Community Discussion: How do you make the decision about whether or not to take the MS medications?

Once you have gotten a diagnosis of Multiple Sclerosis the question will come up as to whether you will begin taking one of the disease modifying drugs to treat your disease. For many people this is not an easy decision to make.  There are pros and cons and also risks to the choice one makes whatever it may be.  I am going to be presenting you with a balanced (hopefully) series of posts of why some people do make the choice to take one of the MS drugs and also why some people choose to wait. 

Today I will be sharing an article written by my fellow blogger, Doctor Nitin Sethi, who has graciously agreed to contribute to this discussion with an article he wrote with the help of Amy Wasterlain.  Thank you both for your time and effort to create this article.

In the days ahead I will be posting about both perspectives of why some people choose to take the disease modifying drugs and why some people (like me) have chosen to wait.  I do hope you will join this discussion by sharing your own experiences here in the form of a comment or in a share post.

And now I present to you Doctor Sethi's article...

I have multiple sclerosis. Do I need to take MS medications? Discussing the pros and cons

Nitin K Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065

Amy Wasterlain

(Amy is currently applying for medical school and has helped me in putting this together)

Merely Me asked me to pen my thoughts about this. It is a question which crosses the mind of every MS patient and their caregivers at some point during their disease course. The decision of taking MS medications is one which requires consideration of multiple factors by both the patient as well as the treating physician. At times the decision to go on medications is relatively straight forward, at other times it requires consideration of multiple factors before deciding on the best course of action.

Let me try to explain this by using a 29-year-old patient whom we shall refer to as Janet.

Case scenario 1. Janet is diagnosed with MS at the age of 29 when she consults a neurologist like me for loss of vision in one eye (optic neuritis) and problems with balance and coordination (ataxia). Her clinical examination and history is compatible with a diagnosis of MS (please refer to my earlier interview where in I go over how a diagnosis of MS is secured). The MRI brain further reveals multiple MS lesions (we call them plaques). Now in this scenario the decision to go on MS medications (and by that I mean disease modifying therapies such as interferons) is relatively straight forward both for Janet as a patient and for me as her treating physician.

What are the pros? ---MANY-Interferons and other disease modifying therapies have the potential for modifying the natural course of her disease and reducing the number of attacks and hence neurological disability. Not just reducing but also delaying the disability thus ensuring a better quality of life. We now know that the earlier you treat patients like Janet the better it is in the long run because once the white matter tracts of the brain degenerate (we call this axonal degeneration), the neurological deficits (disability) are permanent. SO TREAT EARLY AND TREAT AGGRESSIVELY. Once this is communicated to Janet who is already significantly disabled, I imagine it shall not take much convincing for her to agree to start treatment.