Multiple sclerosis

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Multiple sclerosis is a chronic neurological disorder that affects the central nervous system, especially brain, spinal cord and optic nerves. Multiple sclerosis causes problems in strength and muscle control, vision, balance, sensitivity and disorders of mental function.
Brain, spinal cord and optic nerves are connected by nerves and nerve fibers. A protein coating called myelin surrounds and protects nerve fibers. When myelin becomes inflamed or is destroyed (a process called demyelination) result is disruption of normal flow of nerve impulses to the central nervous system. The process of demyelination and its consequence, stopping the flow of nerve impulses, is a disease known as multiple sclerosis.
Tissue damage, called lesions or plaques, are formed in areas of demyelination. In many cases, the cells (oligodendrocytes) that synthesize myelin is destroyed, as nerve fibers (axons). In this situation, the body is unable to restore the layer of myelin or the nerve fibers, which will contribute more to the disability.
Multiple sclerosis may develop one of four ways:
- Relapse-remission, when symptoms may diminish and then recur at random for many years
- Secondary progressive, which initially follows a relapse-remitting type evolution, and later, the disease is steadily progressive
- Primary progressive, where the disease has a progressive evolution from the beginning
- Progressive relapse when steady deterioration of nerve function begins with the first appearance of symptoms, the symptoms come and go but nerve damage is continuous.


The cause of multiple sclerosis (MS) is unknown. It may be a genetic factor involved, because the risk of multiple sclerosis in a person is slightly increased if one parent has MS.
The connection, not always obvious, between the place(geographically) where the individual was born and raised and the risk of developing multiple sclerosis later in life, suggests that there may be some environmental factors involved, such as viral infections or other infectious diseases. However, so far there was not clearly demonstrated that some specific infection would cause multiple sclerosis. And other factors were suspected to trigger multiple sclerosis, but so far it was not demonstrated that either of them would certainly be involved.
In addition, a viral disease that appears in childhood or other environmental factor per se, may not sufficiently explain why some people will do later MS. Research studies in progress, suggests that a problem in the body’s natural defenses (immune system), released early in childhood or after infection, can trigger the onset of multiple sclerosis. The trigger may be an autoimmune reaction where the immune system attacks myelin, the protein coat that protects nerve fibers.


Symptoms of MS vary from person to person, depending on what part of the brain or spinal cord (central nervous system) is affected. Loss of myelin and scarring caused by multiple sclerosis can affect any region of the central nervous system.
Symptoms may come and go or become more or less severe from day to day or, more rarely, from hour to hour. Symptoms become more severe with increasing (or less commonly, decreased) body temperature or after a viral infection.
Some symptoms of multiple sclerosis, such as spastic tremor, pain and difficulty in thinking clearly, are similar to those occurring in other diseases and does not necessarily mean it is multiple sclerosis.
Early symptoms (debut)
The most common early symptoms of multiple sclerosis are:
- Muscle or motor symptoms such as weakness, leg dragging, stiffness, tendency to drop things, feeling of heaviness, clumsiness or awkwardness or lack of coordination of movements (ataxia)
- Visual symptoms such as blurred vision, dark spots or blurred, eye pain (especially in their movements), blindness or double vision
- Optic neuritis, which involves the sudden loss of vision and eye pain, is a fairly common manifestation of disease onset, occurring in up to 23% of people with multiple sclerosis
- Sensory symptoms such as tingling, the sensation of needle pricks, numbness, a grip that feels like a tape around the body or legs or electrical sensations moving along the back up and down.
Early symptoms less common:
- Symptoms of balance, like feeling of dizziness or light head and the feeling that everything is spinning around (vertigo)
- Bladder symptoms such as inability to hold urine (urinary incontinence) or to completely empty the bladder or loss of sensation of urination (inability to feel as your bladder is full, until a sudden need, urgency of urine).
Symptoms when the disease progresses

As MS progresses, symptoms become more severe and may include:
- Increased muscle difficulties, such as weakness, leg dragging, clumsiness, awkwardness or lack of coordination
- Rigid movements, mechanical (spasticity) and tremors can not be controlled, which can make walking difficult, may need a wheelchair sometimes or always
- Pain or sensory symptoms
- Incontinence, or seldom, an inability to urinate (urinary retention)
- Constipation and other bowel disorders
- In men, erectile dysfunction (impotence)
- In women, sexual dysfunction
- Cognitive and emotional problems common in people with multiple sclerosis more time:
- Cognitive problems and memory loss, difficulty concentrating, decreased attention and difficulty in finding appropriate words
- Emotional symptoms such as depression, anxiety and anger, a rare symptom is excessive cheerfulness that seems inappropriate.

