Current treatment options for multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects approximately 400,000 people in the United States.  Caused by damage to the myelin sheath – the protective coating of the nerves in the brain – MS is marked by an array of symptoms, including muscle spasms, loss of vision and difficulty moving arms and legs.

While there is no cure for MS, there are various treatments available for those suffering from the disease.  Dr. Michael Devereaux, a neurologist for University Hospitals Case Medical Center, spoke with about the many options for MS patients looking for symptom relief.  According to him, there are two main goals when it comes to treating MS.

“One is treating the acute attacks,” Devereaux said.  “And then, what you’re really interested in even more is reducing the frequency of attacks and reducing overall disability over time.  That’s been a harder to question to answer from studies and the like, because all the drugs are promoting the idea that they can reduce frequency and overall disability, but there’s been some debate about that.”

Modifying the disease

During MS, white blood cells, called T-cells, become activated and cross the blood-brain barrier into the brain.  While there, they cause an inflammatory response, ultimately damaging the myelin sheath and destroying the axons of the nerves.

Various drugs, called immunologeratory agents, have been developed to dampen the inflammatory response for those with relapsing-remitting MS.  The main injectable drugs include beta interferons (Avonex, Betaseron, Extavia), glatiramer acetate (Copaxone), and the somewhat controversial drug, natalizumab (Tysabri)

“Tysabri has been in the news a lot because it led to breakouts of another condition – progressive multifocal encephalopathy (PML),” Devereaux said.  “It’s a very small percentage of cases. It’s often given to people not doing well.  It’s highly effective, but it has this significant, but small, real risk.”

The last agent is an oral agent called fingolimod (Gilenya), and is the most convenient for patients, according to Devereaux.

Treating MS attacks

MS is marked by periods of remission, alternating with periods of mild to severe exacerbations.  While the agents are used to prevent these flare-ups, there are also treatment options for when exacerbations do occur.  The main treatment is to give patients a high dose of glucocorticosteroids

“There are different protocols for giving it,” Devereaux said.  “They’re often given through IV. Most hospitals have an outpatient service, so you can have at home therapy.  We’ll send a nurse out and actually administer the medication in the home.  That’s done for three days in a row.”

According to the Mayo Clinic, severe symptoms of MS can be treated with plasmapheresis – or plasma exchange.  This procedure actually separates the blood from the plasma - the liquid part of the blood.

Physical therapy and other medications

Most treatment for MS involves managing symptoms. Because MS patients often suffer from muscle spasms and muscle pain, physical therapy can be a very useful tool to help strengthen muscle tissue.

“Strengthening those muscles can be important,” Devereaux said.  “There are various exercises.  For example, one I like a lot is water jogging for people with walking and gait problems.”

Along with physical therapy and exercise, there are a variety of medications patients can take to find relief from their symptoms.

“Some of the common things we treat is spasticity, and there medications that loosen the muscles up so it makes it easier to walk,” Dr. Fred Lublin, a professor of neurology at Mt. Sinai School of Medicine, told  “There are medications to help bladders, because some have a neurogenic bladder – which makes them go too much or not enough.”

Both Lublin and Devereaux noted that depression is fairly common for those with MS, so medications for depression, along with emotional therapy, can be very beneficial.

The future of MS treatment

Many researchers across the world are working to find new approaches to treating MS, if not ultimately a cure.  A recent study published in the Journal of Neuroscience, revealed the potential for a ‘one-size-fits-all’ drug that could treat not just MS, but Alzheimer’s, brain injury, and other neurological disorders as well.

“Our next big expansion is oral medications,” Lublin said. “Much of what we use is injectable.  We have one pill that is available now.  We have two more pills that are in the hands of the FDA that we should be hearing about very soon.  And the pills are very effective and will be a nice substitute for injections.”

Lublin said researchers are hoping to go even further from developing more oral medications.

“Our two main goals are medications for progressive forms of MS,” the most severe forms of MS, Lublin said.  Right after that, I’m looking for agents that will repair the damaged nerve system, through stem cells and other repair mechanisms.  That’s very exciting and important, because if we even stop all attacks, we still have individuals with damage to the nervous system.  That’s not just for MS, but that’s for all neurological disease.”

Devereaux said he is optimistic about the future of MS research, given the remarkable state of MS treatment today.

“The future of MS, like all futures, is based on the past,” Devereaux said. “There has been a very rapid evolution of understanding of what the condition is, which is ultimately going to lead to new treatment.  I do think that it is ultimately curable disease, if not at least a highly-effectively treatable disease.  It’s just going to continue to improve.”