This is another method of treatment that isn’t quite understood by the medical community, though it seems to be related to the way the substance breaks down through the metabolism. In the end, dimethyl fumarate appears to reduce the number of lymphocytes that produce inflammation in the CNS through their attacks, which in turn, leads to fewer and less debilitating relapses in MS patients.
- Natalizumab. A more serious immunosuppressant, natalizumab is a monoclonal antibody that has been used to treat Crohn’s disease as well as multiple sclerosis. For MS patients, infusions of this medication are given every four weeks. Instead of stopping the production of the immune cells involved in the attack on myelin in the CNS, this medication literally blocks those cells from the attack. The immune cells have to breach the blood-brain barrier or the intestinal walls in order to reach the CNS, and natalizumab stops that from happening. With fewer cells able to breach that barrier, there is less chance of relapse. This also helps slow the progression of RRMS into secondary progressive MS for many patients.
- Ocrelizumab. Another monoclonal antibody, this medication works in a completely different way and is only infused in an MS patient twice a year. Ocrelizumab targets a marker on the B lymphocytes that produce the offensive antibodies attacking the CNS in order to destroy them prior to the creation and activation of those antibodies. This not only assists in reducing flare ups of symptoms but reduces the amount of permanent damage done to nerve fibers in the CNS.
Managing MS with chemotherapy
If signs and symptoms of multiple sclerosis become unmanageable through any other means, a physician might prescribe alemtuzumab, a specific type of chemotherapy that could help slow the progression and reduce symptoms of MS. Alemtuzumab works by targeting T cells and B cells. These cells are meant to recognize and create antibodies to fight toxins in the body that don’t belong, such as viruses and bacteria.
However, in MS, they have turned on the body and begun to attack the CNS, resulting in the development and progression of the disease. By targeting and destroying these cells, the chemotherapy treatment can reduce the effects of MS significantly. This method of treatment is usually given in two infusions – one over about five days, and a second a year later over about three days. It is not the initially preferred method of treatment due to some of the serious side effects that come with chemotherapy, but in certain situations, it is preferred because reduction of relapses is significantly greater than with beta interferon.