CLEVELAND CLINIC: CLICK TO READ MORE"There is no known cure for multiple sclerosis, but there are many types of treatments. The interventions prescribed by your physician and other health care professionals are not designed to make MS disappear. Instead, the various treatments, including medications, exercises, adaptive aides, and self-care strategies are designed to help manage symptoms, prevent unnecessary complications, control disease progression, and minimize disability. The medical management of your MS involves an ongoing collaboration between you and your health care team. Decisions about treatment must be made on an individual basis.

The treatment of MS can be grouped into three categories: management of acute attacks, disease-modifying treatments, and management of symptoms.

Management of Acute Attacks
The onset of symptoms over several days or weeks, involving either the development of new symptoms or the worsening of old ones, may indicate an attack or exacerbation of the disease. An attack is usually accompanied by inflammation or demyelination in the central nervous system, either in new sites or old ones. Treatment may be recommended if the symptoms are severe or worsen. The swelling and inflammation of demyelination may be reduced by high doses of an intravenous corticosteroids [Solu-Medrol (methylprednisolone)]. Corticosteroids are used in MS for the management of acut attacks or exacerbations because they have the ability to close the blood-brain barrier and reduce inflammation in the central nerouvs system.

Disease-Modifying Treatments
Only recently have there been treatments that hold promise for reducing the course of MS. A number of new drugs have been shown to modify the course of the disease – Betaseron® (interferon beta-1b), Avonex® (interferon beta-1a), Copaxone® (glatiramer acetate), Rebif® (interferon beta-1a) and Novantrone® (mitoxantrone). These drugs do not cure MS, but they have shown a reduction in the frequency and severity of attacks, reduction in brain lesion development, and a slowing of disease progression with reduction in future disability level. Clinical trials have shown that these drugs can improve the quality of life for many people with MS. Therefore it is suggested that treatment with one of these disease-modifying drugs be initiated as soon as possible. Talk with your physician about what treatment may be right for you.

The decision concerning whether or when to begin treatment with one of these drugs is best made by you and your doctor. Factors that should be considered include potential side effects, benefits, frequency, method of drug delivery, and your personal concerns, priorities, and lifestyle. The most important goal is to find a treatment you can use comfortably and consistently.

Each drug company offers customer support and may also provide some financial assistance for qualifying individuals without prescription drug coverage.

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Berlex (Betaseron®) – MS Pathways 1-800-788-1467
www.betaseron.com


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Biogen (Avonex®) – The Avonex Alliance 1-800-456-2255
www.avonex.com


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Teva Neuroscience (Copaxone®) – Shared Solutions 1-800-887-8100
www.copaxone.com

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Serono (Rebif®) - MS LifLines 1-800-447-3243
www.rebif.com

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Serono (Novantrone®) - MS LifLines 1-800-447-3243
www.novantrone.com

How do these drugs work?

All of these drugs work by altering or suppressing the activity of the body's immune system. These drugs are based on the theory that MS is possibly a result of an adnormal response of the body's immune system that causes it to attack the myelin surrounding the nerves.

The interferon drugs resemble the interferons the body produces during a response by the immune system. It is thought that the interferons reduce nervous system inflammation by inhibiting inflammatory cells from entering into the system.

Copaxone, the only non-interferon medication, is an artifically made protein that resembles a protein that is part of the myelin that surrounds the nerves. Copaxone is thought to reduce nervous system inflammation by restoring cytokine balance by stimulating anti-inflammatory cells that can enter the nervous system.

Novantrone is an immune suppressing medication. It is used for individuals who are considered to have a worsening of the disease or secondary progressive MS.

Comparing the Disease Modifying Drugs

Name
Avonex
(interferon
beta-1a)

Betaseron
(interferon
beta-1b) Rebif
(interferon
beta-1a) Copaxone
(glatiramer
acetate) Novantrone
(mitoxantrone)

Mode of Delivery Intramuscular
Injection Subcutaneous Injection Subcutaneous
Injection Subcutaneous Injection Intravenous Infusion

Frequency Weekly Every other day 3 times a week Daily Every 3 months

Side Effects
Mild flu-like
symptoms

Mild flu-like
symptoms
Possible injection
site reactions Mild flu-like
symptoms
Possible
injection site reactions Injection site reactions
Chest pain
Flushing
Heart Damage (limit
doses of drug is recommended)
Nausea
Increased risk of infection


Management of Symptoms
There are many effective treatments for the symptoms that develop with MS. Many symptoms can be lessened or even reversed with medical approaches. Drugs can help with many of the chronic symptoms that appear, while modifications in diet or lifestyle may help to eliminate or manage symptoms.

Most of the symptoms of MS can be minimized or corrected with appropriate drug treatment, environmental modifications, or physical therapy. To properly care for your disease, routine follow-up visits with your health care team are essential.

Other Treatments

Physical Therapy can be helpful for MS patients at any stage of the disease. A physical therapist can teach you exercises you can use to strengthen and loosen muscles. The goal of physical therapy is to improve your independence and quality of life by improving movement and function.

Occupational Therapy teaches people new ways to function at their highest level possible. The goals of occupational therapy include: restore or improve physical abilities, adapt patients’ surroundings, promote behavioral changes, and teach new skills.

Counseling is beneficial to patients from as early as the first diagnosis. Being diagnosed with MS and dealing with the changes that accompany all aspects of the disease can be stressful. Counseling can help patients and family members cope with stress, depression and anxiety.

Complementary and Alternative Medicine (CAM)
Alternative medicine includes everything from drugs and diet to supplements and lifestyle changes. CAM therapies come from a variety of disciplines and traditions, each with their own beliefs. Some CAM therapies include yoga, guided imagery, relaxation techniques, massage therapy, herbal therapies and many others. Before starting on any CAM therapy it is important to do your homework. Investigate the background of any CAM provider and talk with others who have usde the treatment. You should talk with your physician before starting any CAM therapy and let your physician know if you are currently on any CAM therapy including vitamin & mineral supplements."