Multiple Sclerosis

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is multiple sclerosis?

Your central nervous system—including your brain and spinal cord—is a jumble of wires, or nerves, that transmit messages all over your body. To prevent short circuits, nerves are covered with an insulation called a myelin sheath. Researchers have long believed that multiple sclerosis (MS) occurs when the immune system attacks myelin, which it may mistake for a virus, and damages nerves. Recent findings suggest the myelin may die before the immune system attacks. Your symptoms will depend on where the damage occurs. Problems range from vision abnormalities and fatigue to poor coordination and tingling sensations.

The course of MS is unpredictable, but an acute flare-up is usually followed by a remission that can last for months or years before another episode occurs. After an acute attack, your nerves begin to heal, forming scars, or plaques, over areas of myelin damage. If this acute damage is too great, weakness, fatigue, sensory loss, visual changes, dizziness, tremors, speech difficulties, trouble swallowing, urinary and bowel problems, mood swings, and other residual symptoms may persist. If MS continues unchecked, your muscles become increasingly difficult to control. You may lose the ability to walk.

Who is at risk for multiple sclerosis?

Multiple sclerosis affects twice as many women as men. About 20% of cases are called benign MS: A single attack is never repeated, but most people (up to 75%) have relapsing-remitting MS: You may be symptom-free between attacks, and months (even years) can go by before another flare-up, or relapse. Then there are the more serious forms of multiple sclerosis: secondary progressive, in which years of relapsing-remitting MS changes to continuous deterioration; primary progressive, in which deterioration is slow but constant, with no remission; and (very rarely) progressive-relapsing, in which continuous deterioration is interspersed with sudden episodes of new symptoms or worsened old ones.

Treatment for multiple sclerosis

The goal of MS treatment is to stave off acute attacks (when nerve damage is likely to occur) as long as possible and then manage symptoms effectively. Your success will likely depend on the type of MS you have. Effective treatments for multiple sclerosis have existed only since the 1960s. Since then, doctors have continued to develop treatments for making life with MS easier to manage.

Medications for multiple sclerosis

Pharmaceutical options for treating multiple sclerosis are available only through prescription, so you‘ll have to keep in close contact with your doctor, detailing what’s working and what isn’t. If a drug doesn’t work, don’t despair. There’s usually something else to try.

For treating the disease itself, evidence suggests that interferon medications, if used early enough, can limit irreversible nerve damage and may slow the disease’s progression. If you’ve had an initial attack, and are not on interferon, ask your doctor if it makes sense to start. Drugs often prescribed include interferon beta-1a (Avonex, Rebif) and beta-1b (Betaseron). Studies have found that all three reduce flare-ups for relapsing-remitting MS by 30%, and make attacks less severe if they do occur. Interferon works by suppressing inflammatory mechanisms in the immune system and blocking molecules that target myelin for attack. These drugs also have potentially beneficial antiviral properties: Many experts believe a virus may be one cause of multiple sclerosis.

Another helpful drug is glatiramer acetate (Copaxone), a synthetic molecule similar to a protein found in myelin. It works by tricking your immune system into attacking the drug instead of the myelin sheath. It’s most beneficial if started early in the disease, and its effectiveness increases the longer you take it.

For severe flare-ups, your doctor may prescribe corticosteroids, such as oral prednisone or intravenous methylprednisolone (Medrol). They reduce inflammation in the central nervous system and inhibit your immune system from attacking myelin. Steroids don’t change the progression of multiple sclerosis. They are not prescribed for milder flare-ups because they lose effectiveness if overused.

For the more serious forms of MS, your options are more limited. A drug called mitoxantrone (Novantrone) is the first to be approved for treating secondary progressive MS. It’s shown some effectiveness at slowing relapses and progression of the disease. Side effects, including heart complications, can be serious.

For relieving MS symptoms, a wide array of drugs can be extremely helpful, especially in milder cases. Antispasmodics ease muscle spasms that can accompany MS. These include botulinum toxin injections (Botox), tizanidine (Zanaflex), and diazepam (Valium). Tremors can be controlled with drugs like clonazepam (Klonopin) and primidone (Mysoline). Some people with MS develop urinary complications. For urge incontinence, in which the need to urinate comes on suddenly, anticholinergic drugs, such as oxybutynin (Ditropan), are useful. If urinating is a problem, drugs like maprotiline (Ludiomil) are a good choice. There are also medications to relieve sexual dysfunction: sildenafil (Viagra) for men, low-dose corticosteroids for women.

