Treatment and Management of MS

The nerves of the central nervous system are sheathed in myelin, a substance that assists in nerve function.
Multiple Sclerosis (MS) is a disease of the central nervous system that inflames the myelin and causes plaques
or lesions to appear.

The brain, spinal cord and optic nerves can be affected. The disease most commonly affects young white females living in temperate regions of the world. The cause of MS is not known - it is thought that a virus may be the trigger. There is also evidence of genetic susceptibility.

The two major forms of MS include relapsing-remitting and progressive. There is no cure, but there are treatments available to modify the course of the disease and ease some of the symptoms.

The symptoms vary

The symptoms of MS are varied and unpredictable, depending on which part of the central nervous system is affected and to what degree. The relapsing-remitting form of MS is the more common. The person experiences attacks in which the symptoms are severe for a short time and then improve, often with an almost complete recovery. The progressive form of MS is characterised by a steady worsening of symptoms without any remissions. The symptoms can be any combination of the five major health problems of MS, including:

• Motor control - muscular spasms and problems with weakness, coordination, balance and functioning of the arms and legs
• Fatigue - including heat sensitivity.
• Other neurological symptoms - including vertigo, pins and needles, neuralgia and visual disturbances.
• Continence problems - including bladder incontinence and constipation.
• Neuropsychological symptoms - including memory loss, depression and cognitive difficulties.

Medication treatment

The two principle aims of drug therapy for MS are to ease specific symptoms and hamper the progression of disease by shortening the attacks. The types of drugs used in treatment depend on a number of factors, including the person's form of MS.

Some of the drug treatments available include:

• Immunotherapy - These medications slow the frequency and severity of attacks, which means the myelin sheaths are subjected to less damage. Immunotherapy works by modifying the activity of the immune system. This treatment is most often prescribed for people with relapsing-remitting MS.
• Methylprednisolone - taken either as pills or an infusion. This steroid medication is used to control the severity of an MS attack, by easing inflammation at the affected site.
• Immune Suppressants – sometimes immune suppressants such as methotrexate or mitozantrone are used, especially for people with progressive MS.
• Treatments in development – there are a large number of new therapies being trialled in the treatment of MS. Information about these treatments can be obtain if you contact your local MS organisation. If you require more information about new treatment options and whether you might be eligible to participate in trials, please contact your neurologist.

For more information on immunotherapy Medication treatments see:

• Avonex
• Betaferon
• Copaxone
• Rebif
• Tysabri

MS Australia does not recommend a particular therapy as this is a clinical decision which you need to make with your neurologist. MS staff are able to provide you with detailed information about all of these medications and discuss with you what factors are important in your personal decision making process.

Treatment for specific symptoms

Treatments for specific symptoms may include a range of treatment, including:

• Muscle problems - a combination of medication may ease muscle problems, including stiffness and tremors. Physiotherapy is also recommended.
• Fatigue - some studies have found that medication used to treat the sleep disorder narcolepsy is helpful in controlling MS-related fatigue.
• Neurological symptoms - visual disturbances can be helped with medication, including steroids.
• Continence - treatment for continence problems may include special exercises, medications, continence aids (such as disposable pads) and certain dietary changes.
• Neuropsychological problems - treatment for depression or anxiety may include counselling or medication. Memory problems and other cognitive difficulties can be better managed with professional help from a neuropsychologist.

Health care providers

A person with MS can better manage their symptoms by drawing on the resources of a health care team, including:

• Physiotherapy - including tailored exercise programs to improve strength, coordination and flexibility.
• Occupational therapy - to learn coping strategies and new energy saving skills to ensure a more independent life. These may include the use of aids.
• Neuropsychological therapy - including techniques to improve memory and cognitive skills.
• Other therapies - as needed, such as speech therapists, eye specialists.
• Nursing.
• Social workers.

Alternative therapies

Medications and physical therapies can be complemented by alternative therapies. See your health care provider for information, advice and possible referral. A range of alternative therapies may be helpful.

For more information see: Alternative therapies

Where to get help

• Your General Practitioner (GP)
• Your Neurologist
• Your state MS Society, call MS Connect (1800 042 138)

Things to remember

• MS is an incurable disease of the central nervous system that can affect the brain,
  spinal cord and optic nerves.
• The two principle aims of medication therapy for MS are to hamper the progression of disease by shortening the attacks and to ease specific symptoms.
• The medication used in treatment is prescribed for each individual's specific needs.
• A person with MS can better manage their symptoms by drawing on the resources of a range of different health care providers.

© 2009 MS Australia

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