11th August 2024

Management of multiple sclerosis

Treatment of MS has two main aspects: treatment of acute flares and treatment of the underlying condition with disease-modifying agents. Disease-modifying treatments are not routinely administered during an acute flare.

Treatment of acute relapse

1. Methylprednisolone: accelerates recovery from an acute attack of MS; it does not alter the disease course. Systematic reviews have shown the efficacy of corticosteroids in reducing symptoms of an acute relapse however the optimal dose, route of administration and duration of treatment remain unclear.
2. Plasma exchange: used short term during acute attacks if steroids are ineffective or are contraindicated.

Disease-modifying treatment

1. Interferons (IFN), e.g. IFN beta, peginterferon
2. Monoclonal antibodies, e.g. natalizumab, alemtuzumab, ocrelizumab
3. Sphingosine-1-phosphate (S1P)-receptor modulators, e.g. Fingolimod, Siponimod
4. Cyclophosphamide can be used for the treatment of aggressive MS

Note that natalizumab has been associated with progressive multifocal leukoencephalopathy (PML), a rare and often fatal condition caused by the JC virus.

The Expanded Disability Status Scale (EDSS) is a scale used for quantifying disability in patients with multiple sclerosis and monitoring the changes in the level of their disability over time. It takes into account how ambulant patients are, and the severity of pyramidal, brainstem and cerebellar symptoms. In addition to this, bowel, bladder and visual symptoms are ranked. It has been widely used in clinical trials and in assessing people with MS.