Depression is common if you suffer from MS. It’s due to the effects of the disease on the brain as well as to the impact of living with a degenerative condition. Tricyclic antidepressants work well and may confer other benefits. It’s important to talk with your doctor about the emotional side of this disease. Too many people try to conduct their lives in a “business as usual” fashion when they could be getting effective professional help.

Lifestyle Changes

One of the greatest challenges of multiple sclerosis is dealing with its impact on daily life. The following lifestyle measures may not slow the disease itself, but they will help you deal with it much more successfully.

• Start a regular exercise regimen. Your muscles can weaken when you have MS, so it’s essential to stay in the best shape you can. Exercise helps maintain strength, coordination, and balance, and can reduce spasticity. Try riding a stationary bike, walking, swimming, or doing tai chi or yoga. Just don’t get too warm: Many people with MS find that being overheated worsens their symptoms.
• Eat a well-balanced diet. Proper nutrition helps boost your immune system and prevent colds and flu, which can worsen MS. Get lots of fibre from fruits, vegetables, and whole grains to prevent constipation, a common problem with MS. Drink at least two quarts of water a day. Keeping well hydrated not only beats constipation, but also will prevent the urinary tract infections that occasionally occur among some people with this disease.
• Keep cool. Make sure your air conditioners are working well in summer. Avoid hot tubs, and choose swimming pools that aren’t kept too warm.

Related Procedures for Multiple Sclerosis

Usually recommended only for people whose sudden, severe attacks aren’t helped by steroids, plasmapheresis, or plasma exchange, involves removing blood, spinning out the blood cells from the plasma, and replacing the plasma with a synthetic fluid. The new mix is pumped back into the body. Doctors think the technique may remove destructive factors in your blood, turning off the process that’s destroying your myelin.

Physical and occupational therapy can help you navigate physical limitations. Psychological counselling helps you deal with the mental distresses of a chronic condition. Family counselling is often a good idea, because your loved ones also need coping skills.

Alternative Therapies for Multiple Sclerosis

Nearly 60% of people with multiple sclerosis try some form of nontraditional therapy. Sometimes these approaches can be very helpful, but be sure to talk with your doctor so you’ll know what to avoid. Some popular dietary supplements, including echinacea, garlic, and ginseng, can worsen MS symptoms by overstimulating the immune system. The following therapies have shown some promise:

• K Antioxidants. Because the nerve damage of MS is partly due to oxidation, antioxidants may make sense. In addition to plenty of fruits and vegetables, try vitamin A, C, and E supplements, as well as coenzyme Q10, grape seed extract, and N-acetylcysteine (NAC).
• Acupuncture. Many report this ancient Chinese therapy helps lessen symptoms. Find a licensed practitioner experienced with MS.
• Magnesium. This mineral may help reduce uncomfortable muscle spasms that often accompany MS.
• Essential fatty acids. Flaxseed oil and evening primrose oil, both fatty acids, may help protect the myelin sheath.

Questions for Your Doctor

• Does my condition merit seeing an MS specialist?
• How long will I be able to continue with my usual activities?
• Do you know of any clinical trials that might be appropriate for me?
• How do I know if a particular product or program is bogus?
• Are there support groups that my family can join?
• Do any of the special MS diets work?

Living with Multiple Sclerosis

If you’re living with multiple sclerosis, here are a few quick tips to help you take control:

• Consider taking part in a clinical trial (there are usually a dozen or so for MS at any one time).
• Don’t ignore pain. Pain is the “hidden symptom” of MS and may not be adequately treated. Because pain can really affect the quality of your life, be sure your doctor knows you’re experiencing it and it is treated accordingly.
• Get a flu shot. Flu-related fever means overheating, which worsens MS symptoms.
• De-stress. Too much stress is usually harmful to people with multiple sclerosis. One study found a connection between increased levels of stress (both everyday hassles and major life events) and new nerve damage in the brain.