Multiple sclerosis, or MS, is an autoimmune disease that affects the brain and spinal cord. While the exact cause is unknown, the leading theory suggests an unknown substance triggers the immune system, causing it to attack myelin, the fatty covering over the nerves.
As inflammation and myelin breakdown occur, scarring or sclerosis develops, interrupting nerve signals throughout the nervous system. The result is problems with vision, movement, thinking, muscle strength, and eventually disability.
Anyone can get MS, but it is two to three times more common in women between the ages of 20 and 50. MS also affects white people more often and is most common in areas farther from the equator, though not everyone in these locations has the same risk.
Some areas, like Canada and the Middle East, have a high or increasing prevalence of multiple sclerosis. In Canada, 250 per 100,000 people have multiple sclerosis, while Israel sees 141 cases per 100,000.
What Are Early Symptoms?
Multiple sclerosis is unpredictable and affects people differently. Relapsing-remitting MS causes acute symptoms with periods of remission, while other types may progress rapidly or slowly. Early MS might also be confused with other conditions. Symptoms include:
- Problems with vision
- Bowel or urinary problems
- Trouble thinking
- Numbness and tingling
- Slurred speech
What Are Current MS Treatments?
Treatment for MS is divided into two groups: treatment for relapse or flare-ups and long-term disease-modifying therapies. The type of treatment will depend on the severity of the MS and the general health and age.
Disease-modifying Therapies (DMT)
The goal of DMT is to slow down the progression of multiple sclerosis. These medications usually target the immune system and include:
- Immunomodulators: Medications that lower immune cell action, such as teriflunomide
- Monoclonal antibodies: Drugs that lower the frequency of attacks, like ocrelizumab
- Interferons: Proteins that shorten and reduce the severity of attacks, like interferon beta-1b or beta-1a
- Nrf2 activators: Drugs that lower inflammation and stop nerve damage, like dimethyl fumarate
- Glatiramer acetate: A drug that lowers relapse rates and severity of disease
Monoclonal antibodies, interferons, and glatiramer acetate are often the first treatments used. Studies suggest monoclonal antibodies are highly effective against MS, with a 49 to 69 percent reduction in annual relapse rate, depending on the drug. Some immunomodulators and Nrf2 activators are also moderately effective and lower the annual relapse rate by 48 to 60 percent.
Acute Relapse Treatment
The goal of acute relapse or flare-up treatment is to dampen or interrupt immune activity, which helps manage symptoms and slow attacks. The most common treatment is high-dose methylprednisone pulse therapy, which can improve symptoms within days. For steroid-refractory cases, plasmapheresis is effective, reducing symptoms by 66 to 86 percent.
What Are the Side Effects of Therapies?
All MS medications have side effects, most of which are flu-like symptoms or injection site reactions, though other, more severe side effects exist. Common adverse effects of DMT vary by the drug but can include:
- Allergic reaction
- Urinary tract infections
- Upper respiratory infections
- Elevated liver enzymes
- Low lymphocyte counts
Patients can manage minor side effects with over-the-counter medicines, but liver enzymes and lymphopenia should be monitored with blood work. Some drugs have less common but serious side effects with long-term use. For example, a known risk of monoclonal antibodies and immunomodulators is a rare, opportunistic brain infection from the John Cunningham virus. Some drugs may also have cancer and hepatotoxicity risks.
Common Patient Questions About MS
After a diagnosis, your patients will have questions. They may want to know the impact MS will have on their life, their prognosis, the treatments available, and the possible side effects. Patients may also seek your opinion, guidance, and even reassurance on the best treatment for their case.
An MS diagnosis can cause significant fear and anxiety for the patient and their family. The best approach to any questions is to offer a compassionate discussion about the disease and treatments available while giving the patient accurate facts. Discuss their options based on the current guidelines and the associated risks, and share your insight on the best course of action.
However, patient emotional needs may also extend beyond the limited time available in a clinical setting. Access to therapy, clinical nurse support, and support groups can help patients come to terms with their new diagnosis. Studies suggest patient support groups can help new MS patients gain positive perceptions.
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