What is multiple sclerosis (MS)?
Multiple sclerosis is a medical condition that affects the brain and the spinal cord. Some of the early symptoms of this disease include numbness, tingling sensations, blurry vision, and feeling weak. Individuals with MS also report other symptoms such as thinking problems, stiffness in the muscles, and urinary tract problems.
The treatment provided for MS does not completely cure the disease, but can only help provide relief from the symptoms of MS and also delay its progression. Multiple sclerosis can be referred to as an inflammatory process that involves various areas of the central nervous system. In this disease, the immune system tends to attack the myelin, which is the protective sheath that covers the nerve fibers and leads to problems in communication between the brain and the rest of the body. Gradually, the nerves start to deteriorate and lead to permanent damage of the nerves.
Multiple sclerosis is a disease with an unpredictable pattern of symptoms. It is an immune-mediated, progressive illness. This would mean that the system, which is designed in such a way to keep the body healthy, erroneously attacks its own parts, which are vital for the day-to-day functioning of the body. This malfunctioning system then leads to damaging the protective coverings of the nerve cells, which ultimately leads to the slower functioning of the brain and spinal cord. The symptoms can range from fatigue to numbness, and in certain cases, when the condition gets serious, it can lead to paralysis or loss of brain function. Below are some of the common signs of multiple sclerosis in an individual:
- Vision Problems: This is one of the most common symptoms of MS. The inflammation caused by MS affects the optic nerve, which in turn, causes a disruption in the central vision. This then leads to a blurry vision, loss of vision, or double vision. These symptoms are not easy to recognize immediately since the deterioration would happen at a slow pace. There can be pain accompanied with loss of vision, especially when one is looking up or to one side of the eye.
- Weakness and Fatigue: An individual may experience unexplained signs of weakness or fatigue. This usually affects around 75-80 percent of people suffering from this disease. It is one of the early stages of multiple sclerosis. Chronic cases of fatigue would occur when the nerves get damaged in the spinal column. An individual may suddenly experience signs of fatigue, which could last for several weeks before it starts showing any signs of improvement. At the beginning, one may not experience weakness in the legs.
- Bowel and Bladder Dysfunction: A dysfunctional bladder is also another common symptom associated with the disease. And again, around 80 percent of people with MS get affected with this symptom but lack to identify the exact cause of the same. Dysfunctional bowel movement would include a strong urge to empty the bladder, frequent urination, or finding it difficult to hold back urine. These symptoms may be gradually managed. However, apart from these symptoms, an individual may also experience other symptoms, which include the loss of bowel control, diarrhea, and constipation.
- Lack of Coordination or Balance: Dizziness or a lack of coordination in an individual can lead to a reduction in mobility for someone who is affected with multiple sclerosis. In such cases, the individual may experience feeling dizzy or drowsy, lightheadedness, or vertigo, which is a sensation that the surroundings are spinning. These symptoms usually occur when you suddenly stand up from a seated or lying down position.
- Spasms: Another common symptom of MS are chronic cases of pain and muscle spasms. Almost half of the people affected with this disease have experienced symptoms of chronic pain. Apart from the pain, the muscles can also get stiff or have spasticity. When muscle spasms happen, there is stiffness in the muscles and joints, which become unbearable, and your movements seem like jerking and cause lot of pain. In this disease, the legs are one of the most affected body part. However, back pain is also quite common in most individuals with MS.
- Emotional changes: Those suffering from multiple sclerosis also undergo emotional upheaval such as depression. The stress related to this disease becomes unbearable and leads to signs of irritation and sudden changes in mood, leading to a condition called as pseudobulbar affect (PBA). In this condition, an individual would experience sudden and frequent bouts of crying and laughing.
There is no treatment or cure for multiple sclerosis. However, the treatment provided for MS aims at speeding one's recovery from the attacks, thereby slowing down the progression of the disease. It also helps manage the symptoms of MS. In some cases, people with MS would only have milder symptoms and do not require treatment at all. Multiple sclerosis can be treated with the help of various medications such as:
- Immunomodulation therapy
- Investigational drugs
- Optional therapies such as Gilenya
Steroids are also known as corticosteroids. Certain medications such as Decadron or Solu-Medrol are potent steroids, which are used to relieve inflammation. They are also used to treat episodes of multiple sclerosis. An acute attack of multiple sclerosis is also called as relapse or exacerbation. These attacks lead to a certain increase in the severity of the symptoms of MS. The attack can last for several days or weeks. There can be cases wherein newer symptoms may also appear or the existing symptoms such as tingling sensation, blurry vision, speech problems, or numbness, can worsen or flare-up.