Physiopathogenic mechanism

In general, multiple sclerosis can evolve in one of the four ways, which are called:
- Relapse-remission: evolution consists of alternating periods of active disease when symptoms flare, with periods in which symptoms improve; this cycle can last for many years; in periods of remission, the disease does not progresse
- Secondary progressive: active symptoms are steadily progressive multiple sclerosis, with further damage to central nervous system; symptoms usually worsen as the disease progresses
- Primary progressive: the disease is progressive from the beginning, although the degradation rates of central nervous system differs from person to person and vary the same person; this way of development of multiple sclerosis is very common, but can be devastating
- Progressive relapse: is a rare form of evolution of multiple sclerosis, which causes constant nerve damage, which begins once the first symptoms appear and continues to affect the central nervous system even when there are no symptoms.
Many people with MS have a trend to follow exactly one of these models. Evolution is often difficult to predict. Not only varies from person to person, but the way of evolution in the same individual may change over time.
MS tends to be more severe in men than in women, particularly in middle-aged men who develop the disease.
Usually, multiple sclerosis progresses with more episodes of relapse that occur over several years (such as multiple sclerosis relapsing-remission). In many people, the first episode of multiple sclerosis is only one symptom. It may take several weeks, months or years until a relapse. As time passes, symptoms may linger after each relapse so that it loses the power of complete recovery after the relapse episode. New symptoms occur often as other areas of the brain or spinal cord are affected.
Events that may indicate that it may be a more severe evolution of multiple sclerosis are:
- Frequent relapses in the first few years of disease
- Incomplete recovery between episodes
- Early motor difficulties, persistent, that affects movement
- Numerous “silent” injuries that can be pointed to MRI (magnetic resonance imaging), lesions that do not seem to be causing symptoms at present.
Duration of illness varies. Most people with MS live with it for decades. Although people affected by multiple sclerosis often develop various disabilities while the disease itself is rarely life threatening and may not directly reduce the natural duration of life of the person.
Most people have a relapse-remitting type evolution, after about 10 years, about half of them will have a secondary progressive evolution type. Primary progressive MS occurs in a small number of people in all those with this condition.
Some people have only a few mild episodes with complete cure. This form is called benign multiple sclerosis.
Although rare, though a small number of people die within months of onset. This form is called malignant or fulminant MS.


Complications that can result from multiple sclerosis are:
- Urinary tract infections (UTI): people with multiple sclerosis often have urinary problems, and inability to control urination or to remove urine and these difficulties increase the risk of UTI
- Constipation: slow intestinal motility and intestinal spasms, and decreased physical activity are common in people with multiple sclerosis and can cause constipation
- Painful pressure points: they occur when a person is forced to stay in bed for long periods of time, especially if they are unable to change their position
- Decreased ability to move or walk, which involves using a wheelchair all the time or from time to time.
MS should not interfere with most health care procedures, applied routinely, such as dental anesthesia, general anesthesia (unless that person has breathing problems) or immunizations, such as the flu. However, it is unclear whether the flu vaccine administered as nasal spray (flu mist) can be used safely in people with multiple sclerosis.
Because MS may affect the ability of movement and travel, may limit daily activities, especially as he ages. Many people with MS have different degrees of disability, but this is not always severe or constant. In a recent study on aging persons with multiple sclerosis, one third of them maintained their place of work and two thirds were to go to 25 years after onset.
If someone has multiple sclerosis, is indicated that those closest to him talk to the doctor about how this disease can affect everyday life. More complete knowledge of the ways of evolution and possible complications will be useful in developing future plans.

