Auto-Immunity Attacks the Body by Mary E. Miller

Author:Mary E. Miller
Language: eng
Format: epub
Publisher: Momentum Press
Published: 2017-04-21T04:00:00+00:00

CHAPTER 3

Treatment and Therapy

Treatment and Therapy for Multiple Sclerosis

Currently there is no cure for MS, though several new drugs intended to modify disease progression or to treat the symptoms of the disease have been approved by the US Food and Drug Administration (FDA). In all cases, current treatments are preventative, not restorative. The best outcome would be to treat MS early with disease-modifying regimens so that permanent neural damage can be avoided. Once neuron death occurs, it cannot be repaired. FDA-approved treatments include three different forms of beta interferon (Avonex, Betaseron, and Rebif). Beta interferon is a type of cytokine, a signaling molecule that balances the pro- and anti-inflammatory signals in the brain and may inhibit the development of some types of T cells. Treatment with beta interferon reduces the duration of relapses, and slows the progression of physical disability, though it has exacerbated symptoms in some patients who had to discontinue using it. The FDA has also approved a man-made form of a protein that helps MBP function in the myelin called Copaxone (or copolymer I). Copolymer I may reduce the relapses for a patient by up to one-third. The same drug is also approved to treat patients diagnosed with CSI, but have not yet progressed to a diagnosis of MS. For relapsing forms of MS, the FDA has approved the MS drug Teriflunomid that inhibits the activation of some B and T cells, and dimethyl fumarate which alters cytokine production in lymphocytes and microglial neural support cells. Natalizumab is an antibody treatment that impedes inflammatory cells from entering the brain, reducing inflammation in the brain associated with MS. The immunosuppressant mitoxantrone (trade name Novantrone) is also FDA-approved to treat MS as it progresses to more advanced or chronic forms. Fingolimod exhibits some concerning side effects in clinical trials and is not recommended for initial treatment, but with careful monitoring, could be used as a secondary treatment regimen. Specific symptoms can also be helped through drug treatment. For example, difficulties in walking can be improved with dalfampridine (trade name Ampyra). Spasticity from chronic muscle stiffness or spasms can be treated with muscle relaxants such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene. Fatigue may be treated with amantadine (trade name Symmetrel) or pemoline (trade name Cylert). In all cases, the effectiveness varies among patients.

Physical therapy can have a positive impact on disease symptoms preserving functionality of muscles. In combination with physical aids such as canes, braces, and walkers, physical therapy can help patients maintain mobility. Too much activity and overheating appear to increase fatigue symptoms; so patients are advised to avoid both. Optic symptoms usually improve over time without drug intervention, though steroid treatments are sometimes effective. Depression can be treated with anti-depressants. In all cases of treatment, side effects exist and the possible benefits and side effects should be carefully discussed with physicians. Treatment approaches are influenced by the frequency and intensity of the relapses experienced by the patient whose more active and worsening symptoms would call for more aggressive treatments.

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