When a person experiences multiple sclerosis attacks, then he or she would be given Solu-Medrol or Decadron each day for at least five days at a stretch. This would all be decided by the doctor and a treatment plan would be prepared. One should note that steroids will not have any impact on the ultimate level of recovery because they will only help slow down the progression of the disease. Steroids will work best if they are taken immediately once the patient starts experiencing the relapses. It is recommended to start taking medications within 14 days from the start of the relapse.
One of the standard treatment when it comes to multiple sclerosis is the IV steroids treatment. Such treatment is found to be more effective than the standard oral steroids. Steroids are known to cause a reduction in inflammation, which is associated with the MS process and at the same time hasten the recovery from an acute attack. The two of the most commonly used steroids for MS treatment are methylprednisolone (Solu-Medrol), followed by a prednisone taper. The usual recommended dosage of methylprednisolone IV is 500 mg to 1,000 mg for a period of four days until improvement is seen.
What to expect from steroid treatment?
When you are supposed to be given steroid treatment, then you should arrive at the healthcare facility at least an hour before. The doctor would check your complete blood count result and levels of potassium and sodium. The doctor would also check your blood pressure level along with your pulse rate before and after the treatment is given.
Steroids are given in the form of an intravenous drip for a period of 30-45 minutes or they can be directly injected into the vein. Once the first dose is given, you can resume back to your normal activities. The treatment course usually takes one to five days. Following this treatment, you would be given oral steroids called as prednisone. The doctor would provide a complete set of instructions on how this oral medication should be taken.
Steroids are known to suppress the immune system but can help reduce the inflammation around the site, where there is nerve damage.
Methylprednisolone (Medrol or Solu-Medrol)
Methylprednisolone is one of the commonly prescribed steroids for treating multiple sclerosis. It is a medication that prevents the release of any substance in the body that can lead to inflammation. Apart from multiple sclerosis, methylprednisolone can be used to treat other diseases such as arthritis, lupus, allergic disorders, and any conditions that affect the stomach, lungs, eyes, nervous system, or blood cells.
Methylprednisolone should not be taken if you presently have any kind of fungal infection. Before starting this course of treatment, ensure to inform the doctor about all of your past and current medical conditions. Also, let the doctor know if you have taken medications whether over-the-counter or prescription drugs. The doctor needs to know these pieces of information since there are a number of drugs that can interact with steroids. Moreover, there are other diseases that can lead to certain side effects if they do not go well with steroid therapy. Let your doctor know if you have any heart-related problems, high blood pressure, past case of tuberculosis, glaucoma, parasitic infection, history of seizures, diseases of the kidney or liver, thyroid disorders, and mental illness such as anxiety and depression.
Not all MS relapses would need treatment since most of the symptoms tend to go away without any treatment. However, if the symptoms tend to get worse or become severe, then the doctor can suggest high doses of steroids. Methylprednisolone is available in 100 mg tablets as well as intravenous infusion drips. Below are the recommended doses prescribed for this medicine:
- Tablet form – 500 mg daily for the next five days
- Infusion drip – 1,000 mg daily for three to five days
All five tablets should be taken in the morning with food and should not be taken as individual tablets throughout the day.
Methylprednisolone side effects are usually mild and go away in a few days once the course of treatment is completed. The most common side effects of methylprednisolone are:
- Difficulty in sleeping
- Change in one's taste or a metallic taste in the mouth
- Mood changes
Methylprednisolone tends to irritate the lining of the stomach leading to heartburn or indigestion. If one takes the tablets with food, then it would provide relief from such side effects. To protect the lining of the stomach, the doctor can also prescribe other medications (omeprazole or ranitidine) to deal with the problem. Since it causes a difficulty in sleeping, one may take this medicine in the morning to resolve the issue.
Methylprednisolone weakens the immune system leading to an increased risk of developing infections or worsening of an existing infection. Hence, you should inform the doctor in advance if you have had any illness or infection in the past few weeks. Methylprednisolone should not be stopped abruptly since it can lead to unpleasant withdrawal symptoms.
Side Effects of Steroids
Not all patients would experience side effects after steroid therapy. The following are common side effects reported after taking steroids:
- Irregular or rapid heartbeat
- Irritation of the stomach
- Suddenly feeling warm or cold
- Insomnia or a lack of sleep
- Sudden changes in one's mood
- Metallic taste in the mouth
- Increased energy
Below are long-term side effects of steroids:
Since there is a risk of thinning of the bones, you must include the intake of dairy products in your diet. You can also check with the doctor about calcium supplements or vitamin D for your bones.
The findings of those individuals who have been treated with steroids for multiple sclerosis have shown that steroids have actually worked by decreasing the levels of inflammation. Steroids have also decreased the amount of swelling around the MS lesions, thereby leading to better nerve transmission throughout the affected areas. These positive effects can be seen in the MRI just within a few hours of taking the first dose.