Risk Factors

The risk of multiple sclerosis increases according to:
- Geographic location, or place where the person grew (up to 15 years): people who lived the first 15 years in a cooler climate regions, i.e. those that are more distant from the equator are more likely to make multiple sclerosis than people who lived in regions near the equator during these years
- If there were cases of multiple sclerosis in family: people who have a parent or relative rank first (including a monozygotic twin brother) with multiple sclerosis have a slightly increased risk to the disease
- Race: people living in Western Europe for several generations, have a higher probability of developing multiple sclerosis; is uncommon in Native Americans (American Indians), Eskimos and African
- Sex: Multiple sclerosis is approximately three times more common in women than in men.

Consult a specialist

Some of the symptoms of multiple sclerosis are similar to those found in many other conditions. See your doctor if, for a longer period of time is present at least one of the following symptoms:
- Blurred vision, dark spots, eye pain, loss of vision or double vision
- Feeling of weakness or heaviness, involuntary leg dragging, stiffness, difficulty walking and awkwardness / clumsiness
- Tingling or stinging sensation of the needle, numbness, feelings like the tightening of the belt around the body, arms or legs
- As electric shock sensations moving along the back, to the arms or down to the feet
- Inability to hold urine or to completely empty the bladder
- Dizziness
- Instability, feeling groggy
- Memory problems, decreased attention span, difficulty finding appropriate words or difficulty solving everyday problems.
If a person was diagnosed with multiple sclerosis, you should consult your doctor if:
- Episodes of active symptoms have become more frequent or more severe
- New symptoms appeared, that wasn’t present before
- Symptoms that are already undergoing suffered a significant change.

Watchful waiting

Mild symptoms of multiple sclerosis may be caused by many other illnesses and can appear in healthy individuals. For example, many people experience minor numbness in fingers or slight dizziness periods from time to time.
Stiffness and weakness may occur when a person is more active than usual.
Watchful waiting is appropriate for these types of pain that occur daily. If symptoms become more frequent or don’t disappear, see your physician.
Recommendations for people with multiple sclerosis

It is recommended that the affected person to have a discussion with the doctor to be informed about the expectations he may have in this situation, about the possible evolution and about the treatment. Multiple sclerosis is a disease that can not be predictable, but the person must have an idea about what is normal and what symptoms or problems are cause for concern.
Some people with multiple sclerosis need active support, from their doctor regularly. Others will cope with their situation alone, as much as possible. For the latter, it is advisable to inform about the signs or symptoms that require medical attention and seek help when needed.
Living with multiple sclerosis

Recommended medical specialists

Health professionals who can evaluate symptoms of multiple sclerosis and can treat it are:
- General practitioners or interns: Ask your doctor when symptoms first appear; he will recommend a neurological consultation if necessary, to a person with MS, General practitioners or interns can treat general health problems, while neurologistis in charge of treatment of multiple sclerosis
- Neurologists doctors: neurologist can decide whether the symptoms are caused by multiple sclerosis and may determine with the person in question what is the best treatment for this.
Many university medical centers and large hospitals have departments or work centers where neurologists and other medical professionals specialize in diagnosing and treating multiple sclerosis and may be able to provide the most complete evaluation.
A person diagnosed with MS may need at some point the help of:
- Physical therapist who provides assistance with the exercises needed to maintain body strength and flexibility and teach the person how to deal with the difficulties of moving
- Therapist specializing in occupational therapy, which can help identify ways of accomplishing daily activities if MS has caused physical deficits
- Speech therapist that can help improve speech, breathing and mastication when MS affects the face and neck muscles
- Psychologist or psychiatrist who can help the person in question to deal with pain, maintain physical strength and mental and physical and to adapt with the physical disability; a psychiatrist can evaluate and treat depression, anxiety or other mood disorders and memory problems and concentration, if present
- Pain management specialist who can help in case of significant chronic pain that may occur in some people with multiple sclerosis, it may offer help in finding solutions for pain relief, when possible, or patient support in acquiring the ability to cope with pain when it does not disappear
- Neurosurgeon, to carry out surgery if there is a severe tremor or spasticity


