Definition
Potentially debilitating, multiple sclerosis is an autoimmune disease that involves the nervous system; the altered immune system, directed against the protective myelin coating of the nerves, hinders the correct communication between the brain and the other parts of the body. The disease, irreversible, can arise at any age, but tends to prefer women of a young and adult age.
Causes
Despite being an autoimmune disease, multiple sclerosis is ideally attributable to environmental insults, especially in genetically predisposed individuals. The inflammatory damage of nerve fibers, which characterizes multiple sclerosis, causes a slowing of nerve signals.
- Etiological hypotheses: a viral infection and / or a genetic defect can be potential risk factors for the onset of multiple sclerosis.
Symptoms
The symptomatic picture that distinguishes multiple sclerosis varies greatly depending on the quantity and type of damaged nerves. Among the most common symptoms, there are: alterations of the ligament, weakness, depression, dysphagia, dystonia, urinary disorders, tingling, nausea, nystagmus, blurred vision, dizziness. In severe cases, patients with multiple sclerosis lose the ability to walk (ataxia) and speak (aphasia and dysarthria).
Diet
Information on Multiple Sclerosis - Multiple Sclerosis Treatment Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Multiple Sclerosis - Multiple Sclerosis Treatment Drugs.
Medications and treatments
As mentioned above, multiple sclerosis is a disabling and unfortunately irreversible disease; therefore it is not possible to talk about a real pharmacological cure. However, the administration of drugs and the implementation of parallel therapeutic strategies (physiotherapy, speech therapy, occupational therapy) can prevent complications (bedsores, contractures), delaying disability and improving, as much as possible, the quality of patient's life. Some patients are encouraged to follow support groups and psychological therapies, aimed at the acceptance of the disease.
The most widely used drugs in symptom control therapy are: interferons, immunoglobulins, steroids, antispasmodics (spasmolytics), antidepressants and cholinergic drugs to reduce urinary disorders.
Steroids : the administration of corticosteroids in acute attacks of multiple sclerosis is indicated for a short-term improvement in symptoms. However, it is important to point out that, to date, the ideal dosage and duration of treatment are still under study.
- Prednisone (eg. Deltacortene, Lodotra): indicatively, take an active dose of 5-60 mg per day. Do not take the drug for too long periods.
- Methylprednisolone (eg. Advantan, Metilpre, Depo-medrol, Medrol, Urbason): in general, it is possible to take a dose of drug varying from 4 to 48 mg a day, orally. The drug can also be administered intravenously or intramuscularly. Consult your doctor.
- Dexamethasone (eg. Decadron, Soldesan): to counter the inflammation that accompanies multiple sclerosis, it is possible to take the drug orally, at a dose of 30 mg / day for a week, followed by 4-12 mg a day for a month.
Side effects of long-term steroid therapy: mood alteration, increased risk of infection, cataract, weight gain, hyperglycemia
Immunomodulators : monoclonal antibodies can be used in therapy to lighten the symptoms associated with multiple sclerosis;
- Natalizumab (eg. Tysabri): the drug interferes with the transport of potentially damaging immune system cells, preventing them from reaching the brain and spinal cord. This drug greatly increases the risk of progressive multifocal leukoencephalopathy (brain infection with fatal outcome), therefore its use in the long term is not recommended. The drug should be administered by drip, over a period of 4 hours. The administration can be repeated every 4 weeks. Consult your doctor.
- Glatiramer (eg. Copaxone): indicated to reduce the frequency of relapses in patients with relapsing remitting multiple sclerosis. It is recommended to administer the drug by injection under the skin at an indicative dose of 20 mg per day. The administration of the drug can generate hot flushes and breathing difficulties immediately after the injection. Consult your doctor.
- Mitoxantrone (eg. Onkotrone, Novantrone, Mitoxantrone SAN): indicatively, it is recommended to start therapy to control the symptoms of multiple sclerosis with an active dose of 12mg / m2 (for 5-15 minutes intravenous infusion), every 3 months. The dose can be changed by the doctor based on the severity of the condition and the patient's response to treatment with the drug.
- Cyclophosphamide (eg. Endoxan Baxter, bottle or tablets): the drug is an alkylating agent, immunosuppressant, widely used in therapy for the treatment of certain cancers; indicatively, the active ingredient should be taken intravenously at a dose of 200 mg / kg, for a period of time established by the doctor. Treatment with cyclophosphamide at high doses can, in some cases, stabilize the disease, thereby improving the patient's quality of life. Consult your doctor.
