Multiple Sclerosis: Diagnosis and Treatment

Diagnosis

• A complete history, physical, and neurologic examination is the initial diagnostic step. The neurologic examination includes testing of muscles, nerves, reflexes, sensation, posture, coordination, balance, and gait.
• Magnetic Resonance Imaging (MRI) scan of the brain and spinal cord is the most important test to diagnose MS.
• In some cases, a lumbar puncture (spinal tap) may be necessary to look for proteins and cells in the spinal fluid that are common in MS and to rule out other conditions, such as infection.

Treatment

There is no definitive cure for MS (however, see Nutritional Considerations). In some cases, when only mild disease occurs, it may be reasonable to carefully monitor the disease without treatment. In most cases, however, treatment is beneficial. Medications are available to improve symptoms and others may slow the course of the disease.

• Acute attacks are treated with medications that reduce inflammation and relieve specific symptoms.
• Corticosteroids (e.g., methylprednisolone and prednisone) usually shorten the duration of flare–ups. Therapy may include several days of intravenous corticosteroids, followed by a few more days or weeks of oral corticosteroids. Unless specifically directed by a physician, steroids should not be used for more than a few weeks. Side effects of prolonged use may include osteoporosis and hypertension.
• Muscle relaxants (e.g., Baclofen and Zanaflex) are used to treat muscle spasms, stiffness, and pain. However, they may cause side effects, such as weakness in the legs, drowsiness, or dry mouth.
• Several other types of medications have been used successfully to reduce fatigue (antivirals and antidepressants), pain (anticonvulsants), and bladder control (oxybutynin).
• Disease–modifying medications that may protect nerve cells are often prescribed for patients with relapsing disease. However, these medications should not be used in women who are pregnant or may become pregnant.
• Beta interferons (Betaseron, Avonex, and Rebif) are genetically engineered proteins that help regulate the immune system. They are given as injections on a daily, weekly, or monthly basis. They usually reduce flare–ups of disease, but will not reverse existing nerve damage and are generally only used in patients with relapsing disease that have more than one attack per year. Flu–like symptoms may occur as a side effect.
• Glatiramer may be used in patients with relapsing remitting disease who cannot take interferons.
• Mitoxantrone is a chemotherapy drug that is now FDA–approved for the treatment of aggressive relapsing remitting MS or rapidly progressive disease, and may slow the progression of disease. However, serious side effects may occur, including heart damage, so this medication must be used cautiously.
• Plasma exchange may dilute the blood of damaging antibodies that would otherwise attack nerve cells. This is generally used in patients with sudden, severe attacks who do not respond to steroid treatments.
• Physical therapy may help to improve strength, balance, and movement, and improve daily activities.
• Stress, depression, and frustration are common in patients with MS, and may increase the risk of flare–ups. As much as possible, it is important to stay active, maintain normal daily activities and hobbies, and stay connected with friends. Counseling and support groups are often very helpful for family members and caregivers.