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 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.
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.