If you’re like most people who have recently been diagnosed with multiple sclerosis, you’re probably anxious about what the future has to bring. “That’s a common reaction,” says Dr. Timothy Vartanian, director of the Multiple Sclerosis Center at New York’s Weill Cornell Medical Center. “But I tell my patients their impression of MS is most likely much worse than the reality of the disease. Although there’s still no cure for the condition, there are treatments and lifestyle changes that can slow its progression.”
Multiple sclerosis is an autoimmune disease that affects nerves in the central nervous system. Each nerve fiber in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged, disrupting the transfer of nerve signals and causing a wide range of symptoms that affect different parts of the body — such as muscle movement, balance and vision.
[See: 5 Rare Diseases You’ve Never Heard of (Until Now).]
The Progression
To get a better picture of the progression of the disease, it helps to understand the four types of multiple sclerosis.
Relapsing-Remitting MS, or RRMS. The National Multiple Sclerosis Society says that most people with MS (around 85 percent) have this form of the disease. The first signs of RRMS usually appear when a patient is in his or her 20’s. (Multiple sclerosis is two to three times more common in females.) “After the initial attack, others may occur occasionally but there can also be long periods, even a decade or more, of remission,” explains Dr. Walter Royal III, director of the Maryland Center for Multiple Sclerosis Treatment and Research at the University of Maryland Medical Center in Baltimore.
Secondary Progressive MS, or SPMS. Most patients with RRMS move on to develop SPMS. “Over time, symptoms can worsen more steadily and there may, or may not, be relapses and remission,” Royal says. The change typically happens between 10 and 20 years after the initial diagnosis of relapsing-remitting MS. A large study published in 2006 in the journal Brain shows that over a 20-year period, a relapse is followed by chronic progression of the disease in around 80 percent of cases.”It’s unclear why the disease makes this shift, but we do know that the older a person is when diagnosed, the shorter the time before the disease becomes secondary progressive,” Vartanian says.
Primary-Progressive MS, or PPMS. This is a less common form of the disease affecting around 10 percent of people diagnosed; the average age of diagnosis of PPMS is 40 years old. Symptoms in PPMS slowly worsen from the start of the disease without relapses or remissions.
Progressive-Relapsing MS, or PRMS. Only 5 percent of patients are diagnosed with this type of multiple sclerosis. There’s no remission, and with PRMS, symptoms worsen steadily and relatively quickly.
“Whatever the type of multiple sclerosis, every new lesion in the brain or spinal cord (which can form with or without symptoms appearing) results in some irreversible injury to the nervous system,” Vartanian says. “On the upside, there are medications and other strategies that can be extremely effective in helping patients deal with the disease.”
Treatment With Medications
According to the Mayo Clinic’s website, “Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms.” Drugs for multiple sclerosis can be taken by self-injection, intravenously or orally. “No matter how medications are administered, the earlier you begin treatment, the better the outcome,” Royal says. But he cautions: “All medications have their own particular side effects, as well as interactions with other drugs, and patients need to stay in close contact with their physician. It’s usually necessary to have an appointment scheduled at least once every three months.” Some treatments may require more frequent blood testing.
There are dozens of effective prescription drugs available to treat multiple sclerosis. Ocrelizumab is the latest drug on the market and was approved by the FDA in March 2017 based on three studies conducted by an international team of researchers. The findings were published in the December 2016 edition of the New England Journal of Medicine.
Ocrelizumab was shown to reduce new attacks in patients with RRMS. In one study of 732 patients, those given the medication were found to have fewer new brain lesions and less brain volume loss than those given a placebo.
[See: 9 Ways to Boost Your Immune System.]
Lifestyle Strategies
Medication isn’t the only method to treat the disease. “Taking care of overall physical health may also help to reduce some of the symptoms,” Vartanian says. Strategies include:
Exercise. Vartanian recommends at least 30 minutes of whichever vigorous exercise can be tolerated. “I tell my patients to choose an exercise that’s fun and manageable for them,” he says. Yoga, which can be modified for disabilities, is a good choice. A 2004 study in the journal Neurology showed “significant” improvement in measures of fatigue in a group of MS patients that participated in a 6-month yoga class compared to a group that didn’t.
There have been other studies pointing to yoga’s ability to improve anxiety, depression, bladder function, pain, spasticity, weakness and walking. These are symptoms MS patients frequently experience.
Nutrition. “People with MS do best on a low-glycemic, easily digestible diet that’s predominantly vegetables, with whole grains and lean protein,” Vartanian says. There’s been a connection made, he says, between cow’s milk and MS progression, so it’s recommended patients avoid drinking it.
Sleep. Extreme fatigue is a common symptom, and Vartanian suggests patients follow a sleep hygiene program including a regular bedtime in a quiet, dark and cool bedroom.
Vitamin D. The July-September 2014 issue of the Journal of Traditional and Complementary Medicine reported that people with MS who are vitamin D deficient tend to suffer more significant progression of the disease.
According to the organization Overcoming Multiple Sclerosis: “Supplementing with 5,000 IU of vitamin D daily during winter may be enough for people who get a lot of sun. Those who get less sun might need 10,000 IU of vitamin D in winter and 5,000 IU daily in summer. ”
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
The best approach to all treatments and strategies is to stay in touch your medical team. The National MS Society points out: “They are ideally positioned to monitor all medications a multiple sclerosis patient is taking and can watch out for potentially harmful side effects and interactions.” Doctors can also offer lifestyle suggestions to help multiple sclerosis patients live their lives to the fullest.
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What Do I Need to Know About Progression of MS and Treatment Options? originally appeared on usnews.com
