Treatment

Treatments for MS

The management or treatment of MS can broken up into 6 interrelated categories:

One	Education: What you don’t know can hurt you and what you learn can help you tremendously; this site will help you learn and hopefully achieve better outcomes.

two

Secondary Prevention: We do not mean preventing MS, although this may be a goal in first degree relatives (siblings and children). Prevention in this sense means avoiding complications and eliminating habits that can make MS worsen more rapidly. Prevention must include cessation of smoking (if you smoke), attaining ideal body weight through dietary adjustments, regular aerobic exercise and strength training and remaining physically, mentally and socially engaged and challenged in life.

three

Enhancing recovery from relapses: The standard therapy is corticosteroids and less commonly plasmaphoresis or IV immunoglobulin. Rehabilitation is also an important component.

four	Rehabilitation: This refers to strategies designed to enhance recovery of function and allow you to maintain activities that are meaningful to you.

five

Symptomatic therapy: Many patients have persistent and annoying symptoms that may interfere with life’s activities. Since disease modifying therapies only prevent new symptoms from emerging (if they work correctly) these persistent symptoms must be managed differently. For instance, heat intolerance may be treated with cooling vests, collars or hats; a foot drop may be treated with a brace or an functional electrical stimulation device, burning or stabbing pains may be treated with drugs like gabapentin or Lyrica, spasms may be treated with baclofen and urinary urgency with oxybutynin to name just some examples.

six

Disease modifying therapy: This refers to a group of medications ( interferons (Avonex, Betaseron, Extavia, Rebif), Copaxone, Tysabri, Gilenya, Aubagio and Tecfidera) that are approved by the FDA to reduce the risk of disease relapses and hopefully prevent the disease from worsening over time. Other available treatments may have disease modifying effects but are not specifically approved by the FDA; these include Vitamin D3 supplementation and statins. Many more therapies are still in clinical trials or awaiting approval by the FDA.
These categories or steps are not meant to be achieved sequentially although certain steps will come before others. Instead, they are meant to work together to help you achieve the best outcomes possible. They will also change over time so be prepared to continue learning.

Important Treatment Topics

Selecting Treatment

Platform Therapy

Questions about Treatment

Exercise and MS

JVC and PML

Changing Treatment

Medication Compliance

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Medications

PLEASE NOTE: For the therapies below, we recommend that you search the web for the "package insert" for each of the drugs. The package insert will go over the indications and the Phase III clinical trial findings, as well as side effects. Here is an example of a package insert: this one is for Gilenya http://www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf

Disease Modifying | Oral

Aubagio is a once-daily oral prescription medicine used to treat relapsing forms of MS.
Gilenya is a prescription medicine for the treatment of patients with relapsing forms of MS to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability.
Tecfidera is a prescription medicine used to treat people with relapsing forms of MS.

Disease Modifying | Infusion

Avonex is approved by FDA to treat relapsing forms of MS to decrease the number of flare-ups and slow the occurrence of some of the physical disability that is common in people with MS. Avonex is approved for use in people who have experienced a first attack and have lesions consistent with MS on their MRI.
Betaseron is a prescription medicine used to reduce the number of relapses in people with relapsing forms of MS. This includes people who have had their first symptoms of MS and have an MRI consistent with MS. Betaseron will not cure MS but may decrease the number of flare-ups of the disease.
Copaxone is indicated for reduction of the frequency of relapses in patients with Relapsing Remitting MS (RRMS), including patients who have experienced a first clinical episode and have MRI features consistent with MS.

Plegridy (peginterferon beta-1a) is a subcutaneous injectable therapy for relapsing forms of multiple sclerosis (RMS)

Rebif is used to treat relapsing forms of MS to decrease the frequency of relapses and delay the occurrence of some of the physical disability that is common in people with MS. Rebif is not approved for treatment of chronic progressive MS. Click on the logo below to learn more about Rebif and MS LifeLines which is a facebook page sponsored by EMD Serono.
Tysabri is for adults with relapsing forms of MS to slow worsening disability and reduce number of flare-ups. Since Tysabri increases the risk of PML, a rare brain infection that usually causes death or severe disability, it is generally recommended for patients unable to tolerate or respond well to another therapy.

Symptom Management

Balance/Coordination & Walking Problems

Ampyra is indicated as a treatment to improve walking in patients with MS. This was demonstrated by an increase in walking speed.

Bladder Dysfunction

Ditropan is a prescription medicine used to treat overactive bladder, such as incontinence or a frequent need to urinate by helping a person have more control over the need to urinate.
Toviaz treats symptoms of an overactive bladder such as incontinence (loss of bladder control) or a frequent need to urinate.

Cognitive Dysfunction

Aricept is a prescription medicine that is used to treat memory loss and mental changes most commonly associated with Alzheimer’s disease

Depression

Celexa is a prescription medicine that is used to treat depression. This medicine is an antidepressant called selective serotonin reuptake inhibitor (SSRI).
Effexor is a prescription antidepressant that is FDA approved to treat depression. It is also approved to treat three anxiety disorders in adults: generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD).
Lexapro is a prescription medicine used to treat severe depression and generalized anxiety disorder (GAD). This medicine is a selective serotonin reuptake inhibitor (SSRI).
Prozac is a prescription medicine used to treat a variety of depressive disorders.WellbutrinWellbutrin is a prescription medicine used to treat depression.
Zoloft is a prescription medicine that is used to treat variations of depression in adults.

Dizziness & Vertigo

Antivert is a prescription medicine is used to treat motion sickness and dizziness.

Emotional Changes

Nuedexta is used to treat sudden bursts of crying or laughing for no apparent reason. This is a common symptom of MS.

Exacerbation

Acthar is indicated for the treatment of acute exacerbations of MS in adults. Controlled clinical trials have shown Acthar to be effective in speeding the resolution of acute relapses of MS.

Fatigue

Concerta is a prescription product approved for the treatment of attention deficit hyperactivity disorder (ADHD)
Nuvigil is a prescription medicine used to improve wakefulness in adults who experience excessive sleepiness.
Provigil is a prescription medicine used to improve wakefulness in adults who experience excessive sleepiness.
Lyrica is indicated to treat fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain, and pain after shingles. Lyrica is also indicated to treat partial onset seizures in adults with epilepsy who take 1 or more drugs for seizures.

Seizures

Depakote is used to treat acute manic episodes of bipolar disorder as well as complex partial seizures in adults or simple and complex absence seizures.
Dilantin is indicated for the control of tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures.
Neurontin is a prescription medicine used to treat certain types of seizures.

Sexual Dysfunction

Cialis is indicated for the treatment of men with erectile dysfunction (ED), men with the signs and symptoms of benign prostatic hyperplasia (BPH), and men with both ED and the signs and symptoms of BPH. Cialis is not indicated for women or children.
Viagra is a prescription medicine used to treat erectile dysfunction (ED) which can occur as a result of MS.

Spasticity

Botox is a muscle-relaxing medication used to decrease spasticity related to MS and other neurological conditions.