Therapy and treatments for multiple sclerosis

Even if, to date, there are no definitive therapies that completely eliminate the disease, numerous treatments are available that – in most cases – reduce the incidence and severity of the attacks of multiple sclerosis.

The main objectives of the treatments for MS are:

• reduce relapse and reduce their severity (corticosteroids),
• prevent relapse and prevent or delay the progression of the disease (Disease Modifying Therapy, DMT, treatments modifying the disease).

In other words, the treatments used in multiple sclerosis are used to prevent irreversible damage to myelin and axons , which already occur in the early stages of the disease; for this reason it is important to act promptly ( early treatment ), even after the first attack of the disease, if the clinical and neuroradiological picture already show an anatomic compromise.
Therefore, even if a definitive cure for multiple sclerosis has not yet been identified, therapies are available that can favorably modify the course of the disease , reduce the severity and duration of the attacks and the impact of the symptoms .

In view of the variability of multiple sclerosis and the specific characteristics of the individual person, treatment must be identified from case to case through a relationship of trust between the clinical center MS team and the person with multiple sclerosis.

Attack therapies
Attack therapies are used in the presence of relapses and are based on the use of steroid drugs (cortisone) , in particular methylprednisolone, exploiting its anti-inflammatory effect. Numerous clinical studies have shown that steroids shorten the duration of the attack, reducing its severity, although the response to cortisone varies from individual to individual and relapse to relapse.

Steroids can be administered orally (tablets), or with injections in muscle or vein, in the form of a phleboclysis . The latter is the most frequently used method of intake (typically 500 or 1,000 mg of methylprednisolone for 3-5 days). Sometimes this treatment in the vein follows a short period of steroid therapy by mouth. Steroids used for such short times are usually well tolerated; the most frequent side effects are anxiety, insomnia and gastric disorders. In order to control gastric disorders it is common practice to associate a gastroprotective drug with steroid therapy. The presence of diabetes, hypertension or ulcerative disease may involve particular caution in the use of cortisone.
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Long-term therapies
The drugs that can affect the mechanisms underlying the disease, and therefore change the course, are treatments that act in different ways at different levels of the immune system. As anticipated, these drugs are not yet a definitive cure but are able – in most cases – to reduce the number of relapses and their severity.

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