How Your MS Treatment May Change Over Time

You can help slow your multiple sclerosis (MS) from worsening if you start treatment right after your diagnosis. As your disease progresses, your therapies may need to change along with it.

Treatments for Relapsing-Remitting MS (RRMS)

About 85% of people with MS have this form of the disease. In RRMS, you may have an attack of symptoms, called a relapse. Other times, you may have no symptoms. Many people will stay in this stage for years.

The main treatment goal for RRMS is to slow the disease. Common therapies include:

Disease-modifying therapies (DMTs). The FDA has approved more than 20 DMTs that lower the number of attacks and limit damage to your nervous system. DMTs are the mainstay treatment for MS. They work better if you’re younger and have limited disability. These drugs can’t reverse existing damage.

All DMTs have side effects. Your doctor will help you picks ones that best fit your condition and lifestyle. You can take them as a pill, an injection, or as an intravenous (IV) infusion. If one doesn’t help, you may try others. The most common DMTs for this type of MS include:

Corticosteroids. You may get one of these powerful steroids when you have a serious relapse. You get it through an IV. You’ll take it for 3-5 days. Common corticosteroids include dexamethasone (Decadron) and methylprednisolone (Solu-Medrol). You may need steroids if you have serious vision problems or trouble walking. But many attacks go away on their own without treatment. After one of the high-dose steroids, your doctor may also put you on a dose of an oral steroid, prednisone.

Acthar gel. It’s been used for more than 30 years to treat MS relapses. Like steroids, it lowers inflammation around the myelin, the protective coating for nerves. It helps shorten and reduce the strength of an attack. Your doctor may prescribe Acthar gel if steroids don’t work for you or if they cause too many side effects. It may not be right for you if you have osteoporosis, stomach ulcers, and certain other conditions.

Vitamin D. Some 85% of people with MS are low in vitamin D. But research isn’t clear if taking vitamin D helps prevent relapses or lesions. Ask your doctor If supplements are right for you.

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Treatments for Secondary Progressive MS (SPMS)

Over time, about 90% of people with RRMS move into the secondary progressive multiple sclerosis (SPMS) stage. This happens within 25 years on average from the time of their diagnosis. You may have a harder time carrying out everyday tasks. Studies suggest that if your disease is well managed with medication during the RRMS phase, it may help delay or prevent SPMS.

At this stage, you may have fewer relapses because of lower inflammation. But you may need a new treatment plan during SPMS because your symptoms generally will get worse over time. Some people find this stage easier to manage because you know what to expect.

You will need a well-rounded team of specialists to support you. The goal of your SPMS therapies is to manage symptoms and to help you live more independently.

DMTs. If these drugs worked for you in RRMS, you’ll stay on them. DMTs won’t slow your MS, but they may help with relapses.

Rehabilitation. You can work with a range of specialists to learn easier ways to manage daily activities at home and at work. The goal is to improve the quality of your life.

  • Physical therapy gives you tools that help with your mobility, strength, and tiredness. This may include exercise.
  • Occupational therapy isn’t just for your job. You’ll learn new ways to do chores and tasks to save your energy. Your occupational therapist also can tell you about tools and devices to help you with grooming, cooking, and other everyday activities.
  • Vocational rehabilitation provides support so you can stay employed or switch careers. These programs can be run by federal, state, or local agencies or nonprofit groups.
  • Speech therapy helps you speak more clearly. A speech-language pathologist works with you to strengthen your vocal muscles.
  • Cognitive rehabilitation. MS can make it harder for you to think, remember, and reason. These changes can vary from person to person. Cognitive rehab can teach you “brain training” exercises to help you finish tasks accurately, improve communication, and other strategies.

Healthy habits. They can help you at all phases of your MS. A wellness coach, for example, can help you find ways to lower stress and to boost your mood and your energy. This may include types of exercises that help with mobility other symptoms as well. Getting enough sleep and eating a healthy diet also play a part.

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Treatments for Primary Progressive MS (PPMS)

This is a much rarer type of MS. Only 10%-15% of people with the disease have PPMS. People with it are often diagnosed at an older age. It’s more common in men than women. In PPMS, you’re less likely to have attacks but your disability may be greater. You may have more lesions on your spinal cord. So walking and other activities become more difficult. At this stage, some people may not be able to hold a job.

Treatments for PPMS include rehabilitation and medications. Ocrelizumab (Ocrevus) is the only drug that slows down this type of MS. If you have attacks, you can also start on a DMT. Talk to your doctor about your symptoms. Certain drugs can help with tiredness, muscle spasms, and depression as well as improve your quality of life.

Palliative care . This form of medical care focuses on your whole well-being, including pain management, depression, anxiety, and spiritual care. Palliative care also may include support for your loved ones and other caregivers. The right time for palliative care differs from person to person. You can get palliative care from the start of your MS diagnosis. Hospice is a related type of care that includes palliative care. But hospice care is for people who are expected to live for 6 months or less.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on January 12, 2021

Sources

SOURCES:

National Multiple Sclerosis Society: “Treating RRMS,” “Types of MS,” “Disease-Modifying Therapies for MS,” “Secondary progressive MS (SPMS),” “Rehabilitation,” “Diet, Exercise and Healthy Behavior,” “Primary progressive MS (PPMS),” “Opening Doors: The Palliative Care Continuum in Multiple Sclerosis.”
Multiple Sclerosis Association of America: “Treating Multiple Sclerosis Relapses,” “Acthar Gel.”   
Beacon Health & Fitness: “Wellness Coaching.”
Cedars Sinai: “Primary-Progressive Multiple Sclerosis (PPMS),” “Secondary-Progressive Multiple Sclerosis.”
Johns Hopkins Medicine: “Primary Progressive Multiple Sclerosis.”
Ben Thrower, MD, medical director, Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center, Atlanta. 
Multiple Sclerosis Trust: “Disease modifying drugs (DMDs).”
Mayo Clinic: “Personalized therapy for multiple sclerosis (MS).”
American College of Clinical Pharmacology: “FDA Approves OCREVUS (Ocrelizumab) for Treatment of Adult Patients with Relapsing or Primary Progressive Forms of Multiple Sclerosis.”

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