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Health knowledge made personal
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Health knowledge made personal
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There is no cure for multiple sclerosis (MS), but there are many treatments available which can relieve the many symptoms and relapses, and may help to slow the progression of the condition.
If you have benign MS (BMS) or your symptoms are very mild, you may not need treatment unless you eventually experience a relapse.
Specialist healthcare services for multiple sclerosis
As MS is such a varied and unpredictable condition, each person who has MS will need a different level of medical care and treatment.
Once you have been diagnosed with MS, you should have a thorough assessment involving specialist nurses, physiotherapists, occupational therapists, speech and language therapists and social workers, who make up a specialist neurological rehabilitation team.
Depending on the amount of care you need, you will receive treatment from one, several or all the members of your local neurological rehabilitation team. They can also help you learn to care and treat yourself as much as possible.
Every person who has MS should have access to healthcare professionals trained in treating MS, as well as their doctor.
Medical and complementary treatments for multiple sclerosis
The treatment for MS can be split into four main categories:
Treatment for MS relapses (steroids)
Whenever you experience a relapse of your MS symptoms, you should see your doctor or specialist MS nurse. As a recurrence of your symptoms can be due to a secondary cause, such as an infection, your doctor or nurse must first identify what is causing the relapse, before treating it accordingly.
If your symptoms are due to a relapse, you may be given a 3-5 day course of high dose steroids, also known as methylprednisolone, to help speed up your recovery. These can be given either orally as tablets or intravenously (injected into a vein), and you may receive the treatment either in hospital or at home.
It is not fully understood how steroids help to speed up your recovery from a relapse, but they are thought to suppress your immune system so that it no longer attacks the myelin in your central nervous system. They may also help to reduce the amount of fluid around any nerve fiber damage.
As steroids may cause long-term side effects, such as osteoporosis (weak and brittle bones), weight gain, and diabetes, you cannot take them for more than three weeks at a time, and you cannot take more than three courses of treatment in one year.
Treatments for specific MS symptoms
If you have MS, you may have several different symptoms which may vary in severity. There are treatments available which can relieve each specific symptom, although some symptoms are more easily treated than others.
However, it is very unlikely that anyone with MS would develop all of the possible symptoms.
Visual problems
If your visual problems are mild, such as trouble reading, see your optician for an eye test, as the problem may not be due to MS.
However, if your visual problems are more severe or related to nystagmus (difficulty focusing), you may be prescribed medication called gabapentin.
Muscle spasms and spasicity
Muscle spasms and spasicity can be improved with physiotherapy, as motions such as stretching can help to prevent spasicity (stiffness) occurring. You may be referred to a physiotherapist trained in MS if you find that muscle spasms and spasicity are restricting your movements.
If your muscular spasms and spasicity are more severe, you may be prescribed a medicine which can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are also stronger medicines, such as tizanidine, diazepam, clonazepam and dantrolene.
These medicines all have side effects, such as dizziness, weakness, nausea, and diarrhea, so you should discuss which would be best for you with your doctor or MS nurse.
In rare cases, medicines may not be enough to control muscle spasms and spasicity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.
Neuropathic pain
Neuropathic pain is caused by damage to your nerves, and is usually sharp and stabbing. It can also occur as extreme skin sensitivity or a burning sensation. This type of pain can be treated using the medicines gabapentin, or carbamazapine, or with an antidepressant called amitriptyline.
Musculoskeletal pain
You will probably have musculoskeletal pain if you experience muscle spasms and spasicity, as it is caused by excess pressure and stiffness in your joints.
A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions. If your pain is more severe, you may be prescribed painkillers (analgesics), antidepressants (which can also help with pain), or a procedure which stimulate your nerve endings. This is known as transcutaneous nerve stimulation (TENS).
Mobility problems
As with musculoskeletal pain, mobility problems are usually the result of muscle spasms and spasicity. You may find that you joints tighten, making it hard to move around.
If you experience mobility problems, it is best to try and prevent muscle spasms and spasicity in the first place, with physiotherapy or medication (see above). It is possible for your muscles to tighten to the point where it is painful and difficult to move at all, which is known as a contracture.
If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help to relax your muscles.
There are also medicines, exercises and equipment which can help to relieve a tremor (ataxia) or dizziness caused by MS, which are available from your neurological rehabilitation team.
Cognitive problems (difficulty with thought, memory and speech)
If you experience cognitive problems, any treatment you receive will be fully explained and recorded, so that it is clear to you.
You should be referred to a clinical psychologist, who can assess your problems and suggest ways to manage them. You may also receive treatment from a speech therapist if necessary.
Emotional problems
If you experience emotional outbursts, such as laughing, or crying, for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms, such as a clinical psychologist. They may suggest treatment with an antidepressant, although if you do not want this, learning techniques, to control your emotions can also help.
Depression in people with MS can be treated with antidepressants just as with anyone else. If you often feel anxious or worried, a clinical psychologist may prescribe antidepressants or benzodiazepines, which are a type of tranquillizer that have a calming effect.
If you are prescribed benzodiazepines, it is likely that you will be closely monitored, as this medicine can be addictive.
Fatigue and tiredness
Many people with MS experience extreme tiredness, and your doctor, or MS nurse, should first assess this, to see if there is any other reason for your fatigue other than MS, such as a medication, or poor diet.
