Conventional Medical Therapy for MS

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Dramatic advances have been made recently in the treatment of MS. In the past, no particularly effective therapies were available to change the course of disease.

Since 1993, six medications for MS have been approved by the U.S. Food and Drug Administration (FDA). Four of these are commonly used as initial MS therapies: interferon beta-1b (Betaseron), interferon beta-1a once-weekly (Avonex), interferon beta-1a three-times-weekly (Rebif), and glatiramer acetate (Copaxone). Mitoxantrone (Novantrone) is a chemotherapy medication that is typically used for people who do not respond to the other four medications. Another MS medication known as natalizumab (Tysabri) was approved by the FDA in 2006. These drugs decrease the number and severity of relapses, slow the progression of the disease, and decrease the development of new brain lesions.

Because of the positive effects of the FDA-approved medications, all people with MS should be strongly considered for treatment with one of these drugs. A 1998 statement by the National Multiple Sclerosis Society emphasized the importance of treatment. The statement recommended that treatment with these medications should be started soon after an MS diagnosis is made and should be considered in all people with MS, regardless of age, rate of relapses, and level of disability.

In addition to these medications, several other medications are used to treat MS. Steroids are used for exacerbations. These may be taken orally (prednisone, dexamethasone) or intravenously (methylprednisolone or Solu-Medrol). Some chemotherapy medications other than mitoxantrone, including methotrexate, azathioprine (Imuran), and cyclophos-phamide (Cytoxan), occasionally are used in an attempt to slow disease progression.

Given the wide range of symptoms caused by MS, multiple treatment approaches are possible. Therapies for symptoms include medication-based and nonmedication approaches, such as physical therapy, occupational therapy, speech therapy, and psychotherapy. Common MS symptoms that are treated using these therapies include fatigue, depression, weakness, incoordination, walking difficulties, stiffness, bowel and bladder disorders, and sexual difficulties.

(For more information on conventional approaches to MS, see the other, more extensive texts in this area in the "Additional Readings" section at the end of this chapter.)

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