What are the treatment options for multiple sclerosis?

Multiple sclerosis (MS) is a severe, inflammatory, neurodegenerative disease that affects a predominantly young population. It is typically geographically spread.
The inflammatory process in the central nervous system disrupts the myelin sheaths, the coverings of nerve fibres.
Unprotected nerve fibres are further damaged by inflammation and sclerotise.

There are not one but several such scattered inflammatory foci in the brain and spinal cord, hence the name multiple sclerosis.

Disease manifestations and treatment

The manifestations of multiple sclerosis are non-specific at the outset. Unexplained fatigue usually predominates.

With the progression of the condition, the most diverse symptoms, which are individual in different patients, increase.
The variety of symptoms is due to the different localisation of the inflammatory foci in individual patients - the so-called heterogeneous course.

TIP: Know the warning signs of multiple sclerosis

There is no cure for the disease as such yet, but we have several drugs available to reduce the development of the disease, the number of relapses and to alleviate symptoms.
Many drugs are in the research stage.

In addition to medication, patients have the option of plasmapheresis and bone marrow transplantation, a stem cell therapy.

An important part of the treatment of multiple sclerosis is neurorehabilitation and physiotherapy under the supervision of a specialist.

Can multiple sclerosis be treated? When and what therapy is appropriate?

So far there is no cure for multiple sclerosis!

Multiple sclerosis is a tricky, progressive disease with very unfavourable prospects. There is no treatment for this disease as such yet.

The aim of drug therapy is only to reduce disability. The drugs administered minimize the number of relapses and to some extent slow down the progression of the condition.

The goal of all previous and ongoing research is to find a drug that would stop the inflammatory process in the central nervous system and at the same time activate the remyelination processes of the damaged nerve (restoration of the myelin sheath on the damaged axon).

Treatment of relapses in multiple sclerosis

A relapse means the reappearance of a symptom or a whole set of symptoms. A sudden worsening of symptoms is also considered a relapse.

Multiple sclerosis is characterised by the alternation of relapses with remissions. Remission is, on the other hand, the alleviation of the symptoms of the disease until their disappearance.

Treatment to slow the progression of the disease

In the treatment of multiple sclerosis, first- and second-line modifying drugs are used. These are drugs belonging to a group called DMT (disease modifying therapy).

Patients who have undergone this therapy are slightly less likely to experience rapid disease progression than untreated patients.

It is also used to suppress relapses. Aggressive treatment with DMT significantly reduces the rate of relapse while slowing the formation of new lesions.

Important: However, DMT use is associated with certain health risks. Like any drug, it has side effects such as headaches, back pain, elevated liver enzymes, flu-like symptoms, and sinusitis. More serious ones include heart rhythm disturbances (AV block), macular edema, and various infections.

Corticosteroids - modern generation drugs

Corticosteroids are considered to be the drugs of the modern generation. Their discovery is considered to be one of the greatest milestones of medicine. Until now, the molecules of this drug are indispensable.

They have an anti-inflammatory, anti-swelling and immunosuppressive effect. They are used to suppress nerve inflammation, thereby reducing the number of relapses.

In attacks, methylprednisolone (solu-medrol) is administered into the vein at a dose of 0.5 g. Subsequently, either methylprednisolone or prednisone is administered in tablet form, with a gradual reduction in dose until the drug is omitted altogether.

• Solu-medrol is important in inflammatory and immune processes in the body. Specifically, it suppresses inflammation and its manifestations. The results of treatment depend on the dose of the drug and its duration.
• Prednisone is a synthetic steroid hormone used to suppress the immune response.

β-interferons play an important role in the regulation of immunity

Immunomodulators, specifically β-interferons, are given to reduce disease progression. They are mainly given to patients with frequent relapses.

These agents play an important role in regulating the immune system. They are prescription-bound and costly, but are among the most commonly used drugs in multiple sclerosis.

Medications in tablet form administered by mouth:

• Copaxone - Its recommended dose is 40 mg and is given 3 times a week. Thus, there should be a minimum of 48 hours between injections. It is not yet known how long the injections must be taken. However, the desired result was achieved after approximately 3 months. This drug helps block attacks on the immune system, specifically the myelin sheath, and prolongs the time between relapses.
• Gilenya - This drug significantly reduces the relapse rate of multiple sclerosis. Its active ingredient prevents T-cells (white blood cells) from moving from the lymph nodes to the central nervous system (brain and spinal cord) by blocking the activity of T-receptors. This limits damage to the myelin and provides protection to the axon.
• Tecfidera - Used to treat relapsing-remitting multiple sclerosis. This is a disease in which relapses and remissions are frequent. The mechanism of action of this drug is not fully understood. Preclinical and clinical studies have demonstrated anti-inflammatory and immunomodulatory properties. They suggest that the drug mediates activation of the nuclear factor transcription pathway.
• Aubagio - Reduces the rate of relapses in multiple sclerosis. It helps protect the CNS against immune system attacks by limiting the increase in the number of lymphocytes (white blood cells). This actually limits the inflammatory process leading to nerve damage in sclerosis.
• Mayzent - Based on research, the drug has been shown to reduce the rate of relapses and slow the progression of the disease, including the isolated syndrome, the relapsing-remitting form, and also active secondary progressive disease in adults.