If your fatigue is due to MS, you may be prescribed a medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to prevent fatigue, such as exercise and energy saving techniques.
Bladder problems
If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine, which will help to make the need to pass urine more predictable. The need to pass urine frequently can be treated with a medicine called desmopressin.
If you have an underactive bladder which is not emptying properly, you may be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.
However, if your bladder problems are more severe, you may be referred to a continence specialist, who can offer specialist treatment and advice, such as bladder exercises or electrical treatment for your bladder muscles.
Bowel problems
It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.
However, more severe constipation may need to be treated using suppositories (tablets which are inserted and dissolved inside your rectum), or by having an enema. This involves a liquid medication being rinsed through your rectum and colon, which softens and flushes out your stools.
Bowel incontinence can be treated with anti- diarrhea medication, or by doing pelvic floor exercises to strengthen your rectal muscles.
Treatment to slow the progression of MS
MS cannot be cured but there are treatments which can reduce the number and severity of relapses. They may also help to slow the progression of the condition, although research into their long-term effects is limited.
Disease-modifying medicines
These treatments are injected into your muscle or under your skin, and they can only be prescribed by a neurologist who is part of a specialist neurological rehabilitation team. Your MS nurse can help you with the injections until you feel ready to carry them out yourself.
Disease -modifying medicines work by reducing the amount of damage and scarring to the myelin in your central nervous system, which causes MS relapses.
Disease -modifying medicines are not suitable for everyone with MS; they are only prescribed for the treatment of relapsing remitting MS (RRMS) and secondary progressive MS (SPMS). This is because people with these types have the highest number of relapses.
The different types of disease -modifying medicines are outlined below.
Beta interferons (Avonex, Betaferon and Rebif)
There are three brands of beta interferon licensed for use; Avonex, Betaferon and Rebif. On average, beta interferons can reduce the number and severity of MS relapses by a third.
Avonex is injected once a week into your muscle, Betaferon is injected under your skin every other day, and Rebif is injected under your skin three times a week. Beta interferons can all cause mild side effects, such as flu-like symptoms (headaches, chills, mild fever) for 48 hours after they are injected.
All three beta interferons are licensed to be used by those with relapsing remitting MS (RRMS). Those with secondary progressive MS (SPMS) are licensed to use Betaferon only.
Beta interferons are not suitable for those under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using them at least three months before trying for a baby. If you find out that you are pregnant while you are taking a beta interferon, see your doctor or MS nurse as soon as possible to discuss an alternative treatment.
Glatiramer acetate (Copaxone)
Glatiramer acetate has no effect on the severity of MS relapses, although, on average, it can reduce the number of relapses by a third.
Copaxone is injected under the skin every day. It does not usually cause any noticable side effects, although in rare cases, it may cause tightness in your chest. Copaxone is only licensed to be used by people who have relapsing remitting MS (RRMS).
Like beta interferons, Copaxone is not suitable for those under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you are pregnant while you are taking Copaxone, see your doctor or MS nurse as soon as possible to discuss an alternative treatment.
Natalizumab (Tysabri)
Natalizumab (Tysabri) is the most recently licensed disease -modifying medicine for MS relapses, under the brand name Tysabri. On average, natalizumab can reduce the number of MS relapses by two thirds, and can slow the progression of the condition by approximately half.
Tysabri is injected under the skin once every 28 days. However, it can cause several side effects, including headaches, nausea and vomiting and an itchy rash.
In very rare cases, Tysabri has also been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition which breaks down myelin on nerve fibers, in a similar way to that of MS. It can cause problems with vision and speech, and eventually, paralysis.
Tysabri is only licensed to be used by those who still have highly active relapsing remitting MS (RRMS) after treatment with a beta interferon, or those who have rapidly evolving RRMS. Rapidly evolving RRMS is defined by:
Tysabri is not suitable for those under the age of 18 or over the age of 65, those who have cancer, or those with a weakened immune system, such as those who are HIV positive.
Linoleic acid
Linoleic acid is an essential fatty acid, which is found naturally in several foods. There is some medical evidence that suggests that a diet rich in linoleic acid may help to reduce the duration and severity of MS relapses, and slow the progression of MS.
If you have MS, see your doctor, or dietician, for advice about increasing your intake of linoleic acid. You should aim to incorporate 17-23g of linoleic acid into your daily diet, although this may not be advisable if you are overweight.
Linoleic acid is found in:
Complementary therapies for MS
There are many complementary treatments and therapies which claim to ease the symptoms of MS. Some of the most common of these include:
Although there are many complementary therapies available for MS, there is very little medical evidence to show that they are effective in controlling MS symptoms.
However, many people with MS find that complementary therapies help them to feel better. There is some evidence, although it is limited, that the following complementary therapies may help to promote general health and well-being in people with MS:
Other healthcare issues for people with MS
Immunizations
If you have MS, you should have any of the usual travel vaccinations when you go abroad. You should also ensure that you have an annual flu vaccine, as getting flu can make MS symptoms worse.
Pregnancy
Having MS does not mean that you cannot have a baby. In fact, being pregnant reduces your risk of relapses.
Women with MS can have a normal pregnancy and breastfeed afterwards if they want to. Pain medication used in childbirth does not affect MS.
Anesthetics
All types of anesthetic are safe to use for people with MS.
