Multiple Sclerosis
Treatment Options
There is no cure for the disease but research indicates that early treatment
of MS delays disability by decreasing the injury to the nervous system
caused by the disease.
Treatment of MS can be categorized as follows:
1. Treatment that changes the course of disease by
modifying the number and severity of attacks.
2. Treatment addressing symptom management.
The FDA approved six products for disease modifying
treatments of which three were interferon-beta products
and the other three were unrelated products. The
interferon-beta products include:
Betaseron®
(interferon beta-1b): In
general, a beta-interferon shuts the
inflammation of MS lesions through
various mechanisms such as repairing the
blood brain barrier and reducing the
inflammatory process in the lesions.
Betaseron also helps in decreasing the
relapse rate, increasing the time between
attacks and decreasing the amount of
accumulated lesions as observed in MRI.
Betaseron is injected subcutaneously
every other day.
Avonex®
(interferon beta-1a): This drug
slows the rate of progression of
disability in relapsing-remitting
MS. The drug also helps decrease
the relapse rate and the amount of
accumulated damage as observed on MRI.
Avonex is administered as a weekly
intramuscular injection but in lower
doses than Betaseron or Rebif.
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3. Rebif® (interferon beta-1a): This
drug is effective in reducing the number and severity
of relapses thereby delaying the progression of
disability and reducing the number of new and
accumulated lesions as observed on an MRI. Rebif is
administered by injecting subcutaneously higher doses
as compared to Avonex.
The three drugs other than interferon-beta products
include:
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Copaxone® (Glatiramer Acetate): The
drug Copaxone is different from interferon-beta in chemical structure
and consists of a group of amino acids similar in appearance to myelin.
The drug suppresses the immune system’s attack on myelin and
reduces the frequency and severity of attacks. The drug is injected
subcutaneously and used to treat relapsing-remitting MS.
-
Tysabri® (Natalizumab): This is the
first humanized monoclonal antibody approved for treatment of MS.
The drug blocks the receptors on white blood cells (WBC) that permit
them to enter the brain and spinal cord. By restraining white blood
cells from entering the brain and spinal cord, inflammation is controlled.
The drug given by IV infusion once every four weeks.
-
Novantron® (Mitoxantrone): This drug
is a nontoxic chemotherapy agent retarding the disease progression
and lessening the number of relapses by its ability to suppress the
activity of T cells and B cells. Novantron is approved for secondary
progressive and relapsing-remitting forms
of MS. The drug is administered intravenously once every three months
for two years (9).
Symptom specific management involves usage of many
drugs which include:
Muscle Weakness: Muscle weakness,
numbness and stiffness or spasticity is treated with
muscle relaxants such as tizanidine, baclofen,
benzodiazepines (diazepam) and anticonvulsants
(carbamazepine). Usage of baclofen and tizanidine exhibit
side effects such as drowsiness, dizziness and fatigue.
Side effects of cabamazepine include aplastic anemia and
low white blood cell count (leucopenia).
Fatigue: Fatigue is treated using amantadine hydrochloride
or modafinil and the side effects include nausea, dizziness and headaches.
Balance and Equilibrium Abnormalities:
These are treated with benzodiazepines, clonazepam,
propranolol and mysoline. Side effects of their usage
include drowsiness, confusion and depression.
Bladder Dysfunction: Bladder
dysfunction such as incontinence and nocturia may be
treated with oxybutynin, tolterodine and hyosciarnine.
Side effects of the medication include headache, dry
mouth, constipation and dizziness.
Constipation: Constipation is treated
with mineral oil, docusate, bisacodyl+ and sodium
phosphate+. Treatment also includes eating a high-fiber
diet, increased fluid intake, daily exercise and stool
softeners.
Erectile Dysfunction: Sexual
dysfunction in males is treated with papverine,
tadalafil, vardenafil, alprostadil and sildenafil.
Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com
Bibliography
- Multiple
Sclerosis – Overview, Types, Incidence. Neurology Channel,
July 2007.
- What
is MS?, MS Multiple Sclerosis Society, June 2007.
- Multiple Sclerosis,
eMedicine from WebMD, Marjorie Lazoff, October 2005.
- FAQs, Multiple Sclerosis
Foundation, MSF 2007.
- Multiple
Sclerosis, Health Encyclopaedia, NHS Direct, June 2007.
- Diagnosis:
The Basic Facts, Library Brochures, National Multiple Sclerosis
Society August 2006.
- Symptoms of MS,
Multiple Sclerosis Foundation, MSF 2007
- How is MS Diagnosed?
Multiple Sclerosis Foundation, MSF 2007.
- Treatment,
Multiple Sclerosis Foundation, MSF 2007.
- Multiple
Sclerosis – Treatment, Prevention and Prognosis. Neurology
Channel, July 2007.
- Treatments>Medications
Used in MS, Library Brochures, National Multiple Sclerosis Society
August 2006.
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