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Treatments for Acute/Onset of MS Attack
Treatments for Acute/Onset of MS Attack
Corticosteroid is a drug class of steroid hormones that are used for anti-inflammation. The most common prescription drug is oral pills prednisone and intravenous methylprednisolone. Side adverse reactions are reported as insomnia (trouble falling asleep), edema (water retention), increased blood pressure and high blood glucose sugar levels, and mood changes. [7]
Plasmapheresis is also known as plasma exchange. The patient's plasma will be removed from the cell elements, mostly red blood cells. These erythrocytes will then be mixed with albumin solution (a protein solution) and be injected back to the circulation system of the patient. Plasma exchange is considered when steroids were not effective or respond to. [7]
Treatments for Long-Term Patients
Treatments for Long-Term Patients
Plasmapheresis is only used for patients who are diagnosed early on and when the patient becomes unresponsive to steroids. Like most diseases, implementing an aggressive treatment plan as soon as possible decreases the effects of the disease. In the case of MS, the relapse rate is significantly decreased. However, for more long-term patients, there are other methods to help manage symptoms. For both relapsing and progressive forms of multiple sclerosis, daily oral medication and injectable treatments can be prescribed.
Daily Oral Medication
Daily Oral Medication
Cladribine is mainly used to treat relapsing-remitting and secondary-progressive MS. This drug targets white blood cells and reduces the amount of T and B cells present, without a major impact on the immune system as a whole. Side effects include headaches, tumors, a decrease in white blood cell levels, and upper respiratory infections. For some patients, regular blood tests may be required. [7]
Siponimod is taken once per day in order to reduce the rate of relapse and decelerate the progression of MS. This medication is approved for primary and secondary progressive forms of MS. The drug will trap B and T cells in the body's lymph nodes, preventing these cells from entering the central nervous system. Some common side effects include liver complications, low white blood cell count, headaches, and issues with vision. Patients taking Siponimod are required to attend regular blood test monitoring.
Injectable Treatments
Injectable Treatments
All injectable treatment options need to be inserted under the skin or into the muscle in order to reduce the rate and severity of symptomatic relapses.
Interferon-beta medication.
This kind of medication was the first disease-modifying therapy (DMT) used to treat relapsing forms of MS. The efficacy and safety of interferons in order to reduce the rate of relapse have been continuously tested and confirmed over the years. The mechanism of interferon-beta medication directly impacts the functionality of cells coming from the immune system. Interferons are known to possess immunomodulatory effects. And for MS, IFNβ is part of the type I family of interferons and is used to treat MS. IFNβ is able to reduce the activation of T-cells as well as its ability to cross the blood-brain barrier. This specific interferon is also able to block B-cells, and other antigen-presenting cells, from marking the myelin with antigens to signal it as a foreign pathogen and the consumption by macrophages. A decrease in the number of inflammatory cells capable of crossing the blood-brain barrier results in a decrease in the activity of the immune system within the central nervous system. Overall, IFNβ is able to produce a shift in the immune response from increasing inflammation in the nerves to an anti-inflammatory response. Some common side effects include flu-like symptoms, dizziness, tight muscles, and irritation at the site of injection. [7]
Glatiramer Acetate.
This drug is a synthetically produced copolymer that mimics the basic proteins of myelin. This compound is an immunomodulatory therapy that is mainly used to treat relapsing forms of MS. Glatiramer acetate has been proven to block T-cells from damaging the myelin by inducing a shift in cytokine levels, a factor that directly causes inflammation in the nerves. The increase in glatiramer acetate in the body results in an increase in the Th2 population in the periphery. In response, reactivated cells will secrete anti-inflammatory cytokines. [10] Thus, the body's inflammatory response due to MS is combated with the increase in anti-inflammatory cytokines. The most commonly used brand is called Copaxone. [7]
Infusion Treatments
Infusion Treatments
Infusion therapy are used to ameliorate symptoms for a longer period of time by releasing medication directly into the bloodstream.
Ocrelizumab (Ocrevus).
This antibody medication is the only DMT approved by the FDA to treat both relapsing- remitting and primary-progressive forms of MS. Clinical trials have shown that this type of medication has reduced the relapse rate for relapsing form of MS and slowed the worsening of the disability for both forms of the disease. [5]
This medication is given via an intravenous infusion by a medical professional. [5] With this type of medication, side effects may include irritation at the injected site, low blood pressure, fever, and nausea. Studies have shown Ocrelizumab (Ocrevus) may increase the risk of certain types of cancer, particularly breast cancer. [5]
Natalizumab (Tysabri)
This medication is created to block the movement of damaging immune cells from your bloodstream to your brain and spinal cord. It may be considered first-line for treatment for patients suffering severe MS.
An issue with this medication is it can increase the risk of serious viral infection of the brain called progressive multifocal leukoencephalopathy (PML). [5]
Managing Symptoms
Managing Symptoms
Physical Therapy
Physical therapy for an MS patient involves exercises to strengthen the muscles, improve on how to walk, and balance and coordination. It also includes stretches that can help maintain mobility and prevent muscle spasms. Physical therapy can help the patient understand how their body will change as the disease progresses.
Muscle relaxants
Patients may experience muscle spasms that can be very painful or uncontrollable. Muscle relaxants like baclofen, tizanidine, and cyclobenzaprine may help reduce pain.[5]
Increase walking speed medications
Medications like dalfampridine may help people to increase their walking speed. Patients who have a history of seizures should not take this medication.
Reduce fatigue medications
Amantadine, modafinil, and methylphenidate (Ritalin) may be helpful in reducing MS-related fatigue. [5] Drugs that help treat depression can be taken to reduce fatigue as well.
Other medications
Medications may be prescribed for pain, sexual dysfunction, insomnia, and bladder or bowel control problems that are associated with MS. [5]
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