A diagnosis of multiple sclerosis is not always easy. It may take some time from first symptoms until the diagnosis is confirmed.
MS is diagnosed when neurological tests and neurological examination clearly reveals the presence of lesions in more than one area of the central nervous system (usually in the brain and spinal cord) and the injury occurred in more than one time in life .
The diagnosis of multiple sclerosis is confirmed if there is an association between these conditions:
- Two distinct episodes of neurological symptoms such as weakness or clumsiness, vision problems, tingling or numbness or balance disorders, which are objectified by a neurologist; each episode must have a duration of at least 24 hours and episodes must occur at different moments
- Symptoms that indicate the existence of lesions in more than one region of the central nervous system and laboratory tests that show abnormalities corresponding MS
- Is sure that there is not another condition that can cause these symptoms and the laboratory results
Medical history and neurological examination can identify possible nervous system problems and are often sufficient to suggest the diagnosis of multiple sclerosis. Tests can help confirm or exclude this diagnosis, if only history and neurological examination can not clearly support the existence of this disease.
Tests used to diagnose multiple sclerosis
Urine tests may be needed to diagnose a problem in controlling bladder function in a person with multiple sclerosis.
Neuropsychological tests can be useful to identify thinking or emotional problems that may be present without the person to notice them. Typically, these tests are in the form of questions and answers.
Currently studies are related to a new test, which consists in identifying antibodies in multiple sclerosis; hope is that it might help identify people who will develop active multiple sclerosis after a first episode of symptoms. If this test will prove to be effective, it can help diagnose active multiple sclerosis.
It is important that the person already diagnosed with multiple sclerosis to be reviewed if new problems arise. New symptoms may be caused by other conditions treatable rather than multiple sclerosis or may be a signal to a shift of the disease that could affect treatment decisions.


Treatment can significantly ease the lives of people with multiple sclerosis. The type of treatment depends on severity of symptoms and if the disease is active or in remission phase.
Although with the current treatment, multiple sclerosis can not be cured, though drugs can reduce the number, frequency and severity of relapses and may slow disease progression. Starting the treatment as soon as possible after a diagnosis of multiple sclerosis may prevent or delay the appearance of permanent injury to the nervous system.
Drugs can cause uncomfortable side effects, but usually temporary, such as flu-like symptoms. However, after several months of treatment, most people no longer has side effects due to drugs.
Rehabilitation, consisting of Physiotherapy, occupational, speech and cognitive therapy, that may help the individual cope with symptoms and learn to adapt to situations of daily life and work.
Alternative and complementary therapies can be used in multiple sclerosis are still studied, but so far none has proven to be effective, sometimes even could cause more harm than good.
Initial treatment

In an attempt to slow the progression of multiple sclerosis, drug therapy is recommended as soon after the diagnostic with multiple sclerosis relapse-remitting type. Results obtained from clinical trials showed that people treated immediately after being diagnosed with multiple sclerosis have better outcomes than those that the starting of the treatment was delayed.
In the early stages of the disease can be permanently damaged the nervous system. Early treatment can help prevent or delay at least part of this damage. There are now three types of approved drugs that can reduce the frequency of relapses and probably may slow progression of multiple sclerosis.
This treatment is called disease modifying therapy and includes the following drugs:
- Interferon beta (Avonex, Betaferon and Rebif)
- Glatiramer acetate (Copaxone).
- Mitoxantrone (Novantrone, Onkotrone).
Interferon beta and glatiramer acetate suppress or affect the immune system. This treatment is based on the assumption that MS is an autoimmune disorder that arises from an abnormal immune system response, which consists of attacking normal tissues of the body, in this case, targeting the myelin that insulates nerve fibers.
Although these drugs can not cure MS, they can reduce the total number, frequency and severity of relapses in some people with multiple sclerosis relapse-remitting type. They can also reduce or delay the development of disability associated with this type of multiple sclerosis. Betaferon and Novantrone may also slow disease progression in some people with secondary progressive multiple sclerosis type. If a person decides at some time not to follow the disease modifying therapy ,is recommended to work with the doctor regularly to assess whether the disease has advanced.
Physiotherapy, occupational therapy and non-drug treatment made at home, can help the person in question to deal with symptoms and adapt to professional and everyday situations.


