There is a lot of talk about research and medical advances in the treatment of multiple sclerosis, but I would like to return to the fundamentals of MS care and how these new treatment options fall into the framework of MS care.
There are three important arms of MS treatment:
1. Disease Modifying Agents - Medications that are used to change the course of MS, but which you may not feel any current effect from (though you may have side effects unfortunately), but are like an insurance policy for the future. There are 5 FDA approved medications for Relapsing forms of MS: Avonex®, Rebif®, Betaseron®, Copaxone® and Tysabri®. Novantrone® is a chemotherapy drug, also FDA approved for worsening relapsing MS or secondary progressive MS.
Most of the research you read about is aimed at disease modification: the oral medications (Cladribine, Fingolimod, Teriflunomide, BG00012, Laquinomod, etc.); the newer injectables (Atacicept etc.); the IV infusions (Rituximab, Ocrelizumab, Alemtuzumab, etc.); and the vaccine-type medications (Tovaxin, Neurovax, etc.).
2. Symptomatic treatment - This ranges from Western medicines to Complementary and Alternative Medicines to Acupuncture to Yoga and beyond. This is where the patient's expertise becomes even more important, because only you know your own body best, and we use our knowledge of what has worked for other patients combined with your preferences and prior experiences to help guide you in the right path for you.
Never forget that, you, as the patient, are the center of the MS Team (Multiple Sclerosis Team Approach Rule or M*STAR).
3. Rescue therapy - If you are having a relapse, these medications can help get you out of it faster. But, there can also be side effects, such as weight gain with steroids. Other treatments we sometimes use are Plasmapheresis (Plasma Exchange, similar to hemodialysis in that it cleans out your blood) and IVIG (IV Immunoglobulin), which is basically a blood product pooled from donors in the general population and uses the antibodies from their body to help you fight off MS.
If you are using too much of these types of medicines, then you may need to rethink your Disease Modifying Agent, as it may not be powerful enough for you (remember, everybody's MS is different).
As you can see, there is a lot for you and your neurologist to work together on, and by understanding these fundamentals, it can help you to keep up with scientific advances and to better direct your own care and remain the center of the MS Team.
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