Multiple sclerosis treatment: from holistic therapies, to the common medications and how they work.
MS TreatmentsMS can be treated in many ways, even if it can’t be cured. There are treatments that can slow the progress of the disease, or reduce the regularity of relapsing symptoms. There are also treatments that will help to minimise the symptoms themselves.
FatigueFatigue is a very common symptom of MS, and it can be treated holistically with exercise, regulating sleep patters, staying healthy and using energy-saving techniques. It can also be treated with amantadine. Amantadine is an antiviral drug, and how it reduces fatigue in MS patients is still unknown.
Muscle spasms and stiffnessThis can be improved with physiotherapy. Stretching exercises can help to counter restricted movement and alleviate stiffness. If your spasms are more severe you may be prescribed baclofen, a muscle relaxant, or gabapentin, an antiepileptic medication.
Problems with mobilityThis type of problem can be faced by MS patients for a number of reasons, and they can be treated with an exercise program carried out under the supervision of a physiotherapist, medication for dizziness or tremors, mobility aids, like walking sticks and frames, and home adaptations like grab rails.
Brain painThis is usually caused by damage to your nerves and can be very severe. It can be treated with medications such as gabapentin or carbamazepine, which target neurological pain.
Musculoskeletal painMusculoskeletal pain can be treated by physiotherapy and exercise. If the pain is extreme then painkillers can be prescribed. A TENS (transcutaneous electrical nerve stimulation) machine can also be used. This is a battery-operated device with sticky pads that can be attached to the affected area of the body. The TENS machine will send electrical impulses, causing a tingling sensation. These impulses can reduce the pain signals going through the central nervous system.
Problems with thinking, problem solving, memory, emotions and sexual function or desire can be treated with different types of therapy.
Bladder problemsAdvice from a specialist continence nurse or physiotherapist can help here. There are external stimulators that can help to start the process, and can help to empty the bladder completely. In some cases a catheter can be used, which is a tube fitted that leads directly to an external bag. This avoids accidents and can allow the patient to relax.
Bowel problemsThere are two extremes here; constipation and diarrhoea. Changes to diet can help, as can laxatives or anti-diarrhoea medication. Exercises can also be done to strengthen the rectal muscles and pelvic floor.
Speech and swallowing problemsFor problems with speech and swallowing, a language therapist can help. They can advise about the foods that are easier to swallow and give exercises to strengthen the muscles used in speech.
Multiple sclerosis is classified as an autoimmune disorder. Autoimmune disorders happen when the immune system malfunctions and begins to attack the body’s own tissues and organs.
In MS, the tissues being attacked are in the myelin sheath.
The myelin sheath is basically an electrical insulator that protects the nerve pathways in the central nervous system.
For more information about how MS works, see MS: A Deeper Dive
Medications are used to change the course of the disease and manage symptoms, but there is, as yet, no cure. Treatment for relapses in symptoms usually includes:
- A 5 day course of steroid tablets
- Steroid injections given in hospital for 3-5 days
Disease modifying therapies
Beta interferonsGiven by injection for relapsing and progressive MS. These can cause headaches, chills and mild fever. Interferons were first discovered and isolated in 1957 by Alick Isaacs and Jean Lindenmann. They exist in 3 forms, alpha, beta and gamma. Interferon beta acts as an immune suppressor, which helps to prevent other immune cells from becoming active. They suppress inflammation that can damage the myelin sheath. Interferons are produced naturally in the body to help fight infections, but interferon beta-1a is a man-made version, given to help the body to counter some of the damaging aspects of MS.
Glatiramer acetateBrand name: Copaxone – given by injection every day or 3 times a week for relapsing and active MS. Can cause redness of the skin and palpitations. GA was originally produced for research purposes, not for treatment. Researchers at the Weizmann Institute created it as a mimic for a protein found in myelin, to use in experiments into animal modes of MS. The researchers were surprised when GA suppressed the animal modes of MS, instead of making them worse. An important effect of GA is that it shifts certain cells from a pro-inflammatory pattern to an anti-inflammatory pattern.
TeriflunomideBrand name: Aubagio – a tablet taken once daily for relapsing and active MS. Can cause nausea, diarrhoea, hair thinning, problems with liver function. Aubagio is an immunomodulatory disease-modifying therapy that can reduce the number of relapses by about 30%. How it works is not fully understood, although it’s thought that it reduces the number of lymphocytes (white blood cells), which would cause inflammation that might damage the myelin sheath in the central nervous system.
NatalizumabBrand name: Tysabri – intravenous injection every 28 days for severe MS that’s getting worse quickly. Side effects are rare, but can include itch or rash, headaches, dizziness, joint pain, nausea. Natalizumab is a molecule inhibitor. It stops certain targeted immune cells from crossing through the blood-brain barrier and interfering with the central nervous system. By reducing the number of immune cells that cross into areas of the brain affected by MS, lesions are reduced.
FingolimodBrand name: Gilenya – a capsule taken once daily for relapsing MS, if your relapses haven’t responded to other medications like beta interferons. Sometimes causes headaches, diarrhoea, liver and visual problems. Fingolimod is derived from myriocin, found in the fungus Isaria singlairii. It is an immunomodulatory drug, which means that it helps to moderate the immune response that causes damaging inflammation in the central nervous system. It has been proven to reduce the rate of relapses in relapsing-remitting MS by 50% over 2 years.
AlemtuzumabBrand name: Lemtrada or Genzyme – a 2-course intravenous treatment starting once a day for 5 days, then followed-up a year later for 3 days. Used for relapsing and active MS, it may cause headaches, rashes and fever. Alemtuzumab is used in the treatment of certain types of leukaemia. It binds to a protein on the surface of certain white blood cells, which causes them to be destroyed. Available since 2013, it reduces the number of relapses in relapsing-remitting MS by about 70%.
Dimethyl fumarateBrand name: Tecfidera – tablet taken twice daily for relapsing and/or active MS. Can cause hot flushes, diarrhoea, nausea, abdominal pain, headaches. DMF has immune-modulatory properties. How it works is not exactly known, but it has been shown to reduce relapses in relapsing-remitting MS by 53%, and slow progressive MS by 38%.
The MS Society works hard to fund research and to provide support for people living with MS. You can contact their helpline any time between 9am and 7pm Monday – Friday.
0808 800 8000
You can also download their free e-booklet: For family and friends: when someone close to you has MS.