Clinical trial results have shown that people who begin treatment after being diagnosed with multiple sclerosis have better outcomes than those who delayed treatment.
However, drug administration has some disadvantages. Decision is difficult for many people with multiple sclerosis. Some prefer to wait to see if symptoms develop before deciding to start treatment.
A small percentage of people diagnosed with multiple sclerosis may have a few mild episodes in life and never develop a disability, but can not yet know who will be part of this category.
Maintenance treatment

A person diagnosed with multiple sclerosis may require treatment with interferon beta or glatiramer (or perhaps mitoxantrone) on an undetermined period of time.
The three types of medications approved to treat multiple sclerosis, which are part of disease modifying therapy, are:
- Interferon beta (Avonex, Betaferon and Rebif)
- Glatiramer acetate (Copaxone)
- Mitoxantrone (Novantrone).
These drugs suppress or affect the immune system. There are data suggesting that multiple sclerosis is an autoimmune disease, that being a condition where the immune system attacks normal body tissues; in multiple sclerosis myelin is attacked.
You can also manage other drugs during periods of relapse.
Corticosteroids are often used to shorten relapses and reduce their severity. However, corticosteroids can prevent permanent disability due to multiple sclerosis and could not have been shown to prevent or delay disease progression.
If the person refuses to follow disease modifying therapy is indicated for him to continue working with your doctor to be evaluated the periodically progression. If new lesions occur or if old lesions extend, the decision may be reconsidered and begin treatment.
The person must establish a program with the doctor for regular consultations, monitoring and treating the symptoms and for monitoring the evolution. Monitoring may be useful to see if at some point would be better another treatment.
Physiotherapy, occupational therapy and non-drug treatment made at home, can help the person in question to deal with symptoms and adapt to professional and everyday situations.

Treatment if the condition gets worse

Medications should relieve symptoms of multiple sclerosis that causes discomfort and disability.
Symptoms such as spasticity (strained muscles), pain, fatigue, tremor, depression, sexual disorders and bladder problems, often respond well to medication.
Physiotherapy, occupational therapy and non-drug treatment made at home, can help the person in question to deal with symptoms and adapt to professional and everyday situations.

End of life issues

In rare cases, multiple sclerosis can be life threatening. If the patient’s condition worsens considerably, he may wish to make a will in which to express his wishes regarding the provision of medical care that others need to remember when being in the situation where the person may not be able to make decisions.

Home treatment

It is important that the person with MS to find ways to deal with practical and emotional needs of this condition. They vary from person to person, so the needs that must be satisfied by the outpatient treatment varies.
Outpatient treatment may consist in providing solutions to make housework easier to cope with depression or specific symptoms and gain support from friends and family members.
In this respect we recommend the following:
- Change the family environment or make adjustments in their professional activity; also may be useful to adapt the daily program, so daily life can be less stressful or tiring; tiredness is a common problem in people with multiple sclerosis
- Healthy diet rich in fruits, vegetables, seeds, grains, chicken, fish, lean meats and dairy products low in fat, so eating a balanced diet is recommended for people with multiple sclerosis, and also to most healthy adults
- Get regular exercise, either alone or with a physical therapist; if the person wants to do some exercises, it is advisable to ask the doctor or physical therapist the moves that are appropriate to his situation
- Urinary problems: at some point, most people with MS have problems with bladder, which may consist in the difficulty to maintain or eliminate urine or a combination of these problems; your doctor may prescribe a drug that can be useful and help implement a program of fluid intake and activity, so a person can reach the toilet in time when they feel the sensation of urination
- Changes in the type of food if swallowing difficulties are present, frequently in advanced multiple sclerosis
- More consistent drinks are easier to swallow; you can consume milkshakes or fruit gelatin form
- Avoid foods like crackers or cakes that crumble easily (the person may choke)
- Soft foods that are easy to chew; you can use a blender to prepare food that can be chewed easily
- Eating frequent meals in small amounts to avoid fatigue caused by eating some big meals
- Physiotherapy, occupational therapy and non-drug treatment made at home, can help the person in question to deal with symptoms and adapt to professional and everyday situations

Rehabilitation of persons with multiple sclerosis

Person with MS is advised to make every effort to maintain their health. A healthy diet, rest, intelligent use of energy and practical and emotional support from family members, friends and the doctor can be extremely useful.


