Ins and outs of Multiple Sclerosis - Newer drugs to prevent relapse

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Other drugs to prevent relapse:

Natalizumab

This is a monoclonal antibody that targets alpha-4 integrin on white blood cells. Thus it reduces the number of MS attacks by hampering the movement and subsequent damage of immune cells from the bloodstream to brain and spinal cord.

It reduces the relapse rate by 67%.

It is also associated with 80-90% reduction in inflammatory activity on MRI.

Natalizumab is usually a reserved drug for those who cannot tolerate or did not get any result from other treatment options of multiple sclerosis. This medication is thought to be associated with increases the risk of progressive multifocal leukoencephalopathy (PML) which is a brain infection caused by JC virus. Due this association, people were concerned about it's used. But it was re-approved by FDA in June 2006 as the risk was found to be really low.

There are available blood tests to detect whether a patient has been exposed to the JC virus. It is usually done before or while taking this medication if a high degree of suspicion is there. Some other side effects of natalizumab may include

Allergic reactions

Liver damage



Fingolimod

This is an oral medication given once daily.

This drug traps the immune cells in lymph nodes thus reducing their transfer into the central nervous system. It may prevent attacks of MS and short-term disability as well.

The most notable side effects are

Bradycardia (slowing of heart beat to less than 60 beats per minute)

Opportunistic infections like chickenpox (by varicella-zoster virus)

Headache

Cough

Diarrhea



You have to monitor your heart rate for six hours after the first dose because the first dose is associated with bradycardia the most.



Teriflunomide

This is also an oral medication that reduces attacks and MRI lesions in people with MS.

After administration, the medication stays in the body system for months. If any complication arises, additional medications must be administered in order to increase the elimination of the drug.

It is associated with

Liver dysfunctions

Fetal damage if taken during pregnancy (teratogenic)

Nausea

Diarrhea



Strategies to treat symptoms

As I said earlier, multiple sclerosis is a disease that effects different sites of the body. Thus, patient may suffer from physical disability that can be really frustrating. A practical and planned approach should be taken to reduce the suffering of the patient as much as possible. Here are some options:



Physical therapy

Try some stretching and strengthening exercises to reduce stiffness of your limbs. An occupational or physical therapist can help you to do some regular exercises. There are also some devices that helps to perform daily tasks.



Other measures should also be taken to improve symptoms like

Spasticity

A patient suffering from spastic hand



Fatigue

Bladder and bowel dysfunctions

Pain

Depression

Sexual dysfunction

Erectile dysfunction





About the Author

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Author: Dr Rezahaider

I am a physician by profession. I dream to work on medicine in the near future. I have completed my residency three years back. Now, I am planning to obtain MRCP. This is very hard exam and surely, I am always scared of it. I have also decided to do my specialization on cardiology. Before medical school, I never thought that our heart could be so complex! So pray for me. I usually don't have enough time to write due to my studies. But whenever I get time I love to write. I write on medical related issues. I try to make it simple for you.

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