Multiple sclerosis treatment

Modern methods of diagnosis and treatment of multiple sclerosis

Multiple sclerosis diagnostics:

The initial stage

At the first meeting, the doctor asks about what worries the person, and recognizes the complaints. Then he performs a neurological examination to determine the state and functioning of the brain. If clinical manifestations characteristic of MS are present, the doctor will order an MRI scan.

The second step: instrumental researches

MRI

Ultra-high-field magnetic resonance imaging machines make it possible to confirm the diagnosis and control the course of the disease. The most powerful MRI visualizes the smallest lesions, not visible to other methods of examination.

It helps to see ranges of active inflammation, to assess the chance of developing subsequent relapses and to choose a medical strategy.

MRI with contrast

This is a liquid that is injected into the body to make the image on the tamogram brighter and clearer. Thus, the diagnostic efficiency is increased, after which it is naturally excreted from the body. Contrast fluids contain gadolinium.

This examination is performed at the first clinical attack, allowing for an earlier inference. The sooner the diagnosis is made, the faster treatment will begin, preventing the progression of the disease and improving the prognosis for the patient’s health.

MacDonald’s criteria

It is a combination of clinical, laboratory and instrumental indicators for the early diagnosis of multiple sclerosis. This test allows for the recognition of focus in people with little or no symptoms.

Evoked potentials method

Information received from the outside is transmitted every second through the senses to the brain. Because the sheath of the nerve fibers is damaged in MS, signaling is slowed down. Any delay can indicate damage to the CNS.

The third step: laboratory examinations

Blood test

Your doctor may prescribe it to rule out other diseases with similar symptoms.

The lumbar puncture

This is an additional diagnostic method. The results of this test, combined with a doctor’s examination, MRI and etc, help to make an accurate diagnosis. In people with MS, cerebrospinal fluid usually contains increased levels of immunoglobulins G and a group of proteins called oligoclonal proteins.

Multiple sclerosis treatment:

There are medicines that can ease and reduce relapse, slow the progression of the disease and improve quality of life.

Conservative therapy is used for all types of MS.

The tactics chosen by the spesialist are revised and personalized for each stage of the disease according to the type of flow.

Disease modifying therapies (DMTs)

The effect of using these drugs in the later stages is diminishing, so treatment should be started as early as possible with the strongest drugs possible.

DMTs aims:

• Reduce the frequency and severity of relapses,
• Defer the progression of the disease and the development of disability,
• Improve the quality of life of patients.

Many factors influence the choice of DMTs:

• The disease activity, which is assessed by the frequency of relapses, the rate of increasing disability and the degree of brain activity on MRI. Accordingly, the higher the activity, the earlier you need to start treatment,
• The effectiveness of the drug. The use of DMTs involves their constant use, which means a decrease in effectiveness after stopping the drug,
• The safety of the drug. Taking medication from the DMTs group implies constant thorough monitoring to track the development of possible side effects,
• Risk—taking by the patient. It is important to notify about the possible side effects of drugs and describe the risks of refusing the proposed therapy,
• Planning a pregnancy.

With timely and correct therapy of DMTs, the following options for responses to treatment are possible:

• Lack of relapse,
• Absence of progression of disability,
• Decline of inflammatory activity on MRI.

MS therapy in pregnancy

Women suffer from MS 2 times more often than men. Therefore, a possible or already developing pregnancy is the main aspect during the choice of treatment strategy.

According to international recommendations, it is necessary to achieve maximum control over the disease, which, as a rule, takes 1–2 years, and then discuss pregnancy planning with doctors.

MS therapy during pregnancy is recommended after consideration of the potential risks for both mother and fetus.

The diagnosis of MS is not a condition in which women are advised to refrain from pregnancy. In contrast, existing researches show that the disease does not influence the likelihood of conceiving and favorable pregnancy outcomes. Also, it does not influence the development of the fetus, the likelihood of premature birth and birth defects.

Managing relapses

Recrudescences in MS are due to the development of inflammation in the central nervous system, which leads to damage to the myelin sheath of nerve cells.

Not all exacerbations require treatment. Only severe relapses, the symptoms of which worsen quality of life, are treated with corticosteroids, hormones that reduce inflammation. If you have an intolerance to the recommended therapy, HP Acthar Gel can be used. Its use is limited due to its high cost and difficult availability. This drug is not registered in Ukraine.

In the absence of the desired effect, plasmapheresis is used.

Rehabilitation

The rehabilitation aims are: to restore and maintain the functions necessary for an active socialized life.

Physiotherapy is used to provide the normal functioning of the musculoskeletal system, as well as to prevent complications associated with physical impairment and the occurrence of muscle weakness.

In addition, speech rehabilitation and work with psychotherapists are practiced to provide emotional support.

Stem cell therapy

This is the kind of cells, which are present in the human body as part of the body’s recovery system. Their function is to replace damaged or dying cells.
They have the ability to transform into other cells, such as nerve, blood and muscle cells.

There are several variants of stem cells, which can be easily derived from bone marrow or adipose tissue.

The most well—studied method of stem cell treatment is the autologous (i.e., own) hematopoietic stem cells transplantation (aHSCT). Using your own stem cells minimizes the risk of rejection.

This type of therapy is considered the most preferred and recommended in the treatment of aggressive relapsing—remitting and progressive MS with high activity.

Clinical trials have shown that aHSCT is effective and leads to a slowdown in disability and an improvement in the quality of life.

Transplantation is carried out in several stages, the purpose of which is to reboot the immune system to exclude attacks on myelin and subsequent neurodegeneration.