Pharmacotherapy of MS

Modern treatment of multiple sclerosis requires a comprehensive care of many different healthcare professionals in the field of neurology, physical therapy, emotional health, occupational therapy, cognitive and vocational rehabilitation, therapy for speech and swallowing problems, etc., and especially active and responsible aproach of the patient himself.

According to generally accepted principles, the ideal goal of the treatment efforts is full stabilisation of the disease and postponement of disability, i.e. disease activity free or no evidence of disease activity (NEDA), meaning that the patient is without clinical attacks, without progression of disability, without new lesions and without any progression of atrophy visible with MRI. It is a stabilized patient experiencing quality and valuable occupational and social life.

The current knowledge increasingly indicates that the classic MS is a two-stage process with different characteristics in the early stage (CIS, RR) and the later stage of the disease. At the beginning of the disease, particularly niduses of inflammation form in the central nervous system.

In the later chronic stage, neurodegenerative processes tend to predominate, which were started by the initial inflammation or which are even independent of the inflammation. The inflammation itself then ceases to be under the control of the immune system and practically does not respond to the currently known anti-inflammatory medicines.

At present, we do not have medicines that would be able to replace destroyed nerve fibres. Only anti-inflammatory medicines are available. These can only work at such time when neurons have still not been damaged significantly, that is, at the beginning of the disease. Today, we already know for certain that loss of nerve fibres responsible for the correct function of the nervous system starts to occur at the very beginning of the disease. Therefore, it is very important not to postpone commencement of the treatment and to start in time.

MS therapy can be categorised into an acute treatment (treatment of an attack); a long-term treatment the purpose of which is to influence the chronic inflammation process, to reduce the number of attacks and to postpone disability; escalation treatment if the standard long-term immunomodulating treatment is not effective; and symptomatic treatment.

Acute treatment
Long-term treatment
Symptomatic treatment