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

Well are there any cons? Well in the first case scenario not many actually. The only cons I shall say are the ones associated with side-effects of interferon or other disease modifying therapies. Flu like symptoms associated with interferon therapy at times can be disabling but frequently do respond to analgesic/ antipyretic treatment. The other con, if I can mention it as a con, is the cost involved. Drugs are expensive and frequently a drain on family resources.

Let us now tread on some untested waters and go to case scenario 2.

Case scenario 2. Janet at the age of 29 consults a neurologist like me for loss of vision in one eye (optic neuritis). I examine her and determine that apart from optic neuritis, she has no other neurological deficits on examination. Her MRI of the brain shows no lesions, nor does her MRI of the cervical spine. A spinal tap is done to get more information but shows no features suggestive of MS. Now Janet has a clinically isolated syndrome (CIS) (you can read more about the same in my previous interview with Merely Me). Here the decision to start disease modifying therapies is not relatively straight forward and requires some thought and discussion between Janet and her physician. We now know that many patients with a CIS shall go on to develop MS if they are followed long enough. That said and done, some may not and we still cannot predict with certainty which will and which won't develop MS (many researches are looking into this to try to improve our odds in better diagnosing MS in the CIS group of patients). So in the above case both Janet and her physician have some thinking to do. Should she or should she not start interferons?

What are the pros for taking medications? Well if Janet does indeed have MS (meaning that the CIS leads to MS later on), we have caught the disease real early and can thus effectively slow its progression.

What are the cons for taking medications? Well if she does not go on to develop MS (if somehow we had a crystal ball and could predict the future) well then we have submitted Janet to an unnecessary medications with potential life-threatening side-effects.

I end by saying MS is a complicated disease and the decision to start therapy has to be individualized on a case by case basis.