Unfortunately, multiple sclerosis (MS) has no cure. We try to treat acute MS attacks and reduce the progression of the disease. Sometimes patients with mild symptoms may not need any treatment at all.
Patients education and counselling (very important aspect of the management plan).
Walking aids and orthoses
Management strategies to treat acute attacks:
a. Intravenous methylprednisolone.
Dose: 1 gm/24 hr intravenous/oral for three days shortens relapses. We need to be very cautious about using steroids in long term. High dose steroid in an acute setting on short term basis is indicated but care should be taken when using steroid for longer period. Use wisely and sparingly (maximum twice a year in high dose).
Some well known side effects of steroids are:
High blood sugar, which can trigger or worsen diabetes
Steroid induced cataract
Fluid retention, causing swelling in your lower legs
Increased blood pressure
Central Nervous System
Increased susceptibility to opportunistic infections (along with increased severity), eg chicken pox. Steroids can also cause fever and increase white cell count.
Physicians should explain the side effects of steroids in terms that patients fully understand. If steroid is going to be used in long term, there should be plans to prevent osteoporosis. Remember, risks of steroids are mostly long term. So doctors should be judgmental about explaining each side effects. Using excessive steroids is bad and life-threatening. But explaining every side effects all at once may result in patient being very well informed, but frightened and even dead!
It is worth mentioning that, steroid shortens the duration of acute relapse and hastens patient's recovery, but it does not affect the long term course of the disease.
b. Plasma exchange (for patients who are not responding to steroids)
In this procedure, blood is removed from your body and blood cells are separated from your plasma. Plasma is removed and blood cells are mixed with a replacement solution and returned to your body.