Biologics also provide innovative treatments where conventional therapies have failed

Drugs in concentrated infusion solution administered intravenously:

• Ocrevus is a drug concentrated in an infusion solution. It is administered to patients to treat relapsing-remitting progressive forms of sclerosis. Clinical trials have shown a positive effect in treatment. Reduced relapse rates have been achieved and progression of both forms of the disease has slowed.
• Tysabri contains the recombinant humanized antibody natalizumab, which is designed to block the activity and movement of potentially harmful immune cells from the bloodstream to the brain and spinal cord.
• Lemtrada modifies the immune system's response by limiting nerve damage caused by lymphocytes. The active ingredient binds to the lymphocytes, killing them and replacing them with new ones. The mechanism of action is not fully understood, but the results are nevertheless positive. The product reduces the number of relapses of multiple sclerosis while also controlling some of its manifestations. It is prescription-only, and is available only from registered providers for patients enrolled in a special program (drug safety monitoring).

Chemotherapy is not just for treating cancer

Cytostatics are drugs that are primarily used to treat cancer. People know therapy with these agents mainly as chemotherapy.

Cytostatics, or even chemotherapy drugs, have the ability to destroy tumor-altered tissue (much like an antibiotic destroys a bacterial infection).

Since tumour tissue is very similar to non-tumour tissue, healthy cells are also damaged.

They are used in the treatment of multiple sclerosis when first-line drugs do not work, the condition progresses and the patient has frequent relapses.

• Oncotrone is one of the drugs also called cytostatics. These are known for their use in various cancers. Its use in the treatment of multiple sclerosis is extremely limited. It is rarely used. The indication is determined solely by the doctor in severe and advanced forms of multiple sclerosis. Although it is used to treat cancer, one of its side effects is the development of blood cancer.

Get the manifestations of multiple sclerosis under control - treating the symptoms of the disease

Symptomatic treatment is also very important in cerebral sclerosis. It is a treatment that helps the patient live more fully by eliminating or dampening the symptoms of the disease.

Since multiple sclerosis is dominated by a wide variety of different symptoms, this treatment is highly individual for each patient.

Treatment of the fatigue accompanying any multiple sclerosis

Fatigue is a subjective feeling of the patient, which is accompanied by objective manifestations.

At the same time, it is considered to be a signaller of a number of diseases. One of them is multiple sclerosis, in which it is one of the initial symptoms of the beginning of the disease.

Interesting:
L-carnitine is a substance well known to all those trying to reduce their weight. It is a known fat burner.
People with multiple sclerosis and significant fatigue have been found to have low blood levels of L-carnitine.
This led to research showing that acetyl-L-carnitine works better against fatigue than some drugs.
However, other studies have not been so conclusive. We will see what further research shows.

Medications that promote alertness are recommended to treat it.

• Amatadine (Gocovri, Oxmolex) - Agonistic effect on dopamine, i.e., increases the effects of dopamine in the brain. It increases its extracellular concentration while blocking its reuptake into neurons. No negative effect on genes has been found so far. However, it has a negative effect on the fetus, so it is not given to pregnant women. Studies regarding its cancer-causing effect have not been done.
• Modafinil (Provigil) - Belongs to a group of drugs also called centrally acting sympathomimetics. Studies obtained in vitro and in vivo suggest that the drug binds to the dopamine transporter and slows its reuptake. It affects the parts of the brain responsible for regulating sleep, wakefulness, arousal and alertness. It is used to treat fatigue, but also hypersomnia (excessive sleep), narcolepsy or sleep apnoea.
• Methylphenidate (Ritalin) - This is an amphetamine derivative, i.e. it has a stimulant effect similar to the drug amphetamines. It increases dopamine levels in the brain, thereby activating the central nervous system. It is used not only to treat fatigue, but also for patients suffering from narcolepsy or ADHD (attention deficit hyperactivity disorder).

An important aspect is antidepressant therapy

Depression is a pathological condition where the patient suffers from morbid sadness.

In multiple sclerosis, it is not only sadness from a serious diagnosis that can be considered normal and natural, but also pathological sadness caused by lesions in the brain.

The most commonly used antidepressants are substances known collectively as SSRIs (selective serotonin reuptake inhibitors).

• Citalopram - Used in the treatment of severe depression. The drug must be taken for at least 2 weeks to have the desired effect. Treatment is long-term, with highly individualised dosages. Discontinuation is slow, with gradual reduction in doses.
• Paroxetine - Probably helps to increase serotonin levels in the brain, but not proven. Treatment should be of 3 to 6 months duration.
• Sertraline actavis - Increases serotonin levels in the brain. Prevents depression, treats depression, prevents relapses, and inhibits suicidal thoughts.

