Multiple sclerosis: treatment and life expectancy


Treatment for relapses of multiple sclerosis (MS)

Currently, there is no definitive treatment. This disease is incurable, but the doctor can treat the symptoms.
If the symptoms are caused by a flare-up, high doses of corticosteroids (methylprednisolone) can be taken for three to five days (Myhr et al. – 2009).
The drug is taken orally (tablets) or administered venously (infusion). Treatment is carried out in the hospital or at home.

Experts do not know why cortisone accelerates recovery during a flare-up: they believe that this drug suppresses the immune system. The antibodies then no longer attack the myelin in the central nervous system. Corticosteroids are helpful in recovery after a flare-up, but they do not change the outcome of the flare-up.
Steroids do not change the course of the disease and cannot prevent further flare-ups.

Cortisones cause side effects such as osteoporosis and weight gain after a long time. So you should not take them for more than three consecutive weeks.
Some studies show that vitamin D stops the progression of the disease to the brain.

Treatment of symptoms of MS

MS causes many mild and severe symptoms. There are treatments that relieve the symptoms. Some symptoms are easier to treat than others.

Visual impairment
Multiple sclerosis causes visual disturbances. Usually, the visual disturbances improve on their own in a few weeks. If symptoms are severe, the doctor will prescribe corticosteroids to speed recovery.
The doctor prescribes drugs such as gabapentin (Starck et al. – 2010), baclofen (Serra et al. – 2018) or clonazepam (Stahl et al. – 2002) for problems with eye movements (nystagmus).

Spasticity and muscle spasms
Spasticity and muscle spasms improve under physiotherapy. Stretching exercises prevent spasticity (stiffness). A physical therapist treats spasticity and muscle spasms when movement is restricted.

If the muscle spasms are severe, the doctor may prescribe a medication that relaxes the muscles (muscle relaxant) and reduces spasms. Active ingredients are baclofen or gabapentin, although there are alternative drugs such as tizanidine (Lapierre et al. – 1987), diazepam and dantrolene.

All these drugs have side effects such as:

  • Vertigo
  • Myasthenia
  • Nausea
  • Diarrhoea.

If side effects occur, you should talk to the doctor or physiotherapist.

Medications and physiotherapy are sometimes not enough to control spasticity and muscle spasms. The doctor may recommend stretching exercises with ropes and weights or the infiltration of drugs into the spinal canal (in the area of the spinal cord).

Among the novelties (latest findings) is the use of cannabis (marijuana) to treat spasticity (Corey-Bloom et al. – 2012). The doctor may prescribe it in the form of tablets (Malfitano et al. – 2008) or spray (Collin et al. – 2007).

Neuropathic pain
Neuropathic pain is caused by nerve damage and is acute, shooting and accompanied by the sensation of skin burning. This type of pain is treated with gabapentin or with drugs such as carbamazepine (Espir et al. – 1970) and amitriptyline (Pöllmann et al. – 2008).

Skeletal muscle pain
MS causes stress and tension of the body muscles.
A physical therapist can provide helpful recommendations on how to prevent skeletal muscle pain through exercises and postures.
If the pain is severe, the doctor prescribes painkillers, cortisone and antidepressants (for pain relief).
You can do treatment sessions with a device that stimulates the nerve endings (TENS).

Mobility problems
Mobility problems are the result of muscle spasms, weakness and spasticity. These can also be caused by balance problems or dizziness.

The doctor may prescribe botulinum toxin for injection. This drug relaxes the muscles.

Cognitive disorders (difficulty thinking and memory impairment)
A psychologist assesses the problems and suggests cognitive rehabilitation to improve the patient’s abilities.

Emotional problems
If emotional problems occur (such as gratuitous laughter or crying), a psychologist must assess whether they are caused by MS.
The primary care doctor or neurologist may prescribe antidepressants or benzodiazepines to treat anxiety and depression.
Psychologists use cognitive behavioral therapy (CBT) to treat depression.

Exhaustion and tiredness
Many people with MS suffer from fatigue.
The most common causes are:

  • adverse drug reactions,
  • poor nutrition.

If the exhaustion is caused by MS, the doctor may prescribe amantadine (Generali et al. – 2014).

Bladder problems
For hyperactive bladder, the doctor may prescribe an anticholinergic drug, such as oxybutynin (Gajewski et al. – 1987) or tolterodine (Ethans et al. – 2004).
This reduces the urge to urinate. If this medication does not work, a newer drug can be taken: mirabegron.
The need to urinate more at night can be treated with a drug: desmopressin.
In the case of retention bladder (it is not completely emptied), a catheter must be placed.
The catheter is a small tube that is inserted into the bladder and drains the excessive urine.
For the treatment of incontinence, one should consult a urologist.

Eine Verstopfung wird durch eine Änderung der Ernährung oder durch die Einnahme von Abführmitteln behandelt.
Ausgeprägte Verstopfungen werden mit Zäpfchen oder einem Einlauf (Klistier) behandelt. In dem Klistier befindet sich ein flüssiges Medikament, das das Austreten des Stuhls erleichtert.
Stuhlinkontinenz wird mit Medikamenten gegen Durchfall oder durch Übungen zur Kräftigung des Beckenbodens (nach Kegel) und der rektalen Muskulatur behandelt.

What is the life expectancy? Prognosis

Patients can live as normally as possible for many years in each of the phases of the disease or quickly become physically disabled.
About 25% of patients have some form of MS without “disability”.
5% of patients experience frequent flare-ups without improvement.
These lead to disability or premature death.
15% of patients become disabled in a short period of time.
20% of cases are progressive from the beginning (primary-progressive).
The life expectancy of a person with multiple sclerosis is no less than that of other people.

Women with multiple sclerosis can become pregnant, give birth under epidural anesthesia and breastfeed.
The children carry a slightly increased risk compared to others to develop this disease. The relapse rate is lower during pregnancy, but increased after childbirth.

Prospects for MS sufferers

The prognosis for a long life is good, except in cases of primary-progressive MS. MS patients have problems that limit quality of life.

The UMMC reports alarming statistics of suicide rates among people with MS. According to the UMMC, about two-thirds of MS patients walk without a wheelchair twenty years after diagnosis.

Some people need crutches or a walking stick.
Few patients use an electric scooter or wheelchair to travel further distances.
Untreated MS causes mobility problems in more than 30% of patients.

There are two extreme situations in MS:

  • The first is a “benign” syndrome in which patients have numerous lesions. They are small and there can be decades between the flare-ups.
  • The second is a very serious condition known as the “Marburg variant of multiple sclerosis”, in which symptoms are progressive and lead to death over the course of 1-2 years.

Read more: