Today, we will focus on the different treatment approaches and preventive measures that can be used in multiple sclerosis. These include acute treatment of relapses, disease-modifying therapy as a preventive measure before upcoming activity, the treatment of MS symptoms to ease them, personal lifestyle, good vaccination status, and complementary therapy.
This article is only meant to be an overview, since disease-modifying and symptomatic therapy are both very extensive areas and require their own articles.
Table of Contents
Acute Treatment of Relapses
Intravenous cortisone is usually used in the acute treatment of relapses. However, cortisone is not necessary for every relapse. Nowadays, the extent to which the symptoms of the relapse affect daily life is weighed up and whether the use of cortisone and the possible side effects associated with it are justified. Thus, in the case of sensory disturbances or other tolerable symptoms, the relapse treatment can often be avoided.
If, on the other hand, paralysis, visual impairment or other severely disabling symptoms occur, an attempt is usually made to end the relapse quickly, but this is not always successful. If treatment with high doses of cortisone does not have any effect, plasmapheresis and immunoadsorption, known to many as blood washing, are theoretically still available. Since they are more complex and invasive, they are not offered everywhere because special technical equipment and trained personnel are required.
Important to know: None of the acute treatment options can guarantee success, meaning the early ending of the relapse and its associated symptoms.
Disease-Modifying Therapy (DMT) or Immunotherapy
Disease-modifying therapy, or DMT for short, also known as immunotherapy, is about taking preventive action against new inflammatory activity in MS. Most MS specialist consider it as one, maybe the most important cornerstone to slow down in best case even stop the disease activity completly and therefore positively influence the progression and long-term prognosis.
The immunotherapy has no direct influence on already existing limitations. However, if the DMT works and successfully slows down MS, the body has rest and can spend more time on its repair mechanisms, so that there may well be improvements in existing symptoms after the immunotherapy has had its full effect. There are now about 20 approved drugs with different mechanisms of action that have different effects on the immune system.
In an autoimmune disease such as multiple sclerosis, a small part of the immune system overreacts and mistakenly attacks the body’s own cells.
Disease-modifying therapies use a variety of strategies to try to prevent this autoimmune response. Because every MS runs differently and we are all individuals, there is no one therapy that is effective for all MS patients in every case. Rather, it is a matter of finding the appropriate therapy for each person affected in her or his personal situation. Sometimes it works immediately and for a long period of time. For others, it can be a long journey with many changes of therapy. Doctors and scientists are trying to find suitable biomarkers that predict whether a therapy will work for patient X or not, but this search and finding of suitable tests is still ongoing.
Important to know
If there is a disease breakthrough under therapy, after the individual start-up time of the drug, the therapy should be changed and time should not be wasted unnecessarily. A disease breakthrough is defined by a relapse event or the appearance of new lesions on MRI. In most cases, the next step is to switch to a more effective therapy or at least to try a different mode of action within the same efficacy class. Please always keep in mind that active MS consumes brain volume and neurological reserve and it is therefore important to stop MS as quickly and effectively as possible.
The symptomatic therapy plays as well a very important role as most people with MS will experience one or more symptoms over the years. Depending on the MS symptoms present, individual therapy should be used, with the neurologist being the first point of contact.
Especially important is the treatment of disorders of the urinary bladder and gastrointestinal system, for which a (neuro)urologist should be consulted.
MS patients suffer more often than average from depression and anxiety disorders, which is why psychological and psychiatric care is of great importance. Because someone who is in a depression can hardly actively help to keep the MS in control.
Cognitive disorders are also a major burden. Here neuropsychological tests are important, because these problems can be treated with special neurocognitive training.
More therapeutic options
Besides the special areas just mentioned, physiotherapy, occupational therapy and speech therapy play a major role.
For some symptoms there are suitable medications, as in the case of spasticity or depression. Medical aids are another important support when it comes to relieving symptoms or to cope better with everyday life. The most present are probably the various walking aids to wheelchairs, but also disposable catheters play a major role in MS.
And for some problems, special surgeries can be used, for example to insert a bladder or/and bowel pacemaker or a Baclofen pump to better treat permanent spasticity.
It is important to treat MS holistically and this includes each individual symptom. This is the only way to keep the quality of life high and to prevent additional stress on the immune system, which can then lead to a worsening of MS.
Personal lifestyle can have an important influence on the course of MS.
A lot of exercise, preferably a combination of endurance sports, weight training and coordination training, together with sufficient stretching helps to alleviate symptoms and put the immune system into a more relaxed mode.
A healthy diet, high in fiber, rich in variety, low in sugar, low in salt, avoiding processed foods as much as possible, instead organic, regional and seasonal, helps reduce inflammation and support the good strains of bacteria in the gut microbiome.
Avoiding nicotine, alcohol and other addictive substances keeps neurotoxins away from the central nervous system, which otherwise cause additional damage and change the healthy balance toward a more inflammatory milieu.
Those who are firmly integrated into social structures pay more attention to themselves and their health and receive positive intellectual stimulation.
In addition, the emotional balance should also be mentioned. I include both the people who surround you in private and hopefully make you happy, but also the professional environment, where you should experience appreciation.
All aspects count
Every single aspect of lifestyle mentioned can help improve the course of MS. If you are already living a healthy life, of course, there is not much to improve. But if you smoke heavily, eat mostly fast food, are in an unhappy relationship and only watch others play sports, you can do yourself a favor and adjust your life step by step. Please don’t do it all at once, that almost always goes wrong.
Good Vaccination Status
With multiple sclerosis, it is important to pay attention to a good vaccination status. This is because any infection that stresses the immune system can lead to a worsening of MS.
If you are receiving immunosuppressive therapies, it is important to give the vaccination at the right time in the medication cycle so that it works most effectively.
In addition to standard vaccinations, such as tetanus, diphtheria, and poolio, annual vaccinations against influenza and, more recently, corona are also quite advisable. Further vaccinations depending on the possible contact with the pathogen can be useful. Please discuss this with your neurologist.
Complementary therapies are often not reimbursed and must be paid for by the patient. They include acupuncture and acupressure, Ayurveda, homeopathy, the drug therapy of traditional Chinese medicine (TCM), or ostheopathy, to name a few. In addition, scientific proof of efficacy is often lacking. Therefore, please be critical when you use them. If they are good for you, you can afford them and you do not have to give up or restrict other clearly proven beneficial factors such as exercise or a healthy diet, nothing stands in the way.
If a provider promises you a guaranteed cure or a guaranteed stop of the disease, you should be alert. Unfortunately, there is still no cure for MS, even if this is sometimes promised. That is a lie. And whoever gives false promises to patients is for me clearly untrustworthy and above all interested in my money.
Please remember that the immune system is partly overactive in MS. So if a therapist wants to help you strengthen your immune system, she or he has not understood the disease and may even be causing harm and additional MS activity.
I hope the article has given you an overview of how to treat MS. In later episodes I will go into detail on most of the points.
See you soon and try to make the best out of your life,
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