Understanding Multiple Sclerosis Treatment Options

Understanding MS: A Primer for the Newly Diagnosed (Part 2)

Rahul Davé, MD, PhD, is Medical Director, Multiple Sclerosis and Neuroimmunology Center in the Inova Neuroscience and Spine Institute.  

No two MS patients experience the same disease course. Depending on an individual’s course, however, MS symptoms can be quite manageable. As the Medical Director of Inova’s Multiple Sclerosis and Neuroimmunology Program, my goal is to help patients live well with MS. If you are diagnosed early, it’s realistic to hope to live a normal life.

If you have recently learned you have MS, you should know that many good treatments exist – including four new ones approved in the last year – that can help slow progression of the disease and sometimes lead to improvement.

Types of MS Medications

MS medications “redirect” the immune system away from the brain, leading to better short- and long-term outcomes. Treating MS with so-called disease-modifying therapies, or DMTs, has been proven to lead to less-frequent relapses as well as slow, or even prevent, progression. Some patients can improve with treatment.

More than two dozen medications are available to treat MS, and it is the job of an MS specialist to match the right treatment to each patient. Some MS medications are taken by mouth, while others are injected and/or administered intravenously, usually in a hospital.  Intravenous medications can prevent a relapse from becoming more severe and causing permanent damage.

Managing Relapses

When MS relapses occur, prior symptoms can flare up or new ones can emerge. Typically, MS medications work better on easing relapses than preventing the disease from progressing over time. It is also more difficult to treat patients whose disease continues to progress without relapses. Nevertheless, treating MS relapses is important, because we know this can delay or stop progression and that some medications can slow progressive disease.

It is important to distinguish between a true relapse – which suggests the MS is not completely controlled, and the brain is at risk of injury – and a pseudo or “false” relapse. Pseudo relapses can be due to factors such as infection, dehydration, fever or exercise, but the brain isn’t at risk of further damage. An experienced MS neurologist can distinguish the two, sometimes with the help of an MRI scan.

What medications can help with MS relapses? If severe – including vision loss, poor balance or increased weakness – your doctor may prescribe corticosteroids to tamp down inflammation. These and other medications used for relapses include:

• High-dose Solu-Medrol (methylprednisolone by IV)
• High-dose Deltasone (prednisone by mouth)
• HP Acthar Gel (ACTH by injection)

Patients whose relapses or disease progression has led to damage to parts of their brain can experience significant or worsening symptoms. For these patients, symptom management is a key part of their overall treatment plan.

Comprehensive Approach

Medications are just one tool to treat MS, but optimal treatment requires a comprehensive approach. Recent research suggests that controlling other chronic diseases like diabetes, high blood pressure and sleep apnea might also help control MS progression. Finally, optimizing diet, nutrition and exercise are critical to a patient’s overall outcome. [See more on these tactics in Part 3: Living Well with MS].

Since MS symptom severity can vary day by day, patients and physicians should act as partners in managing symptoms. In addition to an MS specialist, other specialists can be pivotal in helping lessen debilitating MS symptoms. These include urologists, pain specialists, rehab therapists, ophthalmologists, gastroenterologists and neuropsychologists. Many such Inova specialists with special interest and expertise in treating MS patients practice in the Northern Virginia and Washington, DC region.   

---

To schedule an appointment with Inova’s Multiple Sclerosis and Neuroimmunology Program’s clinic, call 703-280-1234.

Our team includes neurologists, rheumatologists, infectious disease specialists, urologists, radiologists, rehab physicians and other specialists who work together to determine your care.

Inova is a designated member of the Consortium of Multiple Sclerosis Centers.

---