- Interferon Beta-1a-1a (eg Rebif, Extavia, Avonex, Betaferon): this drug is widely used in therapy against multiple sclerosis, since its administration slows the rate of symptomatic degeneration of the disease. The expected drug dose is 44 mcg, to be taken 3 times a week, by subcutaneous injection. For adolescents between the ages of 12 and 16, the expected dose is halved. Consult your doctor.
- Azathioprine (eg Azathioprine, Immunoprin, Azafor): the drug is an antirheumatic-immunosuppressant, used in therapy to treat symptoms of multiple sclerosis, rheumatoid arthritis, and systemic erythematous lupus. The indicative dose to treat multiple sclerosis is 1.5 mg / kg, to be taken every day for 1 month; after that, you can continue with the therapy by increasing the dose by 50 mg (at 6 month intervals), always taking the drug every day. The medicine is often associated with interferon beta-1a, to be taken at a dose of 8 million IU subcutaneously, every other day. The maintenance dose is expected to take 2 mg / kg of active ingredient.
- Methotrexate (eg. Reumaflex, Methotrexate HSP, Securact): the drug is an antagonist of folic acid synthesis, able to heavily influence the body's immune response. The dosage must be carefully determined by the doctor based on the severity of the disease.
Muscle relaxants - antispasmodics : muscle spasms constitute a rather annoying problem in patients with multiple sclerosis; consequently, the administration of some drugs can reduce the condition.
- Baclofen (eg. Baclofen MYL, Lioresal): start taking the drug orally at a dose of 5 mg, three times a day for 3 days. Continue with 10 mg, 3 times a day for another 3 days; increase the dosage by 5 mg for another two weeks. The maintenance dose is expected to take 40-80 mg of the drug a day. The active ingredient can also be taken intrathecally.
- Tizanidine (eg. Sirdalud, Navizan): to reduce muscle spasm in the context of multiple sclerosis, it is recommended to take the drug at an initial dose of 4 mg, once a day. If necessary, repeat the administration every 6-8 hours, up to a maximum of three doses in 24 hours. It is possible to increase the dose by 1-2 mg every 4-7 days, until the desired therapeutic response is obtained. Do not exceed 36 mg per day and 12 mg per single dose.
Innovative drugs to correct gait disorders in multiple sclerosis.
- Dalfampridine (eg Ampyra): the drug is a blocker of the potassium channels of the membranes of neurons; the administration of the drug is useful to increase the capacity of transmission of the nervous impulse and to improve the motor capacity. The recommended dose should not exceed 10 mg every 12 hours. The drug can be taken with or without food. If a dose is forgotten, subsequent administration should not be double. The tablets should be taken whole, orally. Useful for alleviating gait disorders in the context of multiple sclerosis.
Drugs for the treatment of depression : mood alteration, irritability and tendency to cry may accompany multiple sclerosis; to improve the patient's mood, the use of antidepressant drugs is recommended:
- Imipramine (eg Imipra C FN, Tofranil): the drug belongs to the class of tricyclic antidepressants. Initially, the drug should be taken at a dose of 75 mg per day, divided into several doses. Dosages can be increased up to 150-200 mg; in some hospitalized depressed patients, the dose of the drug may increase up to 300 mg a day. The maximum dose to be taken before bedtime is generally 150 mg. This dose should be reduced if administered to elderly patients.
- Duloxetine (eg Xeristar, Yentreve, Ariclaim, Cymbalta): it is possible to take this drug (serotonin and norepinephrine reuptake inhibitor), for a period of time established by the doctor, based on the severity of the depression. The drug is indicated for the treatment of major depression (in which the patient complains of severe mood depression for at least two consecutive weeks) also (but not only) in the context of multiple sclerosis. It is recommended to take a dose of 40 mg of the drug, divided in a double dose of 20 mg in 24 hours. In some cases, it is possible to take two doses of 30 mg each, without food.
For further information: see the article on drugs for the treatment of depression
Recently, two hypotheses have been formulated:
- The Fingolimod drug (eg. Ginleya), with an immunosuppressive activity, is an innovative active ingredient for treating multiple sclerosis: Fingolimod is ideally able to sequester lymphocytes from lymph nodes, preventing it from reaching the CNS; therefore, the uncontrolled autoimmune responses, typical of multiple sclerosis, are denied. Indicatively, take 1 capsule of 0.5 mg orally, once a day.
- stem cell transplantation could be a very important treatment option for the treatment of multiple sclerosis.
