When faced with an illness or injury, such as an infection or a broken bone, we usually think of going to a doctor and getting medicine or undergoing a procedure that will help us get back to normal again. However, when it comes to a disease like MS, we need to think a little differently when we talk about treatment.
The goal of MS treatment
Currently there is no cure or easy fix for MS, so the goal of treatment is to manage the disease and learn to live as fully and as normally as possible. To help you do this, there are a number of effective treatment strategies to help manage relapses, to manage MS symptoms, to alter the disease course, and to take care of your body and mind through rehabilitation and psychosocial support.
For many people with MS, relapses (exacerbations, attacks, or flare-ups) occur despite the use of the best and most proven disease management approaches. Relapses will typically resolve without treatment. However, if the flare-up is severe, medications can be used to help bring it under control and speed recovery.
Because MS relapses involve nerve damage caused by inflammation in the CNS, the goal of treatment is to control the inflammation and to close the leaky blood-brain barrier (BBB) so that the body can begin to heal itself.
Corticosteroids (or steroids) are often given to help control the inflammation causing symptoms during a relapse. There is some disagreement among doctors as to whether corticosteroids should be given by IV (intravenously, by which infusion is delivered directly into a vein) or orally. Most neurologists agree that a course of high-dose corticosteroids is the best treatment for a severe MS relapse. Intravenous methylprednisolone (IVSM) is typically given in 3- or 5-day courses with 1 gram (1000 mg) of steroids infused daily.1
For those who cannot tolerate corticosteroids, plasmapheresis may be used for acute relapses. Plasmapheresis is a plasma exchange, in which the liquid portion of the blood is separated from the blood cells, mixed with a protein solution, and reinfused back into the body.1,2
Disease-modifying treatments (DMTs)
A number of medications called disease-modifying treatments (DMTs) or disease-modifying drugs (DMDs) are given orally, by injection, or by IV. Disease-modifying treatments have been shown to be effective in decreasing the frequency of relapses or exacerbations and decreasing the development of lesions or plaques in the brain or spinal cord. Some of these medications have also been shown to slow down the rate at which a person with MS becomes disabled.1,3
Managing MS symptoms
Effective symptom management plays a crucial role in treatment of MS, encompassing the range of symptoms that can arise with the disease. Effective symptom management contributes to quality of life in a person with MS. Approaches to symptom management are individualized based on the nature of symptoms the person is experiencing and may include a variety of drug treatments, surgical interventions, complementary and alternative therapies, including massage and acupuncture, rehabilitative approaches including physical therapy and occupational therapy, and mental health services.
The rehabilitation plan for a person with MS depends on the nature of that individual’s disability or disabilities and may involve the expertise of a broad range of health professionals, including a physiatrist (a health professional who specializes in rehabilitation), a physical therapist, an occupational therapist, or specialists in speech/language and other functional areas commonly affected by MS.
Rehabilitation for the person with MS commonly involves an exercise program or intervention, including appropriate medication, tailored to address the variety of physical challenges and symptoms that can arise with MS, including mobility problems, musculoskeletal problems, difficulties with speech/language, bladder/bowel problems, and problems with vision.
A chronic disabling disease, such as MS, poses a profound challenge to a person in terms of both mental health and the ability to continue functioning within society. Psychosocial support plays an essential role as part of a person’s overall plan for living a full, rewarding life with MS. Resources for psychosocial support for people with MS include mental health professionals, such as social workers, psychologists, psychiatrists, and counselors, trained in addressing the emotional, social, and interpersonal challenges presented by MS, support groups, family members and friends who form the core support structure for a person with MS, and advocacy organizations who serve and represent the interests of people with MS.