Muscle stiffness and muscle cramps

Muscle stiffness or muscle cramps are not uncommon in multiple sclerosis.

Medicines belonging to the group of muscle relaxants (myorelaxants) help to relieve these unpleasant feelings and conditions.

These are substances that release muscle tension and spasms. They lead to muscle relaxation.

The mechanism of action is to block acetylcholine (a neurotransmitter - a molecule of the nervous system) on the neuromuscular disc.

• Baclofen (Baclofen, Gabapentin, Lioresal) is indicated in spastic muscle disorders after stabilization of the condition, due to side effects. It reduces increased musculoskeletal tension. Secondary suppresses pain associated with muscle spasms.
• Tizanidine (Sirdalud, Zanaflex) is one of the centrally acting myorelaxants. It relieves spasticity in neurological diseases, thereby relieving pain similarly to baclofen.
• Botulinum toxin is also known as sausage poison. It is often used in aesthetic medicine to smooth wrinkles. In multiple sclerosis patients, it relieves skeletal muscle spasticity, relieves tremor, and even helps with bladder hyperreflexia.

Interesting:
Cannabis - marijuana - is also used to treat moderate and severe spasticity in multiple sclerosis.
It contains the active substances tetrahydrocannabinol (THC) and cannabidiol (CBD). These relieve spasticity, counteract convulsions, relieve pain, and alleviate nausea and vomiting.
It has also been shown to have psychoprotective effects (treatment of depression).

Treatment to improve gait

Dalfampridine is better known by the commercial name Ampyra. It is one of the potassium channel blockers.

It helps to improve motor as well as sensory function in multiple sclerosis patients, thus increasing walking speed. It is so far the only drug on the market helping multiple sclerosis patients with walking.

Other drugs used in suppressing the symptoms of multiple sclerosis

In addition to the above mentioned drugs, other drugs are also used in the treatment of multiple sclerosis.

• pain-reducing drugs
• insomnia medications
• drugs to control bowel activity
• medicines to control bladder function
• drugs for sexual dysfunction

Plasmapheresis and stem cell therapy

Medications are not the only alternative to improve the lives of multiple sclerosis patients. Modern medicine offers several options.

Plasmapheresis - a treatment for autoimmune diseases, including sclerosis

Plasmapheresis is a treatment method in which blood plasma is separated from other blood elements. Harmful substances in the removed blood plasma are eliminated extracorporeally and the cured plasma is returned to the patient's body.

This treatment is used not only in patients with sclerosis, but also in other autoimmune diseases.

Therapy with own stem and mesenchymal cells

Stem cell transplantation has been used in medicine for decades. Primarily, it is used to treat malignant blood diseases. Patients first undergo chemotherapy, which, among other things, destroys the immune system. Subsequently, the transplanted patient receives stem cells. He or she also receives them in the form of an infusion.

In order for the therapy to be possible at all, a suitable donor must be found, which is often a problem. The solution is cord blood collection. If a specific disease develops, transplantation with the patient's own stem cells is then possible.

Interesting fact: In 2015, a study was published by Dr. Burt, who conducted research with 151 patients suffering from multiple sclerosis. The research group underwent treatment with their own stem cells, and were followed for up to 4 years. During this four-year period, up to 87% survived without progression of the condition. This research is of significant benefit to all patients suffering from this tricky disease. But not everyone is a suitable candidate.

Infusion therapy with mesenchymal cells from various sources (bone marrow, adipose tissue) is now more widely used.

Rehabilitation and its importance in the treatment of sclerosis

Rehabilitation is a very important aspect of sclerosis treatment.

It is of great importance not only as an adjunct to medical treatment. It is also considered a comprehensive therapy that improves not only the physical but also the psychological state of the patient.

This form of therapy is carried out by trained personnel. This can be a neurologist and a physiotherapist, but also a health professional with a specific specialisation (psychiatrist, speech therapist, occupational therapist, prosthetist...). It depends on the specific symptoms of the individual patient.

Methods of rehabilitation:

• Neurorehabilitation - This form of rehabilitation should be initiated as soon as multiple sclerosis is diagnosed. It is aimed at stimulating the nervous system and then activating the reserve nerve fibres of the damaged pathways. This takes advantage of a unique property of the nervous system, called neuroplasticity. This means that the nerve fibres have the ability to respond to and adapt to stimuli.
• Physiotherapy - This method deals with exercises. A plan should be developed for the individual patient, taking into account the stage of the disease and his or her overall health. In the active stage, only positioning is recommended. Most often, antispastic positions are used, according to Bobát. In the remission stage, facilitation techniques such as the Vojta method, targeted movements, occupational therapy, speech therapy, and others are appropriate.