Multiple Sclerosis is a diagnosis that brings a lot of questions and the answers are not that great. There is no cure for this disease. The cure has been dodging researchers and doctors for decades but there have been some great leaps and bounds with most of the progress being made in recent years. In recent years several medications have been developed and have had significant impact of MS and the course of the disease for those who have it.
Relapsing and Remitting multiple sclerosis (RRMS) which is the most common form of MS has to be treated in several ways, generally the the person gets longterm ongoing treatments, acute treatment for the relapses and finally treatment for various symptoms of the disease. RRMS has flairs or relapses where the patient experiences an "attack" which is an acute episode of symptoms resulting from the MS attacking the patients myelin. After the relapse the patient goes into remission and the body will heal over time initially the healing can be complete meaning the neurological symptoms resolve as the body recovers however over time and sometimes even in the beginning of the disease the damage caused by the flair does not heal completely and can become a permanant deficit. These deficits lead to problems for the MS patient like paralysis or weakness, visual symptoms, and a whole list of other neurologic problems that plague the individual. Patients need acute treatment when a relapse occurs tho stop the flair and limit the damage and then in-between relapses there are treatments to delay and hopefully prevent relapses from occurring.
The relapses or flairs are generally treated with high dose steroids which have powerful anti-inflammatory properties. The goal is to stop the acute flairs or active disease that are actively attacking the myelin. This is an important time and treatment is needed to prevent and or slow the attack which will hopefully stop and prevent permanent damage. The steroids are usually given at ~20 x's the typical steroid dose and are given intravenously over 3 - 5 days and then the patient is put on a steroid taper and takes steroids in pill form and slowly taper the dose over 2 - 6 weeks depending on different variables. Time is of the essence during the relapse period as the disease is actively assaulting the nervous system.
These medications used to treat ongoing MS are called Disease Modifying Therapies (DMT's). DMT's are used to manage MS and the patient usually takes these the rest of their life and often have to switch between different DMT's as they stop working or just fail over time or cause complications and side effects that are intolerable and some can even lead to a fatal complication called progressive multifocal leukoencephalopathy (PML). PML is an opportunistic viral infection of the brain that usually leads to death or severe disability. Some of the DMT's increase the chances of developing PML. Another issue is that these medications cost abut $6,000.00 / month and even with insurance still can run thousands of dollars / month. The cost of ongoing MS medications ~$70,000.00 / year for life and this does not account for acute medicines or symptom related medications, doctor's appointments, MRI's, ER visits, physical therapy or other medical costs.
There are many medications used to treat the symptoms of different MS related symptoms. There are pain medications, medications for bladder symptoms, medications for muscle spasms and whatever else the patient may develop. These medications are taken as needed or sometimes may be required for life depending on the symptom / problem being treated.
There are other approaches for dealing with MS that include dietary changes and exercise programs and stress relieving activities that have also had varying degrees of success in some patients. There are several dietary plans that have been touted as cures and have anecdotal stories of individuals finding varying degrees of success. Certainly we know that diet and exercise and lifestyle modifications can play an important role in managing MS and better controlling the course of the disease.
There are off-label unapproved treatments that are available but I will not go into the various treatments in this post but maybe in a future post.
There are also some treatments that are not FDA approved and are currently in clinical trials and evaluations to determine their effectiveness and safety. One of the most promising therapies is called HSCT (Hematopoietic Stem Cell Transplantation). I will discuss this in more detail in a future post.
Saturday, February 16, 2019
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