Definition
Potentially disabling, multiple sclerosis is an autoimmune disease involving the nervous system; the altered immune system, directed against the protective myelinated covering of the nerves, hinders the correct communication between the brain and other parts of the organism. The disease, irreversible, can arise at any age, but tends to prefer women at a young and adult.
Causes
Despite being an autoimmune disease, multiple sclerosis is also ideally attributable to environmental insults, especially in genetically predisposed individuals. The inflammatory damage to the nerve fibers, which characterizes multiple sclerosis, causes a slowing down of nerve signals.
- Etiological hypotheses: a "viral infection and / or a genetic defect may be potential risk factors for the onset of multiple sclerosis."
Symptoms
The symptomatological picture that distinguishes multiple sclerosis varies considerably according to the quantity and type of damaged nerves. Among the most common symptoms, we mention: alterations of the alvus, weakness, depression, dysphagia, dystonia, urinary disorders, tingling, nausea, nystagmus, blurred vision, dizziness. In severe cases, multiple sclerosis patients lose their ability to walk (ataxia) and to speak (aphasia and dysarthria).
Diet
The information on Multiple Sclerosis - Medicines for the Treatment of Multiple Sclerosis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Multiple Sclerosis - Medicines to Treat Multiple Sclerosis.
Medicines and treatments
As mentioned previously, multiple sclerosis is a disabling and unfortunately irreversible disease; therefore it is not possible to speak of a real pharmacological treatment. In any case, 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 life of the patient. Some patients are stimulated to follow support groups and psychological therapies, aimed at the acceptance of the disease.
The drugs most used in therapy for symptom control are: interferons, immunoglobulins, steroids, antispasmodics (spasmolytics), antidepressants and cholinergic drugs to reduce urinary disorders.
The following are the classes of drugs most used in therapy against multiple sclerosis, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
Steroids: Administration of corticosteroids in acute attacks of multiple sclerosis is indicated for short-term improvement in symptoms. In any case, it must be emphasized that, to date, the ideal dosage and duration of treatment are still being studied.
- Prednisone (eg Deltacortene, Lodotra): indicatively, take a dose of active equal to 5-60 mg per day. Do not take the drug for too long.
- Methylprednisolone (eg Advantan, Metilpre, Depo-medrol, Medrol, Urbason): in general, it is possible to take a dose of the drug ranging from 4 to 48 mg per 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 dosage of 30 mg / day for a week, followed by 4-12 mg per 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 alleviate the symptoms associated with multiple sclerosis;
- Natalizumab (eg Tysabri): the drug interferes with the transport of potentially harmful immune system cells, preventing them from reaching the brain and spinal cord. This drug enormously increases the risk of progressive multifocal leukoencephalopathy (brain infection with fatal outcome), therefore its use in the long term is not recommended. The drug is administered by injection drop by drop, over a period of time equal to 4 hours. It is possible to repeat the administration 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 the indicative dosage of 20 mg per day. Administration of the drug may cause flushing and difficulty breathing immediately after injection. Consult your doctor.
- Mitoxantrone (eg. Onkotrone, Novantrone, Mitoxantrone SAN): indicatively, it is recommended to start therapy to control multiple sclerosis symptoms with an active dose of 12mg / m2 (for intravenous infusion of 5-15 minutes), every 3 months. The dose can be adjusted 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, immunosuppressive agent, widely used in therapy for the treatment of some tumors; 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 high-dose cyclophosphamide 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 down the rate of symptomatological degeneration of the disease. The expected drug dose is 44 micrograms, to be taken 3 times per week, by subcutaneous injection. For adolescents aged 12-16 years, the planned dose is halved. Consult your doctor.
- Azathioprine (eg. Azathioprine, Immunoprin, Azafor): the drug is an antirheumatic-immunosuppressant, used in therapy to treat the symptoms of multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus.The indicative dose for treating multiple sclerosis is 1.5 mg / kg, to be taken every day for 1 month; Thereafter, it is possible to continue with therapy by increasing the dose by 50 mg (at 6-month intervals), always taking the drug every day. The drug is often combined with interferon beta-1a, to be taken at a dose of 8 million IU subcutaneously, every other day. The maintenance dose is to take 2 mg / kg of the active ingredient.
- Methotrexate (eg Reumaflex, Methotrexate HSP, Securact): the drug is an antagonist of folic acid synthesis, capable of heavily influencing the body's immune response. The dosage should be carefully established by the doctor on the basis of the severity of the disease.
Muscle relaxants-antispasmodics: muscle spasms constitute a rather annoying problem in patients with multiple sclerosis; as a result, the administration of certain medications 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 involves taking 40-80 mg of the drug per 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 the initial dosage 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 achieved. Do not exceed 36 mg per day and 12 mg for any single dose.
Innovative drugs to correct walking 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 nerve impulse transmission capacity and to improve motor capacity. The recommended dose should not exceed 10 mg every 12 hours. The drug can be taken with or without food. In case of forgetfulness. of one dose, the subsequent administration must not be double. The tablets should be taken whole, orally. Useful for relieving walking disorders in the context of multiple sclerosis.
Drugs for the treatment of depression: altered mood, irritability and a tendency to cry can accompany multiple sclerosis; to improve the patient's mood, the administration 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 dosage 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 per day. The maximum dose to be taken before bedtime is generally 150 mg. This dose should be reduced when administering 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 set 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 drug dose equal to 40 mg, divided into a double dose of 20 mg over 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 to treat depression
Recently, two hypotheses have arisen:
- The drug Fingolimod (eg Ginleya), with immunosuppressive activity, is an innovative active principle to treat multiple sclerosis: Fingolimod is ideally able to sequester lymphocytes from the lymph nodes, preventing them from reaching the CNS; therefore, the uncontrolled autoimmune responses, typical of multiple sclerosis, are denied. As a guideline, take 1 capsule of 0.5 mg orally, once a day.
- stem cell transplantation could be a very important "therapeutic option for the treatment of multiple sclerosis."
