Managing MS

Although we don’t yet have a cure for MS, there are many ways of managing life with MS through drug treatments, physical and psychology-led therapies and lifestyle changes. MS affects everyone differently, and changes over time, so living well with MS involves trying out different strategies to find out what works best.

Your MS Team

If you live in the UK and have MS, a multi-disciplinary team of specialist clinicians should be on hand to provide support and guidance on treatment options, and to help you develop self-management strategies.

The MS team in your area should include, or have access to:

MS nurses
MS specialist physiotherapists
specialist occupational therapists
clinical psychologists
neurologists

DISEASE MODIFYING THERAPIES

DMDS

The introduction of a range of Disease Modifying Drugs (DMDs), which can change the course of MS, has probably been the most outstanding achievement of MS research and treatment over recent decades.

DMTs suppress the immune system through a variety of mechanisms, such as depleting B-cell or T-cell lymphocytes (types of white blood cells) or limiting their movement across the blood–brain barrier. To date, most have been focused on reducing the number and severity of relapses in relapsing remitting MS. Recently, DMDs for progressive MS have started to become available for wider use.

Doctors are given very specific guidelines to help them decide which DMDs to prescribe. Over time, new options become available, and occasionally drugs are withdrawn as others with fewer side effects or greater efficacy become available. The NHS periodically issues statements on best practice for DMDs available in the UK. These are based on analysis of research and post-research findings and national and international best practice.

Your MS medical team will be able to advise of any changes that could affect your treatment.

For or up-to-date information on DMDs in the UK, see NICE's Multiple Sclerosis product list.

Taking control of your DMD regime

You may find that the first drug you start on works well for you. But it’s important to remember that some DMDs can have significant side effects. So there will always be some risk attached to their use and any unwanted changes should be reported to your MS team or GP.

You may need to change your DMD over time, although It’s unusual to swap one drug for another unless there are clear indications of change in MS.

You are very much a part of your own treatment. If you are prescribed a DMD, it’s important to:

follow all up-to-date advice from your MS Team
attend all appointments for blood tests and medication reviews

Stem cell treatment

Clinical trials are ongoing, but some NHS centres now provide Autologous Hematopoietic Stem Cell Transplantation (AHSCT), although there is very limited availability and strict medical criteria need to be met. The procedure involves:

collecting, then freezing stem cells from a person’s blood or bone marrow
chemotherapy to deplete the immune system
returing the stem cells via infusion to reboot the immune system.

Stem cell therapy should only be considered through one of the NHS centres or as part of a clinical trial.

Myelin repair

Myelin is the protective covering around the nerves that becomes damaged when cells from the immune system cross from the blood to the brain. After an MS relapse, the body can repair myelin to some extent but this becomes increasingly difficult over time resulting in permanent disability.

There are ongoing clinical trails to investigate drugs that can help repair myelin in the brain and spinal cord.

SYMPTOMATIC TREATMENTS

Many treatment options for MS don’t affect the underlying condition, but instead help manage the physical or mental symptoms MS can cause. These include:

Medications for symptoms like pain, spasms and bladder issues
Physiotherapy, which can improve symptoms like walking difficulties, spasticity, balance and deconditioning and provide strategies for self-managing these issues.
Psychological treatments, such as cognitive behavioural therapy, which can be helpful for a range of symptoms, including manging pain, depression and fatigue
Rehabilitation treatments, such as cognitive rehabilitation therapy to aid memory and cognition, physiotherapy for the management of physical symptoms and the use of assistive technologies such as Functional Electrical Stimulation (FES) to help foot drop
Complimentary therapies, such as pilates, acupuncture and yoga can have positive effects on health and wellbeing. Please note, alternative therapies should be treated with caution, as there is limited evidence for their effectiveness and some, such as certain herbal medicines, can cause harmful effects when taken alongside other medications. So check with your GP or MS Team before adopting any of these.

For more on specific symptoms, see MS Symptoms.