Treatment of multiple sclerosis (MS) depends on the form of the disease and the patient's condition. Drugs are given to modify the course of the disease, reduce seizures, and relieve the symptoms of multiple sclerosis caused by damage to the nervous system. The treatment of MS also includes rehabilitation, physiotherapy and psychotherapy.
Treatment of multiple sclerosis( SM ,sclerosis multiplex ) is not always easy, difficult there may be, for example, side effects of medications taken by the patient. The management of multiple sclerosis generally focuses on three aspects. The first is to mitigate the consequences of the so-called relapses of MS, i.e. episodes during which new symptoms of the disease appear or worsen previously existing symptoms. The second goal of treating multiple sclerosis is to keep patients in a stable remission stage as long as possible. The treatment of accompanying ailments also plays an extraordinary role in MS patients - here the management depends strictly on the course of the disease in a given patient.
Treatment of multiple sclerosis: medications to alleviate MS relapses
Glucocorticosteroids (GKS) are the first group of drugs that are used in MS patients. These preparations are administered in the case of multiple sclerosis relapses - the use is e.g. anti-edema and anti-inflammatory effect of these preparations. Thanks to glucocorticosteroids, it is possible to shorten the duration of the neurological symptoms of an MS relapse. These drugs can be administered to patients both intravenously and orally. GKS intravenously is usually used for several days, in the case of oral pharmacotherapy, it may be recommended to patients for a period of several days, and sometimes for several (3-4) weeks. Drugs from this group are primarily used, such as methylprednisolone, prednisone or dexamethasone.
Treatment of MS: preparations that inhibit the progression of the disease
Different than in the case of exacerbations of MS, the treatment of patients in remission stage. In the periods between relapses, the main goal of treatment is to reduce the frequency of their emergence and to slow down the progression of multiple sclerosis.
Currently, first-line drugs for the most common type of MS (i.e. the form ofrelapsing-remitting) are interferon (IFN) preparations and glatiramer acetate. Interferons are preparations that modulate the activity of the immune system. Beta 1a and 1b interferons are used in MS. The differences in the case of these types of IFN concern, inter alia, frequency of their use - all interferons are administered subcutaneously, however, for agents containing IFN beta-1a, it is possible to use it once a week, while for drugs containing IFN beta-1b, injections are given daily.
Glatiramer acetate was the second-reliever treatment option to inhibit the progression of MS. This preparation is composed of amino acids that resemble those contained in one of the proteins in the structures of the nervous system. The exact mechanism of action of this agent is still unknown, but it is noticeable that glatiramer acetate has the ability to reduce the activity of one of the lymphocyte populations. This drug, like interferon preparations, is administered subcutaneously, injections are performed by patients every day.
Other drugs that are sometimes used in MS patients (included in the so-called second-line treatment) are:
- natalizumab(anti-lymphocyte integrin antibody administered intravenously every 28 days),
- fingolimod(daily oral drug that reduces the release of lymphocytes into the peripheral blood),
- mitoxantrone(a preparation with cytotoxic and immunosuppressive activity, administered intravenously every 3 months until the maximum permissible dose of the drug is administered to the patient).
Time matters in MS treatment
About the importance of rapid implementation of appropriate therapy in the treatment of multiple sclerosis, says Magdalena Fac-Skhirtladze, Secretary General of PTSR. The statement was recorded during the scientific conference "Physiotherapy for he alth".
Treatment for MS: alternative treatment options
Multiple sclerosis - despite the fact that many studies have been carried out on this entity - still remains a disease of interest to many scientists. Its causes are still being searched for, and research into the use of other drugs in the treatment of multiple sclerosis is underway. For example, in some patients attempts are made to use cytostatic and immunosuppressive preparations (such as, for example, mycophenolate mofetil or methotrexate). A significant number of drugs are being investigated because they are suspected of having beneficial effects in MS patients. Examples of them include:
- dimethyl fumaric acid (dimethyl fumarate, tecfidera)
- alemtuzumab
- daklizumab
- ocrelizumab
- laquinimod
- teriflunamid
Analyzes of multiple sclerosis treatment options focus not only on the use of pharmacotherapy. Research is conducted focusing on, inter alia, the effect of using cannabis extracts to relieve symptoms of multiple sclerosis such as pain and muscle stiffness. There are also theories (currently quite controversial) regarding the possibility of surgical treatment in the case of the disease in question - we are talking about the Zamboni treatment of MS.
