The treatment goals for multiple sclerosis (MS) focus on suppressing the immune system's attack on the nerve myelin, slowing disease progression, and effectively managing symptoms to enhance the quality of life for patients. Current treatment strategies combine pharmacological therapies, non-pharmacological therapies, and lifestyle adjustments to form a multifaceted integrated medical plan.
Treatment decisions need to be customized based on the patient's disease course type (such as relapsing-remitting or progressive course), severity of symptoms, and individual health conditions. Early intervention can significantly reduce the accumulation of neurological damage, making early diagnosis and continuous monitoring crucial. The treatment process requires close collaboration among physicians, patients, and families to ensure the plan meets individual needs.
Current treatment strategies are divided into three main directions: "Disease-Modifying Therapies" (DMTs), symptom relief, and supportive therapies. Disease-modifying therapies are the core, capable of reducing relapse frequency and delaying disability progression; symptom management provides specialized treatment for neurological dysfunction, bladder issues, and more; supportive therapies include physical therapy and psychological support, assisting patients in adapting to long-term disease courses.
Treatment plans need to be regularly assessed and adjusted. Physicians will dynamically adjust medication dosages or treatment strategies based on clinical indicators such as changes in MRI imaging and the Expanded Disability Status Scale (EDSS) assessments.
Pharmacological treatment is central to controlling disease progression and is mainly divided into four categories of mechanisms:
First-line treatment medications such as β-interferons (e.g., interferon beta-1a/b-1b) and glatiramer acetate can regulate immune system activity, reducing annual relapse rates by 30-50%. These medications require subcutaneous or intramuscular injection, with common side effects including injection site redness or flu-like symptoms.
Second-line potent medications such as natalizumab and fingolimod are suitable for patients with relapsing forms or those unresponsive to first-line medications. Natalizumab works by blocking immune cell migration to the cerebrospinal fluid but requires regular monitoring for the risk of brain vasculitis; fingolimod is an oral medication that may cause bradycardia and requires electrocardiogram monitoring.
Non-pharmacological therapies play a key role in improving functional disabilities and enhancing quality of life. These methods are typically used alongside pharmacological treatments to form a complete treatment network:
Physical therapists design personalized exercise programs targeting muscle weakness and balance disorders. Aquatic exercises can reduce joint stress, while balance training such as Tai Chi can lower the risk of falls. Occupational therapists assist in developing skills for using assistive devices, such as walkers or specialized utensils, to maintain daily functions.
About 50% of patients may experience depression or cognitive impairment, and specialized psychological therapies (such as cognitive behavioral therapy) can effectively improve emotional issues. Brain stimulation training can alleviate memory or attention deficits, while speech therapy helps patients with speech disorders regain communication abilities.
Lifestyle adjustments can enhance treatment effectiveness and reduce symptom impact. The following key strategies should be implemented long-term:
Temperature management is crucial for heat-sensitive patients; using cold compresses and wearing ventilated clothing can alleviate limb numbness. Smoking cessation has been shown to delay disability progression and should be included in the treatment plan.
Current research focuses on precision medicine and emerging therapies. Gene therapy trials are attempting to repair myelination genes, while mesenchymal stem cell transplantation trials show potential for repairing nerve damage. The development of oral medications continues to progress, with a new generation of S1P receptor modulators (e.g., siponimod) showing relief effects for progressive courses.
Hematopoietic stem cell transplantation (HSCT) has shown the ability to reset the immune system in severe cases, but it needs to be performed at experienced medical centers. Gene therapy trials are exploring the potential to repair oligodendrocytes, which may become key to repairing nerve damage.
Wearable devices monitor symptom changes in real-time, while AI-assisted MRI analysis can more accurately assess lesion progression. Telemedicine platforms allow patients in remote areas to continuously receive professional follow-up, enhancing treatment consistency.
Immediate medical attention is required if the following conditions occur: new onset symptoms (such as sudden blurred vision or limb weakness) lasting more than 48 hours, or existing symptoms severely affecting daily activities. If severe side effects (such as liver function abnormalities or infection symptoms) occur during treatment plan adjustments, alternative options should be discussed with the physician.
It is recommended to undergo neurological evaluations every 3-6 months, including EDSS assessments and MRI follow-ups. If balance disorders affect walking or bladder dysfunction leads to recurrent urinary tract infections, early evaluation by a multidisciplinary medical team is necessary.
During treatment, monitoring of complete blood count, liver and kidney function, and specific therapeutic indicators, such as MRI brain scans to assess lesion changes, is required. Physicians may arrange specialized tests based on the characteristics of the medication; for example, when using interferons, attention should be paid to blood coagulation status to ensure treatment safety and efficacy tracking.
How does rehabilitation therapy specifically help alleviate the motor impairments of multiple sclerosis?Physical therapy can alleviate gait instability through balance training and muscle strengthening, while occupational therapy designs specific movements for hand coordination issues. Speech therapists can assist with expressive difficulties caused by brain lesions, and combining electrical stimulation and other technological aids can effectively improve daily functional capabilities.
What personalized factors should be considered when choosing between oral and injectable medications?Physicians will determine the type of medication based on disease stage, lesion activity level, and the patient's lifestyle. For example, patients with milder symptoms or those who find daily injections inconvenient may opt for oral medications, but should be aware of the risk of elevated liver enzymes; while those with rapidly expanding lesions may prioritize high-dose injectable immunomodulators.
How can daily lifestyle adjustments help slow disease progression?Regular aerobic exercises (such as swimming or yoga) help maintain neural plasticity but should avoid high-temperature environments that may trigger temporary symptom exacerbation. In terms of diet, an anti-inflammatory diet is recommended, supplemented with vitamin D and Omega-3, along with stress management techniques to reduce the risk of relapses.
If seizures occur during treatment, how should they be coordinated with the underlying treatment?Seizures are a potential complication for some patients and need to be assessed by a neurologist to determine if antiepileptic medications are necessary. When selecting medications, attention should be paid to interactions with immunomodulators; for example, some antiepileptic drugs may accelerate the metabolism of interferons, requiring dosage adjustments and enhanced liver function monitoring.
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