Multiple sclerosis (MS) is a chronic condition that attacks the central nervous system (CNS) and often causes disability. The CNS includes the optic nerve, the spinal cord, and the brain. Nerve cells are like wires that conduct electrical impulses from one cell to another. These signals allow the nerves to communicate. Like wires, nerve cells need to be wrapped in a form of insulation to function correctly. Nerve cell insulation is called myelin.
MS involves gradual, unpredictable damage to the myelin of the CNS. This damage causes nerve signals to slow down, stutter, and distort. The nerves themselves may also suffer damage. This can cause MS symptoms such as numbness, loss of vision, difficultly speaking, slow thinking, or even inability to move (paralysis).
Your doctor will likely want to start treatment right after you’re diagnosed. Learn more about what to consider when you evaluate your MS treatment plan.
Every case of MS is different. For this reason, treatment plans are designed to fit individual needs. Symptoms may come and go, gradually worsen, and sometimes the major symptoms disappear. It’s important to regularly communicate with your doctor, especially when symptoms change.
Treatments focus on slowing the damage caused by the immune system’s attacks on myelin. Once a nerve itself is damaged, however, it can’t be repaired. Other treatment approaches are targeted at providing symptom relief, managing flare-ups, and helping you cope with physical challenges.
Asking the right questions
Doctors are now encouraging MS patients to take a more active role in selecting their treatment. To do this, you’ll need to become more health literate and consider a variety of factors based on your preferences and overall treatment goals.
As you begin your research, it’s critical to think about the factors that are most important to you. Ask yourself the following questions:
What are your treatment goals and expectations? Are you comfortable with giving yourself injections at home? Would you rather get an infusion at a licensed clinic? Could you remember to administer an injection or take oral medication daily, or would you rather take a medication with less frequent dosing? What side effects can you live with? What side effects will be most difficult for you to cope with? Can you manage the need to schedule regular liver and blood tests? Will your travel or work schedule affect your ability to take your medications on time? Will you be able to store your medications safely and out of reach of children if you need to? Are you pregnant or planning to become pregnant? Are you already taking any medications or supplements? Which medications are covered by your particular insurance plan?
Once you’ve answered these questions on your own, openly and honestly discuss all concerns with your doctor.
Available treatment options
Knowing what treatment options are available to you is the first step in making a decision about your MS treatment plan.
During MS attacks, the disease actively causes physical symptoms. Your doctor may prescribe a corticosteroid drug during an attack. Corticosteroids are a type of drug that helps reduce inflammation. Examples of corticosteroids include:
prednisone (taken by mouth) methylprednisolone (given intravenously)
The main goal of treatment is to slow progression of the disease. It’s important to treat MS even during remission, when there are no obvious signs of illness. While MS can’t be cured, it can be managed. Strategies to slow the progression of MS include a number of different drugs. These drugs work in different ways to slow myelin damage. Most are classified as disease-modifying therapies (DMTs). They have been developed specifically to interfere with the immune system’s ability to destroy myelin.
When researching DMTs for MS, it’s important to consider whether they are injected, infused, or taken by mouth.
beta interferons (Avonex, Rebif, Betaseron, Extavia) glatiramer acetate (Copaxone, Glatopa) peginterferon beta-1a (Plegridy)
The following drugs are taken orally as a pill, either once or twice a day:
fingolimod (Gilenya) teriflunomide (Aubagio) dimethyl fumarate (Tecfidera)
These DMTs must be given as an infusion at a licensed clinic:
natalizumab (Tysabri) alemtuzumab (Lemtrada) ocrelizumab (Ocrevus)
The cost of MS treatment can be a source of stress for you and your family. MS requires lifelong treatment. While insurance companies will cover most options to some degree, copayments and coinsurances can add up over time.
Before starting a particular drug, check with your insurance to learn how much of the cost you’ll be responsible for. There may be less expensive treatment options available that your insurance company needs you to try before you can try a more expensive option.