Treatment of MS: new drugs, new therapies
The progress in the treatment of multiple sclerosis, new drugs and therapies available for patients with MS says Dr. n. med. Barbara Zakrzewska-Pniewska, Department of Neurology, Medical University of Warsaw. The statement was recorded during the scientific conference "Physiotherapy for he alth".
Treatment of MS: problems arising during drug therapy
Virtually every drug has some typical, possible side effects of its use. It is no different with preparations intended for the treatment of MS - sometimes the occurrence of side effects means that the therapy with a given drug has to be discontinued and the patient has to be offered an alternative therapeutic option. carefully. These preparations can lead to arterial hypertension, carbohydrate disorders, dermatological problems (such as acne), and even to mental disorders (in the form of depressed mood, but also psychotic episodes). GCS can also irritate the structures of the gastrointestinal tract, therefore in overburdened patients (e.g. those with an increased risk of gastric ulcer disease) protective administration of drugs from the group of proton pump inhibitors is sometimes used. In the case of interferon preparations, skin reactions at the site of drug administration may be a problem. Other common side effects of these drugs are flu-like symptoms, liver dysfunction and mood disturbances in the form of depression. Glatiramer acetate is a drug that, like the interferon described above, can provoke skin reactions at the injection site, but also may lead to lipoatrophy. . However, the side effects of the preparations used as second-line treatment in MS are different. For example, fingolimod can lead to cardiac disorders or respiratory disorders. In the case of mitoxantrone, the occurrence is reportedpatients with nausea and vomiting, and occasionally hair loss and increased infection rates. Natalizumab, on the other hand, may lead to an increased incidence of urinary tract infections and headaches.
Treatment of multiple sclerosis: symptomatic therapy
In patients with MS, it is important not only to treat the potential causes of MS itself, but also to appropriate interventions to alleviate or eliminate various problems that arise in patients. One of them is spasticity, which is a condition in which patients experience increased stiffness and excessive muscle tension. This disorder may be accompanied by mobility problems, but also severe pain. In the treatment of spasticity, both pharmacotherapy (such as administering baclofen) and surgical techniques (such as trimming the anterior roots of the spinal cord) are used. Regular rehabilitation can bring great benefits to patients with multiple sclerosis. Exercise can help people stay fit for as long as possible, and help improve muscle weakness, and other problems that occur in some MS patients may require specific treatment approaches. Examples include:
- constipation (in order to prevent them, patients should be properly hydrated and eat foods containing fiber),
- bladder dysfunction (these can include both urinary incontinence and difficulties with urination itself, in order to control them, patients are given appropriate medications, and sometimes the patient may need to self-catheterize),
- sexual dysfunction (treated both pharmacologically and - if necessary - surgically),
- significant pain (in the case of the so-called neuropathic pains in MS patients, e.g. tricyclic antidepressants are used, sometimes preparations such as pregabalin or gabapentin are also used),
- fatigue syndrome (it is sometimes treated pharmacologically with drugs such as amantadine and modafinil),
- psychiatric disorders (patients with MS may experience, for example, depression, in which antidepressants from various groups are used).
Early rehabilitation in multiple sclerosis: a role in MS treatment
Why should rehabilitation in multiple sclerosis be as early as possible and on what levels? What is the role of early rehabilitation in treatmentSM? These questions are answered by Magdalena Fac-Skhirtladze, secretary general of the Polish Multiple Sclerosis Society.