Multiple Sclerosis (MS) (cont.)

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What are multiple sclerosis treatment options?

Many factors go into consideration for the treatment of a patient who has multiple sclerosis. During an acute exacerbation, steroids given through an IV are commonly prescribed, and often help patients recover more rapidly. If a patient cannot receive steroids, plasma exchange can be used.

Once a diagnosis of multiple sclerosis has been confirmed, disease-modifying therapy is often recommended. This therapy can decrease the number of exacerbations that a patient experiences; often, the exacerbation may not be as severe when a disease-modifying therapy has been used. In addition, many of these therapies have been shown to decrease the potential for developing long-term disability.

Interferon therapies (Avonex, Betaseron, Extavia, Rebif) must be given by an injection. The frequency of injections ranges from every other day to weekly. Some patients develop flu-like symptoms following each injection; other patients may develop severe depression.

Glatiramer acetate (Copaxone) works along a different path than the interferons, but is still thought to modify the immune system and has been shown to reduce relapses. Another new drug, dimethyl fumarate (Tecfidera), may function by preventing immune cells from attacking cells located in the central nervous system, and may have anti-inflammatory properties. Dimethyl fumarate is used to reduce or prevent relapsing forms of MS.

Natalizumab (Tysabri) is a monoclonal antibody, and has been approved for patients who have relapsing-remitting multiple sclerosis. Because of significant side effects, including the risk of severe brain infection, it is typically used for patients who have failed to respond to one of the interferon products or who have been diagnosed with very active disease.

There are some oral medications which have been approved to treat multiple sclerosis, including fingolimod (Gilenya) and teriflunomide (Aubagio). Although these medications are dosed orally, there is a risk of significant side effects, including heart disease (fingolimod) or severe liver injury (teriflunomide).

Mitoxantrone (Novantrone) is a chemotherapy agent for leukemia or prostate cancer which has been shown to be of benefit in treating secondary-progressive multiple sclerosis, progressive-relapsing multiple sclerosis, and advanced relapsing-remitting multiple sclerosis. Of note, Mitoxantrone and Betaseron are the only medications identified to help patients with relapsing-primary multiple sclerosis.

In addition to treating multiple sclerosis itself, many symptoms caused by multiple sclerosis, including spasticity, fatigue, memory loss, urinary frequency, pain, erectile dysfunction, and others, can be successfully treated by approved medications. It is important for patients to have an ongoing dialogue with their physician to describe any residual difficulty or symptoms following an exacerbation so that these symptoms can be addressed and treated.

A new medication, dalfampridine (Ampyra), has been approved to specifically help with walking problems caused by multiple sclerosis. The specific way in which this medication works is unknown. There is a risk that this medication may cause seizures, even in patients without a history of seizure or epilepsy. As such, the use of this medication needs to be monitored carefully.

Medically Reviewed by a Doctor on 3/18/2015

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