Early Treatment for Multiple Sclerosis

From the WebMD Archives

Michael Williamson was 16 years old when he noticed a few odd cramps one day at a cross-country track meet. His coach told him to run them out. A day or so later, he woke up paralyzed from the waist down.

After a lot of testing and poking and prodding, Williamson was told he had something called transverse myelitis. "I saw a lot of specialists, but no one mentioned MS," says Williamson, now 27 and the owner of an adventure travel company in Colorado.

Push for Earlier Treatment

If Williamson had his first symptoms today, he would likely start a disease-modifying drug right away. Doctors tend to diagnose MS more quickly than before.

Each time you have symptoms, it’s called a flare-up, relapse, or attack. Doctors used to wait for a second bout to be sure you have MS. Since 2010, though, doctors may diagnose MS after the first flare if both of these are true:

  • Symptoms of MS last for at least 24 hours. They could be as dramatic as Williamson’s paralysis, or more subtle, like an arm or leg with numbness that doesn't go away when you shake it out. A sudden blind spot or blurry vision in one eye can be a symptom, too. (Within 1 to 2 weeks, vision often returns to normal.)
  • An MRI shows changes in the brain. In MS, your system goes awry and attacks the tough sheath around the nerves of your brain and spine, called myelin. An MRI scan can show early damage here.

That means you and your doctor can start fighting MS sooner than in the past.

Hopes and Benefits of Prompt Treatment

Researchers aren’t sure yet whether MS drugs will change the ups and downs of the illness over the long run. Most people do not become severely disabled. In a smaller group who may face a disability, could early use of drugs keep someone out of a wheelchair 10 years from now?

"That's still uncertain," says Mark Keegan, MD, a Mayo Clinic neurologist. "There are some ongoing studies that might tell us more, but it's a hard question to answer."

Continued

However, research does suggest two benefits from prompt treatment:

  • Taking medicine soon after your first symptoms cuts down on how many times those symptoms come back.
  • People who take MS medicines early are less likely to have a disability -- at least over the short term -- compared with people who don't take MS meds. That means that within 6 months to 2 years after diagnosis, people who started medicine early were less disabled than those who began medicine later.

What if you've already had MS symptoms for a while? Maybe it took some time to get a diagnosis. Your doctor is likely to suggest that you start taking a disease-modifying drug. Even if you don't start the medicine at your earliest symptoms, you may still have fewer relapses.

Drug Choices

There's no drug or treatment yet that can cure MS. The drugs prescribed for people with MS usually target their overactive immune system; many different medications work this way.

Is one of these drugs better than others? Not across the board, Keegan says. "Right now, there’s no one first-line medication that’s known to be absolutely superior to others,” he says.

You need to have a detailed talk with your doctor. Go over the risks, benefits, side effects, and costs to find out which medicine suits you best. One drug may give you side effects that another doesn't, for example. Or, you may find the effects of one drug easier to live with than another.

Some are more expensive than others (although all are costly), and your insurance company may have rules about how much it will cover.

Some People Don't Need Medicine

Most people with MS will need to start treatment right away, but that might not be the case for everyone, Keegan says. Your doctor may watch you closely for a while if you have:

  • A very mild episode that goes away completely
  • A normal neurologic exam
  • An MRI that shows little damage in the brain and spinal cord

The "watchful waiting" approach spares you from side effects and high costs, if it's not clear that you need medicine right away. "But we always look carefully at treatment options for all of our patients right from the start," Keegan says.

WebMD Feature Reviewed by Brunilda Nazario, MD on January 16, 2014

Sources

SOURCES:

B. Mark Keegan, MD, associate professor of neurology, Mayo Clinic, Rochester, MN.

Edward J. Fox, MD, PhD, clinical assistant professor of neurology, University of Texas; director, Multiple Sclerosis Clinic of Central Texas, Round Rock, TX.

Archives of Neurology.

Annals of Neurology.

Multiple Sclerosis Association of America.

National Multiple Sclerosis Society.

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