Wise Words – Multiple Sclerosis

Submitted by Dr Becky Wise

Multiple Sclerosis

Multiple Sclerosis (MS) is a disease where the protective coverings of your nerves (known as myelin sheaths) are destroyed. The cause of MS is not completely known but researchers believe a combination of genetics plus triggers such as viruses or other environmental factors such as smoking or lack of sunlight may cause the immune system to attack its own myelin in the central nervous system. Therefore it is considered to be an “auto-immune” disorder, and is usually first diagnosed when you are age 20 to 45 years old. Childhood and late middle age diagnoses of MS are rare. MS affects twice as many women as men and people of Northern European decent are particularly at risk, but fortunately, 85% to 90% of patients with MS are expected to live just as long as their peers.
mutiple-sclerosis-WEBThere are two main types of Multiple Sclerosis: 1) relapsing-remitting MS and 2) primary progressive MS. The difference is evident in the names, but the first form involves “attacks” or exacerbations of the neurological dysfunction with periods of time where your symptoms are absent, where the second form remains the same or progresses continually without any periods of remission. The relapses may be worse over time, or not. Every patient has a different journey through this disease so yours will be as unique as you are.

The most common Signs and symptoms of all forms of MS include (but are not limited to):
loss of body control (usually arms and hands or legs and feet, and occasionally all of these at the same time)
* spasticity in the legs
* numbness, tingling or pins & needles sensations
* double vision
* bladder dysfunction
* constipation

The motility problems can dramatically affect your quality of life, so you may require assistance performing daily task and self-care. Don’t be afraid to ask for help. Walking aids and driving ads can be valuable tools to help you be mobile and live a fuller life. Older patients with MS believe they have less freedom and need more assistance than their peers, in addition to having to deal with age-related issues sooner. Older MS patients are more likely to have urinary infections, pneumonia, septicemia, and cellulitis but are also less likely to be diagnosed with heart attack or failure, angina, cerebrovascular disease, diabetes, or lung disease.

There is currently no cure for MS. The drugs that are available are designed to shorten the duration of acute attacks, decrease how often attacks occur, and provide relief to symptoms. Thus far, there is very little research on how health care professionals can better treat older patients with MS. New studies will provide a better understanding of this disease and allow care takers to design better treatments and strategies to target the specific needs of MS patients as they advance in age. The drugs your doctor may try include the following, but remember that there may be a lot of trial-and-error to determine what is the best fit for your unique set of issues.

Corticosteroids (IV methylprednisolone and oral prednisone)
for acute relapses and to shorten the duration of MS attacks

Beta Interferons (Avonex, Betaseron, Rebif, Extavia)
Reduce relapses by 33% and reduces inflammatory lesions by 50% to 80%

Glatiramer Acetate (Copaxone)
Mimics myelin and acts as a decoy
Recommended for patients who cannot tolerate beta interferons

Mitoxantrone (Novantrone)
Suppresses the parts of your immune system that can attack myelin

Natalizumab (Tysabri)
Prevent leukocytes from adhering to their receptors on myelins thus preventing attacks

Fingolimod (Gilenya), first orally administered drug for MS
Blocks the migration of lymphocytes from lymph nodes into the CNS

Dalfampridine (Ampyra)
Oral drug designed to improve walking in patients with MS
Blocks potassium channels on the surface of nerve fibers to improve conduction

In addition to one or more of these meds, most MS patients also use other medications or alternative therapies, so be open to several other opportunities for medication therapy. These Symptomatic Treatments include muscle relaxers, anti-anxiety meds, and drugs for depression, bladder incontinence, fatigue, etc. depending on what the patient experiences. Alternative Therapies include acupuncture, physical therapy, cold therapy, meditation, yoga, cannabis, and some herbals like cranberry, vit. D, and fish oil. All of these have varying results in different patients. Never start any of these without a complete discussion with your physician.

In summary, MS is a condition that has an unpredictable etiology and varied progression but is always debilitating. However, patients can slow progression and manage symptoms with proper diet, exercise, and medication therapy management. The best way to have a full life is to employ a good health care team that includes a physician, pharmacist, physical therapist, and dietitian, as well as anyone else specifically trained in how to help the unique issues of each patient.

Submitted by Rebecca Miller Wise, BS, MEd, PharmD, CGP,
Certified Geriatric Pharmacist for Life Works Erie


Be Well, Be Wise,
Dr.Becky

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Dr Rebecca Wise
Dr Rebecca Wise

Wise Words…. is a general medical information column from Rebecca Miller Wise, MEd, PharmD, CGP. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is a nationally board certified geriatric pharmacist and an assistant professor at a local medical college.

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