Treatment and Forward Planning

There are lots of different treatments available for MS, but it is important to remember there is no cure for MS. There are two sorts of treatment, the symptom control and also disease-modifying therapies. With regards to symptom control, it depends on what sort of symptom that you present with, it depends on what sort of medication we may treat you with. For example, if someone had spasms, we may treat with anti-spasmodics to make their legs or arms less stiff and less painful. We may treat with different painkillers for pain. We don't use normal painkillers, for example, paracetamol or Nurofen. We tend to use painkillers that would interrupt nerve pathways, for example, drugs we use in epilepsy like gabapentin or pregabalin.

The other way that we can treat symptoms is by referring on to different services. For example, a physiotherapist may be able to help with stiffness of limbs, mobility, balance problems, or if we needed to refer to, for example, a speech and language therapist they may be able to give you advice on swallowing. If someone has an exacerbation of their MS, I.e. An MS relapse, then we may treat with high-dose steroids. These can either be given via a drip, an intravenous drip, over a period of three or five days and that would be a day case admission to hospital, or we could give as an oral tablet over five days, depending on how severe the relapse is and also patient preference. We also may consider how they may travel to the hospital, whether they are able to or not, with regards to how we give the high-dose steroid treatment. It's important to remember that when using steroids, this just speeds up the recovery of the symptoms, it doesn't actually affect the eventual outcome.

Disease-modifying treatments are treatments which modify the course of the disease. DMTs target inflammation and reduce the damage caused by a clinical relapse. DMTs affect the number and severity of relapsing to varying degrees. Some drugs have also been found to delay the long-term progression of MS. Disease-modifying treatments can come in all sorts of forms. They can come as an injection or as a tablet, or as an intravenous infusion. Depending on how severe the MS is, it depends on which treatment we may or may not treat you with. A patient, in theory, can choose which medication they want to go on after we have gone through and spoken about 11 drugs that are available to date on the market. However, people do choose the disease-modifying therapies for different reasons. For example, someone may not want to use an injection, other patients may not remember to take an oral tablet once a day or twice a day and other people may not want the inconvenience to travel out to the hospital to receive an infusion. These treatments are only offered to patients with relapsing-remitting MS who've had two relapses within a two-year period.

Many people with MS use complementary therapies. These may include acupuncture, hyperbaric oxygen, aromatherapy. It is the patient's choice as to whether or not they use complementary therapies. We do, however, suggest that they take these, in addition to any other medication that may be suggested by their GP or neurologist. There are two main things that may be helpful to support self-care. One of these is diet. We recommend a healthy eating diet for anybody with multiple sclerosis. And if they are significantly overweight, then we do suggest that they try to lose weight, which will help with their MS in the long term and also any mobility problems. We do stress that patients stop smoking, as this can reduce the rate that their MS progresses.

Exercising in patients with MS is very important. We do emphasize that patients should exercise as much as they possibly can. Obviously, there are factors which can prevent exercise, for example, extreme fatigue. However, any type of exercise is important. For example, simple stretching, going swimming, a brisk walk, really is just to try anything they possibly can in very small amounts, gradually increasing over time to increase their stamina and also their fatigue levels. We also recommend that patients take a vitamin D supplement. We will suggest that you discuss this with your neurologist as to what dose to take.

I am not on any treatment now because I have got secondary progressive MS. And at the moment, they say, for me, there is no treatment. I used to be on a disease-modifying treatment when the MS was different, which was really, really effective for quite a long time. And then my local neurologist said that he didn't think the disease-modifying treatment was a suitable fit for me anymore, something that I have to say I am not entirely happy about and I want to further pursue that really.