Treating MS involves the consideration of many factors. The individual with MS, along with their healthcare team, should be at the centre of all decision-making. Friends and family can also play an important role throughout the treatment process. While the treatment goals and process may vary from person to person, it is most important for everyone to treat early, to treat regularly and to be aware of how they are responding to their MS treatments.
The following sections are designed to help provide information one can use in developing a treatment plan that works.
BEING YOUR OWN BEST ADVOCATE
People living with MS play an important role in making disease management decisions.
Taking care of one’s body and mind through rehabilitation and emotional support is a good start. To help with the important decisions along the way, individuals will interact with a broad team of healthcare professionals, including general practitioners, neurologists, pharmacists, nurses and others.
Benefits of early treatment
It is important to start treatment as early as possible after diagnosis
Studies suggest that relapses in the first two years can impact early disease progression.
Even in instances where disease activity may be going unnoticed, MS can continue to damage the central nervous system (CNS), leading individuals to experience new symptoms later on.
Once MS is identified, the goal is to reduce early disease activity – both the clinical symptoms (for example, numbness, tingling, vision impairment, etc.) and the underlying changes in the CNS that may not be readily apparent.
MS treatment plans vary from person to person because each individual's symptoms and treatment goals may be different. Once diagnosed with MS, it will be important to establish one's own personal treatment goals. Often, these may be developed through discussions and advice with healthcare professionals, family and friends.
Healthcare professionals will have certain treatment goals in mind:
- Reducing the frequency of relapses
- Slowing disability progression
- Managing symptoms
A person diagnosed with MS will have their own specific goals in mind:
- Improving quality of life
- Career aspirations
- Family life
- Managing symptoms
- Impact of their MS on family and friends
Personal treatment plan
Once treatment goals have been established, an individual and their healthcare professional may develop a personalized treatment plan that will likely consist of two parts:
1. The use of MS-specific therapies and treatments (which is explored in more detail in the sections below).
2. Additional therapies or treatments to help with symptoms that people may experience due to their MS are outlined in more detail in the LIVING WITH MS section.
How MS medication can help
There are many medicines available to help treat MS. Some are used to treat the underlying course of the disease by adjusting the way a person’s immune system is acting. Others focus on attempting to find ways around the problems MS can cause, and help patients regain some of the abilities it can affect.
MS therapies are effective in treating several areas of the disease:
IMMUNE SYSTEM ATTACKS
The immune system generally helps protect the body by attacking germs. In MS, the immune system becomes overactive or “unbalanced” and begins attacking the myelin sheath around nerve fibres in the brain and spinal cord.
MS medications seem to work by stopping the body’s immune system from attacking and damaging the myelin. The effect of stopping the immune system attack can help reduce the number of relapses and slow down the disabling effects of MS.
The good news is that not all relapses (attacks) require treatment. Mild sensory changes (numbness, pins-and-needle sensations) or bursts of fatigue that do not significantly impact a person’s activities can generally be left to get better on their own. For severe relapses involving loss of vision , severe weakness or poor balance – which interfere with a person’s mobility, safety or overall ability to function – most neurologists recommend treatment with corticosteroids.
- Corticosteroids are substances that work to actively contain the inflammation, which in turn helps to improve relapse symptoms and speed healing.
- They are usually given by an infusion or drip (which allows the medication to go directly into the bloodstream), with side effects that may include an upset stomach or difficulty sleeping.
- Used over short term (generally the treatment lasts three to five days), steroids are considered to be relatively safe by most practitioners.
- Other treatment options include: injections, infusions and oral pills.
MS patients have identified mobility as the most important function to maintain as the disease progresses. It is important to understand, record and identify how mobility affects the body (fatigue, muscle weakness, numbness, etc.).
Consulting with a doctor about a treatment that can help manage mobility symptoms is a proactive approach for adults living with MS.
Evaluating MS treatment options
With many different MS therapies available, finding one that is best suited to one’s needs means considering treatment goals and a plan that works.
As a starting point, here are a few things one might consider:
Effectiveness, side effects and safety
MS is a highly complex disease and affects everyone differently.
MS medications target the inflammatory process of MS and have been shown to slow the natural course of the disease. MS medications have been evaluated for their impact on reducing the frequency and severity of relapses; reducing the number of new lesions in the brain and spinal cord as seen on MRI; and slowing down the accumulation of disability.
