Treating Relapsing Multiple Sclerosis
To Treat or Not to Treat
Even when they are untreated, however, acute relapses of MS typically resolve on their own over a matter of days or weeks. For that reason, and because corticosteroids are powerful drugs with some unwanted side effects, doctors may recommend using them only for relapses that significantly affect a patient’s function. Adverse side effects of corticosteroids can include fluid retention, weight gain, elevated blood pressure, and mood swings.
“If a patient comes in with a little bit of numbness in one foot, I may recommend just waiting it out,” Thrower tells WebMD. “But if a patient comes in with significant problems walking, for example, I’ll recommend corticosteroids.”
One of the most common forms that MS relapses take is optic neuritis, cause by temporary inflammation of the optic nerve. Symptoms include blurred vision and eye pain. Like so many other features of the disease, the severity of optic neuritis varies widely among patients. “If a patient has only mild vision problems, we may decide to watch and wait without treating the relapse,” says Cross. “But if vision is significantly affected or there’s pain, then we’ll usually recommend treatment.”
In addition to immune-suppressing corticosteroids, which suppress the underlying disease process in MS, a variety of drugs can be used to treat specific symptoms of relapses. These include antidepressants to treat depression, erectile dysfunction drugs to ease sexual problems associated with MS, and a new drug called dalfampridine (Ampyra), which has been shown to help improve walking in some patients.
Quality of Life
Can treating relapses quickly and aggressively reduce nerve damage and slow the long-term progression of the disease? Doctors don’t have a complete answer yet. In theory, it makes sense that if you limit damage from inflammation, the disease will progress more slowly. Some researchers have even tried using periodic treatments with corticosteroids in hopes of delaying the progression of MS. But so far, there’s little evidence that the approach offers any benefit.
“In general, I believe that steroids hasten recovery and may reduce the risk of future relapses for a time,” neurologist Elliot Frohman, MD, an MS researcher at the University of Texas Southwestern Medical Center, wrote in an email to WebMD.
But one recent study, called the Optic Neuritis Treatment Trial, found that treating relapses may have little if any effect on the long-term course of MS. Researchers looked at acute relapses that caused optic neuritis. Some patients were given oral prednisone. Others received no treatment at all. Patients in the high-dose prednisone group recovered more quickly from optic neuritis. But a year later, researchers found no difference between the treated and untreated groups in terms of disease progression.