Recommended drugs in multiple sclerosis can be used:
- During a relapse, to decrease the duration and severity of the episode
- Long time to influence the natural history of disease (disease modifying therapy)
- To control specific symptoms when they occur

Treatment of relapses

Medications can shorten a sudden relapse and may help in getting a faster recovery. Temporary treatment with medications called corticosteroids is the most commonly used to control a relapse. It was shown that these drugs could influence the evolution of long-term illness or would prevent the emerging of the disability

Disease modifying therapy

Well-documented studies suggest that multiple sclerosis is caused by the action of the immune system, which caused an inflammation and attack myelin (nerve sheath and nerve fibers). Drugs that modify the immune system can reduce the number and severity of episodes that alter the protective myelin.
Currently, interferon beta (Avonex or Rebif or Betaferon), glatiramer acetate (Copaxone) and mitoxantrone (Novantrone) are the only drugs approved for this purpose. In people with multiple sclerosis relapse-remitting type, these drugs can decrease the number and severity of relapses and can lead to a smaller number of brain lesions. They also can delay the appearance of disability in some people.
Betaferon and Novantrone may delay disease progression in some people with secondary progressive multiple sclerosis type.
Primary progressive multiple sclerosis type: currently, there is no effective disease modifying treatment in primary progressive multiple sclerosis type.
Type of relapse-remitting multiple sclerosis: drugs used to reduce the number and severity of relapses and probably delaying the appearanceof the disability are:
- Interferon beta (Avonex, Rebif or Betaferon)
- Glatiramer acetate (Copaxone)
- Mitoxantrone (Novantrone).
Type of secondary progressive multiple sclerosis: the recommended drugs for the treatment of this type, and possibly for delaying disease progression include:
- Interferon beta-1b (Betaferon)
- Mitoxantrone (Novantrone).


Treating specific symptoms can be effective, even if you can not stop disease progression.
Symptoms that can often be controlled or improved with medication are:
- Fatigue: drugs that reduce fatigue or that may be helpful in improving sleep can be amantadine (Viregyt) or fluoxetine (Prozac)
- Muscle stiffness (spasticity) and tremors: drugs that can relieve muscle spasms or stiffness are baclofen (Lioresal, Baclofen), dantrolene (Dantrium), gabapentin (Neurontin), diazepam or clonazepam (Rivotril); sometimes a combination of these drugs has very good result in reducing the symptoms of muscle
- Constipation and urinary problems: drugs used to reduce frequent urination may be propantheline (Pro-Banthine), oxybutynin (Ditropan) or tolterodine (Detrol); to relieve constipation can be used daily laxatives
- Pain and abnormal sensations: depending on the severity of pain, can be used both drugs obtained by prescription, and over the counter; prescription drugs obtained frequently used to relieve pain in multiple sclerosis are baclofen (Baclofen, Lioresal), carbamazepine ( Carbamazepine, Finlepsin, Neurotop, Taver, Tegretol, Timonil, Stazepine) or gabapentin (Neurontin); nonprescription medicines can be acetaminophen (Tylenol), ibuprofen or naproxen sodium
- Depression: antidepressants can be used to decrease depression, which is common in people with multiple sclerosis; are often used antidepressants – such as amitriptyline, desipramine (Norpramin) and imipramine (Antideprin) – or selective serotonin reuptake inhibitors, SSRIs or SSRI – such as fluoxetine (Prozac) or sertraline (Zoloft) and others
- Sexual difficulties: drug indicated for this purpose is sildenafil (Viagra), both women and men; Yohimbine and clomipramine (Anafranil) are also shown to improve erectile dysfunction (impotence).
MS may affect more regions of the nervous system, producing a wide range of symptoms. Choice of drugs depends on the existing symptoms.
Medications may be used only occasionally or regularly, depending on how severe or constant is a specific symptom.
Changes in diet, daily routine, moderate exercise and other habits, can also be useful to the person concerned to handle some of these symptoms.
Medications used to treat an episode of multiple sclerosis symptoms and for faster recovery from a relapse are:
- Corticosteroids (such as methylprednisolone)
- ACTH (adrenocorticotropic hormone)
- Intravenous immunoglobulin (IVIG) or plasma preparations (none is used frequently).

Drugs in experimental stage

Have been tried in treating multiple sclerosis a variety of immunosuppressive drugs and other medications and biological chemicals (derived from or identical to substances made by the body). Although none of them is certainly proved to be beneficial in multiple sclerosis, and none have been approved to manage this condition, however they can be used if standard therapies fail. Some of them are currently being tested in clinical trials. Some people with MS who have failed standard therapy choose to take part in these studies.