Each therapy is unique and comes with its own safety and side effect considerations. The benefits and risks of each of the treatment choices should form part of the discussion that is had with the MS team.
Types, forms and frequency of medication
When evaluating treatment options, there are choices between different types of medication, different forms of medication, and the frequency in which the medication is taken.
TYPES OF MEDICATIONS
Currently, there are a number of medication types being produced by several companies that have been approved for use in the treatment of MS in Canada.
BETASERON® (interferon beta-1b)
AVONEX® (interferon beta-1a)
PLEGRIDY® (peginterferon beta-1a)
TECFIDERA™ (dimethyl fumarate)
EMD Serono Canada Inc.
REBIF® (interferon beta-1a)
EXTAVIA® (interferon beta-1b)
Teva Pharmaceutical Industries Ltd
COPAXONE® (glatiramer acetate)
FORMS OF THERAPY
For relapsing-remitting MS, the 3 most common ways therapies are administered:
Pills, also known as oral medications, are a more recent development in RMS treatment. They can be an effective alternative to infusions and injections. If you don’t like the sight of needles, this may be an option worth considering with your doctor.
MEDICAL PLANS AND INSURANCE
Different people have different levels of medical coverage that may cover all or part of the costs associated with their MS treatment.
- Private insurance
The Biogen ONE ™ Support Program can help determine insurance eligibility, facilitate insurance authorizations and explore options for additional reimbursement support as necessary.
MS is typically diagnosed when a person is between the ages of 20 to 40 years old, the family building years.
If someone living with MS is planning on starting a family, it is important to evaluate information pertaining to how MS treatments could affect pregnancy.
Biogen has developed a helpful guide that helps to answer many of the questions some may have.
CLICK HERE TO DOWNLOAD
Most people with MS can travel safely with some advanced research and planning. Staying active is beneficial and travel is a good way to get out and get moving.
Those living with MS might want to consider potential side effects and the need for a schedule (frequency of treatment). Having a discussion with a doctor can help establish whether safe travel travel with medications is possible and what preparations might need to be made before leaving.
Getting the most out of a treatment plan
It is important to remember that MS medications are designed to reduce the basic disease activity.
With treatment, the progress of MS may be slowed down, possibly leading to fewer relapses or a reduction in symptoms. Many may not be able to feel them working at all (as they are working behind the scenes to help slow disease), but sticking to a treatment plan is the best possible strategy for managing MS.
However, taking medication to treat MS regularly over a long period of time can be challenging. It is important to understand the role of medication in the overall MS treatment plan, and to be aware of the obstacles that can most often interfere with sticking to that plan.
Staying on track involves several key elements: remembering when to take medicine, monitoring symptoms over time, recording relapses, dealing with medication fatigue and injection techniques.
REMEMBERING WHEN TO TAKE MEDICATION
- It may help to take medication along with another daily activity, such as meal time or when teeth are brushed
- Setting a reminder on a smartphone that goes off at the same time each day, or making a note on a calendar
There are many widely available smartphone apps that can help with remembering when to take medication
- Keep a journal of MS symptoms. Write in it every day or just when new symptoms appear. This journal will be helpful when discussing a treatment plan with a healthcare team
There are many widely available smartphone apps that can help with the recording of symptom occurrences that can be found on iTunes or Google Play.
Sometimes a person may feel fine but later experience an episode of worsening symptoms
- These episodes are called relapses or attacks, and they may reveal important information about the status of someone with MS.
- It is important to keep track of when these relapses occur, how long they last and what symptoms are experienced. By doing so, doctors can learn what is happening.
Injections are a common form of administration of MS medications, and fear or anxiety related to injections has often been a common concern shared by the MS community.
Education about injection techniques, and about what the patient can reasonably expect from therapy, is a key strategy to successfully following a treatment plan.
Information about injection techniques can be obtained from healthcare professionals or support programs such as Biogen ONE™ .
Consequences of leaving MS unchecked
If left untreated, MS could eventually become what is called “secondary progressive MS.” In secondary progressive MS, a person’s level of disability steadily decreases, and people with secondary progressive MS do not tend to recover completely from a relapse.