Multiple Sclerosis (MS) Treatment

Multiple sclerosis (MS) is a chronic disease affecting the central nervous system (the brain, spinal cord and optic nerves). MS is believed to be an autoimmune condition in which the body’s immune system attacks the myelin sheath (a fatty protective layer) of nerves. Scars (sometimes called ‘lesions’) eventually form on the nerves, interfering with the transmission of messages between the brain and spinal cord. This can result in symptoms such as:

• Extreme fatigue;
• Pain;
• Tingling, numbness or pins and needles;
• Muscle weakness, tremor, stiffness or spasms;
• Difficulty with walking, balance and coordination;
• Sensitivity to heat and/or cold;
• Slurring or slowing of speech;
• Visual disturbances, such as blurred or double vision; and
• Changes in memory, concentration and/or reasoning.

The severity and specific symptoms experienced by people are difficult to predict. They vary from person to person and over time in the same person. The progress of the disease is similarly unpredictable. MS can be grouped into four broad classifications based on the way the disease progresses.

1. Relapsing-Remitting Multiple Sclerosis (RRMS): the person has intermittent ‘attacks’ of MS (a ‘relapse’ or ‘flare’) followed by full or partial recovery. This is the most common form of MS.
2. Progressive-Relapsing Multiple Sclerosis: symptoms gradually worsen over time, with distinct attacks along the way. The person may or may not recover to some degree after each attack.
3. Secondary-Progressive Multiple Sclerosis (SPMS): occurs in approximately 50% of people with RRMS within 10 years of diagnosis; the attacks of RRMS cease and symptoms progressively worsen over time.
4. Primary-Progressive Multiple Sclerosis: symptoms steadily progress without recovery or remission.

There are over 26,000 people living with multiple sclerosis in Australia, 85% with RRMS and 12% with PPMS. Most people are diagnosed with MS between the ages of 20 and 40 years old and is three times more likely to occur in women than in men.

The prevalence of multiple sclerosis both in Australia and overseas has increased over the last decade, which most likely reflects improvements in MS treatment and the resulting increase in survival of people with MS.

Multiple sclerosis treatment in Australia focuses on two distinct areas – controlling the symptoms of MS and reducing the risk of relapse and disease progression. Symptoms may be controlled by the use of medications such as:

• Steroids (e.g. prednisolone) to reduce inflammation and control the severity of an attack;
• Botox® to relieve muscle spasticity in a particular area of the body or to treat incontinence; and
• Baclofen for muscle control and to alleviate muscle spasticity.

The risk of relapse and disease progression can be reduced using disease-modifying therapies (DMTs). The range and efficacy of medications available as DMTs has increased significantly in recent years. In 2017, 64% of all patients with MS were being treated with disease-modifying therapy, compared to 25% in 2010.

Examples of DMTs include interferon (Avonex®, Betaferon®), glatiramer acetate (Copaxone®) and fingolimod (Gilenya®). ‘Biological’ DMTs treat multiple sclerosis by targeting the parts of the immune system responsible for damaging the myelin around nerve cells. Examples include:

• Lemtrada® (alemtuzumab);
• Tysabri® (natalizumab); and
• Ocrevus® (ocrelizumab).

Many of these biological DMTs must be given directly into the bloodstream by intravenous infusion, administered by a nurse specifically trained in their use. Many people regularly attend a major hospital to have such doses administered and appointments can take up a lot of time.

In many cases, it is possible for these infusions to be administered in your own home by one of our highly trained nurses. Contact one of our friendly team members to see if home infusions with View Health – chemo@home might be suitable for you.