Multiple Sclerosis Treatment Options

Conditions & Diseases: Brain & Nervous System

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 nervous system caused by 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.
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:

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 in 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. The drug 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 headache.

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

Sources:

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.
Research identifies new genes linked with MS, Reuters, Julie Steenhuysen July 2007.