Long-term treatment with interferon beta and glatiramer acetate can improve quality of life of people with some type of relapse-remitting multiple sclerosis, making relapses less frequent and less severe.
Some studies suggest that these drugs can also reduce or delay the appearance of the disability caused by this form of disease.
National Multiple Sclerosis Society of the United States recommended that treatment with interferon beta or glatiramer acetate be initiated immediately after the diagnosis of multiple sclerosis is made with certainty. Most neurologists support this recommendation and now agree that permanent damage to the nervous system may occur earlier, even if symptoms are still quite mild. Early treatment can prevent or delay the appearance of some of the damage. Generally, treatment is recommended until it is clear that has no benefit anymore.
Despite the recommendation, however, some people may find difficult the decision to begin to follow a disease modifying therapy, especially when their symptoms were mild. Some may refuse to bear the risks and side effects of interferon like influenza status if they are not sure if treatment is needed. Others might like to see if their condition worsens before starting therapy. A small percentage of people diagnosed with multiple sclerosis may not have only a few mild episodes in their lifetime and may never develop any disability, but the disease can not be predictable.

Recommendations for disease modifying therapy
If the person decides not to follow disease modifying therapy, is advised to work with the doctor, so that his health will be monitored through regular examinations and MRI’s done routinely to assess whether the disease progresses.
If new lesions occur or if existing ones are expanding, the person may reconsider the decision to seek treatment.
The need and desire for medication vary. If symptoms are mild, the person may choose to refuse medication. If symptoms are present and they are annoying, some drugs may be useful in their control. The person may choose to use medication only during relapses.
Be taken into account:
- Possible side effects of corticosteroids or other medications used to treat symptoms or relapse control; some people have only minor side effects, while others can have side effects that may antagonize rather than ease the symptoms
- Cost of treatment and relapse of symptoms; in some cases, the use of medication to control symptoms and relapses may reduce hospital stay.
- Other personal problems which the person has to face at work or home
It is also important to remember that it can be difficult to say whether drugs can be effective. Multiple sclerosis is a disease with spontaneous remissions, which means that the person’s condition may improve by itself, without any treatment. The fact that symptoms improve after treatment does not necessarily mean that treatment is effective.

Surgical treatment

People with MS who have a severe tremor, affecting body movements, can benefit of a surgical treatement.
People with severe spasticity (muscle stiffness) may respond well to insert a pump into the dorsal region, to deliver medications when oral administration of drugs wasn’t effective.
Indications for surgery include:
- Deep brain stimulation: tremor that causes severe disability at the slightest movement of the limbs, may respond to implant a device that stimulates a specific area of the brain; this operation can be performed by a neurosurgeon
- Implantation of a catheter or medication pumps, in case of spasticity; severe pain or spasticity may respond to the implantation of a catheter or a pump in the lower dorsal region, releasing a steady medication such as baclofen (Lioresal ).


Deep brain stimulation is usually a last resort after all other therapeutic options have been tried unsuccessfully in treating multiple sclerosis symptoms. It is indicated only in people with severe tremor.

Other treatments

Unpredictability and variety of symptoms caused by multiple sclerosis led to trying several ways of treating this disease.

Experimental treatments

Experimental treatments for multiple sclerosis include decreased activity of the immune system with immunosuppressive drugs or other methods, such as total lymphatic irradiation where the entire nodal lymphatic system is exposed to irradiation.
Although these methods have been used successfully to treat other medical conditions, they failed to obtain significant benefits when they were tested in controlled clinical experiments.
They remain experimental therapies for multiple sclerosis, although they may be considered for people who have not responded to any form of treatment.
Bone marrow transplant, a procedure for replacement of the immune system has been used experimentally to treat multiple sclerosis. However, there is no evidence that would be effective, so it is not routinely recommended.

Complementary Therapies
Other types of treatment for multiple sclerosis are alternative therapies to allopathic medicine. These alternative therapies attract people with multiple sclerosis, especially those where conventional treatments have had little success. A recent study showed that one third of people with multiple sclerosis has tried some form of unconventional therapy, usually in combination with standard therapy.
Clinical trials have demonstrated that any of these complementary therapies are effective in the treatment of multiple sclerosis and therefore are not recommended.
Many complementary therapies have been proposed as a treatment for multiple sclerosis. None of them proved that they could modify the disease.
The most common of these are:
- Diet and vitamin supplements, minerals, herbal or nutritional
- Acupuncture
- Massage therapy – often used by physiokinetotherapists
- Biofeedback.
Although clinical research has shown that anyone of these complementary therapies is effective, a person with MS may have a satisfactory result if he uses safe nontraditional therapies to complement conventional medical treatment.
Some complementary therapies can relieve stress, muscle tension and can improve overall quality of life.
A recent, large, indicated that vitamin D supplementation may decrease the risk of multiple sclerosis in some women. The study shows that vitamin D supplements can also slow disease progression, however, more research is needed to demonstrate clearly that they are effective.
Also, clinical studies could not demonstrate that treatments such as bee venom therapy, with procarin (a combination of caffeine and histamine) and hyperbaric oxygen therapy would be of benefit to people with multiple sclerosis.
On the contrary, some of these therapies might be harmful and costly and not recommended by most experts.


MS can not be cured. So far, the only treatment proven effective in modifying progression of the disease are interferon beta (Avonex, Rebif or Betaferon), glatiramer acetate (Copaxone) and mitoxantrone (Novantrone). Other types of treatment should not replace these medications as long as they have not been tried and proved to be ineffective.
Complementary therapies have not proved effective in the treatment of multiple sclerosis, but some people have said that they have worked for them. This could be due, at least in part, to the placebo effect, which is common in people treated for multiple sclerosis.
It also could have been because of some complementary therapies, that although they can not treat the disease itself, can improve overall well-being of the person, helping her feel better and healthier. And, in some cases, symptoms may improve by itself.
Therefore people with multiple sclerosis who are considering trying a complementary treatment are advised to obtain as much information first.
They are also advised to consult their doctor if it:
- Is sure: it is recommended to discuss with your doctor about safety and about the treatment’s possible side effects, and this is especially important in people taking drugs for multiple sclerosis, because some complementary therapies can be dangerous if they are associated with drugs; a treatment that can be harmful and that may improve or not the symptoms doesn’t worth the risk
- Is effective: multiple sclerosis, because the symptoms can come and go, may be difficult to predict whether a particular treatment is really effective; it is best to remember that if the person feels better after taking a specific treatment, that is not always the reason for improving the symptoms; MS often get better on its own (spontaneous remission)
- Cost: an expensive treatment, which hasn’t proved to be effective, is not worth the price, so people concerned are advised to be cautious towards the therapists or products that require significant financial investment at the beginning of treatment
- Will improve your overall health: even if they are not effective in treating multiple sclerosis, some additional procedures (such as massage, yoga or acupuncture) can be safe and can lead to practice healthy habits that improve overall well-being; they could be tested.
In case of a difficult to treat diseases, such as multiple sclerosis, can be very tempting to call the treatment that promises to be effective. But people affected by this kind of disease are advised to be cautious towards the attempt of treatments not proved with certainty that would be good.


In general, currently can not be prevented multiple sclerosis or episodes of the disease. In people with type relapse-remitting multiple sclerosis treatment with interferon beta or glatiramer acetate may reduce frequency of relapses, and interferon beta may delay disability development.
Interferon beta-1b (Betaferon) or mitoxantrone (Novantrone) may delay disease progression in some people with multiple sclerosis, secondary progressive type. About half of people with relapse-remitting type of multiple sclerosis will progress to secondary progressive type multiple sclerosis in 10 years.
It was assumed that multiple sclerosis may be due to an injury, shock, pregnancy or some vaccinations, but these hypotheses have not been scientifically proven so far.
A person who already has multiple sclerosis, viral infections (e.g. influenza virus) can cause the emergence of a new episode.
During pregnancy, women with multiple sclerosis often have fewer relapses. In the first 3 to 6 months after birth, however, they often tend to have more relapses.
People with MS are advised to avoid overheating of the body whenever possible. Increased body temperature can temporarily worsen symptoms because it overwhelms the nerves that are already affected by multiple sclerosis. We recommend air conditioning, maintaining cooler temperatures in the room and avoid swimming pools with hot water and hot baths. During seasons with high and very high temperatures it is recomended performing activities in rooms with air conditioning and as little as possible outside.



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