Multiple Sclerosis Treatment and Management

Targeted disease-modifying therapies to reduce relapses and lesions.

Multiple Sclerosis Treatment and Management

Targeted disease-modifying therapies to reduce relapses and lesions.

Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.

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Multiple Sclerosis: Treatment and Care

There is no cure for MS right now, but treatments have improved a lot in the past 20 years. The main goal is “NEDA” (No Evidence of Disease Activity), which means no relapses, no new MRI lesions, and no worsening of disability. Treatment focuses on three things: treating relapses, managing symptoms, and using Disease-Modifying Therapies (DMTs) to change the course of the disease.

Disease-Modifying Therapies (Injectables)

These were the first medications approved for MS and remain a safe, effective option for many.

Interferon Beta: Proteins that mimic natural immune system substances to reduce inflammation (e.g., Rebif, Avonex, Betaseron).
Glatiramer Acetate: A synthetic protein that mimics myelin, acting as a decoy to distract the immune system (e.g., Copaxone).
Pros: Long safety record and fewer serious side effects.
Cons: Requires self-injection (subcutaneous or intramuscular) and can cause flu-like symptoms or injection site reactions.

Oral Medications

Oral treatments offer convenience and high efficacy, making them a popular choice for modern management.

Teriflunomide (Aubagio): Inhibits the proliferation of rapidly dividing cells, including activated T cells.
Dimethyl Fumarate (Tecfidera): Reduces oxidative stress and protects nerves while modulating the immune response.
Fingolimod (Gilenya) & Siponimod: Trap white blood cells in lymph nodes so they cannot enter the brain and spinal cord.
Cladribine (Mavenclad): A short-course therapy that selectively reduces B and T cells, offering long-term remission with minimal dosing.

Managing Acute Relapses

Corticosteroids

When a significant flare-up occurs that interferes with daily function (e.g., loss of vision or inability to walk), high-dose steroids are the first line of defense.

Administration: Usually given intravenously (IV methylprednisolone) for 3 to 5 days, sometimes followed by an oral taper.
Mechanism: They powerfully reduce inflammation and close the blood-brain barrier, shortening the duration of the relapse.
Limitations: They do not repair existing damage or alter the long-term progression of the disease; they only accelerate recovery from the current attack.

Plasmapheresis (Plasma Exchange)

For severe relapses that do not respond to steroids, plasma exchange is an option.

Process: Blood is removed from the body, the plasma (containing the attacking antibodies) is separated and discarded, and the blood cells are returned with replacement fluid.
Indication: Used as a rescue therapy for sudden, severe attacks.

Infusion Therapies

Infusion therapies are often high-efficacy drugs reserved for active or aggressive disease.

Ocrelizumab (Ocrevus): Targets CD20-positive B cells. It is the first and only drug approved for both Relapsing and Primary Progressive MS.
Natalizumab (Tysabri): Prevents immune cells from crossing the blood-brain barrier. Highly effective but carries a risk of a brain infection called PML.
Alemtuzumab (Lemtrada): Resets the immune system by depleting lymphocytes, allowing the body to repopulate with healthy cells.
Schedule: These are administered in a hospital setting at intervals ranging from every 4 weeks to every 6 months.

Symptomatic Management

Treating the underlying disease is crucial, but managing daily symptoms is what improves quality of life.

Spasticity: Muscle relaxants (baclofen, tizanidine) and stretching exercises help reduce stiffness.
Fatigue: Energy-conservation techniques and medications such as modafinil or amantadine can help.
Walking Speed: Dalfampridine (Ampyra) is a potassium channel blocker that improves nerve signal conduction to enhance walking speed.
Bladder/Bowel: Anticholinergic medications help with urgency and frequency.

Rehabilitation and Therapy

Physical and occupational therapy are essential components of MS care, not just after a relapse but for maintenance.

Physical Therapy: Focuses on gait training, balance, and core strength to prevent falls.
Occupational Therapy: Teaches energy conservation and adaptive techniques for daily tasks (dressing, cooking).
Speech Therapy: Addresses speech clarity (dysarthria) and swallowing difficulties (dysphagia).
Cognitive Rehabilitation: Exercises to improve memory and problem-solving skills.

Emerging Therapies and HSCT

Research is constantly evolving to find ways to repair myelin (remyelination).

HSCT (Stem Cell Transplant): Hematopoietic Stem Cell Transplantation is an aggressive procedure that “reboots” the immune system using chemotherapy and the patient’s own stem cells.
Indication: Currently recommended for highly active relapsing MS that has failed other treatments.
BTK Inhibitors: A new class of drugs currently in clinical trials that target B cells and microglial cells in the brain.
Remyelination Agents: Investigational drugs aiming to stimulate oligodendrocytes to repair damaged myelin sheaths.

Why Choose Liv Hospital

Liv Hospital takes a personalized approach to MS treatment. We know that one plan does not fit everyone. Our specialists look at your specific disease markers, lifestyle, and risk tolerance to choose the best Disease-Modifying Therapy for you. We offer a comfortable, modern infusion center for biologic treatments and have support staff to help you manage your medications and any side effects. Our rehabilitation team is also part of your care plan, making sure physical therapy works together with your medical treatment for the best results.

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FREQUENTLY ASKED QUESTIONS

Do I have to take medication forever?

MS is a lifelong condition, so long-term treatment is usually needed to prevent future disability. Stopping medication often causes the disease to become active again.

What are the side effects of MS drugs?

Side effects depend on the drug. Injections may cause flu-like symptoms, pills can cause stomach upset or lower white blood cell counts, and infusions may cause reactions during treatment.

Is stem cell therapy available?

HSCT is a complex procedure available for specific candidates. It is not a standard “first-line” treatment but is an option for aggressive cases.

Can I switch medications if one doesn’t work?

Yes, you can. If you have a relapse or new MRI lesions, your doctor will likely switch you to a stronger therapy.

Will treatment fix the damage I already have?

Current treatments mainly prevent new damage. However, rehabilitation and the brain’s ability to adapt can help you regain some function.

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