Corticosteroids, such as prednisone and methylprednisolone, are the most helpful drugs to treat acute exacerbations of multiple sclerosis. The medications decrease edema and inflammation at the site of demyelination. Oral and intravenous steroids are similar in efficacy; however, patients who present with optic neuritis should be given intravenous methylprednisolone because oral prednisone may increase the risk of recurrence. Adrenocorticotropic hormone (ACTH) may be given if the patient cannot tolerate high doses of steroids.
Interferon beta drugs are immunomodulators used for the initial treatment of multiple sclerosis. Examples include Betaseron (interferon beta-1b), Avonex (interferon beta-1a), Rebif (interferon beta-1a), Extavia (interferon beta-1b), and Plegridy (peginterferon beta-1a). Depending on the formulation, the medication is administered either subcutaneously or intramuscularly. Rotate injection sites with each subcutaneous dose to prevent tissue damage. Assess the patient for depression and instruct them to wear sunscreen while exposed to sun.
Dimethyl fumarate (Tecfidera) helps decrease inflammation by activating the NrF2 pathway. The pathway allows cells to defend themselves against oxidative stress. The medication is used to treat relapsing-remitting multiple sclerosis.
Fingolimod (Gilenya) decreases symptoms caused by multiple sclerosis by preventing lymphocytes from reaching the central nervous system and causing damage.
Mitoxantrone (Novantrone) is an intravenous antineoplastic medication reserved for more active and aggressive forms of multiple sclerosis. Serious side effects include cardiotoxicity, leukemia, and infertility.
Natalizumab (Tysabri) is a monoclonal antibody administered intravenously. The medication is reserved for more active and aggressive forms of multiple sclerosis. However, the medication increases the risk of a viral brain infection resulting in progressive multifocal leukoencephalopathy.
Physical therapy and exercise are recommended to decrease muscle spasticity and increase coordination. Increasing the patient's exercise also helps retain unaffected muscle function. Water exercise is recommended, since the buoyancy gives the patient more control over the body to perform a wider range of activities.
The patient with multiple sclerosis should be able to identify triggers that lead to exacerbations of the disease. Examples include infection, trauma, immunization, stress, and change in climate. Help the patient identify particular triggers and instruct them to avoid or minimize their effects.
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