Treatment types

For every individual’s MS, there are treatment options that we can discuss, In general treatments for MS are classified into 7 categories:

Symptom management can cover a whole range of things, but these are some of the more common ones:

  • Movement difficulties or balance problems,
  • Bladder and bowel control difficulties,
  • Pain, fatigue or weakness,
  • Visual or sensory disturbances
  • Speech and swallowing difficulties
  • Low mood, emotional fluctuations or cognitive impairments

Relapse treatment can vary. Firstly, it is important that we look at whether the change in symptoms is caused by an actual relapse, or a ‘pseudo-relapse’. This is when symptoms get worse but not in relation to an increase in the disease’s actual activity.

If the MS relapse symptoms affect a person’s bodily functions and/or interfere with their daily life, we usually recommend treatment which might include:

  1. A short course of high dose of the steroid methylprednisolone (given either orally or intravenously)
  2. Neuro-rehabilitation either alongside or after the steroid course.

MS causes inflammation to the nerve cells in your brain and spinal cord. Disease-modifying therapies (DMTs) are courses of medical treatment that help the immune system to reduce this inflammation. This can then help reduce the number of relapses experienced by someone with MS, and how bad those relapses are when they do happen.

Disease-modifying therapies (DMTs)

As well as reducing the frequency and severity of relapses, we can see on MRI scans that these immune therapies prevent new MS-related lesions in the brain. There are a number of different DMTs available, and the way they are taken, how often they are taken, and their side effects are all different too.

The current way to use a DMT is to start treatment as early as possible after diagnosis. This is to stop neurodegeneration, by which we mean the deterioration of the brain’s neurons and so how well it is able to work.

If, after assessment and discussion, one of our patients decides that a DMT might be a good fit for them, we would talk through all the options available to make sure the treatment chosen best fits their needs and priorities. Our recommending a treatment would be based on a number of things, including:

  • Recent ‘clinical activity’, or how someone has been experiencing their MS lately, including any sudden changes in their MS, how bad that change was, and how long it took to recover from
  • The neurological examination findings
  • The impact of the MS on both brain and spinal cord, which we would find out through looking at recent MRI scans
  • Any other illnesses or treatments experienced that might interact with the MS treatment
  • The side effects experienced in any previous MS drugs, and the potential side effects of new medications
  • What we will need to do to monitor your response to the treatment
  • Preferences regarding type of therapy (oral or injectable)
  • Any lifestyle choices or values that might impact treatment choice, such as family planning (particularly for women).

Neuro-rehabilitation refers to the specific area of support for people with neurological difficulties such as:

  • fatigue,
  • spasticity,
  • pain,
  • bladder, bowel or sexual problems,
  • memory or cognition problems.

These symptoms can be experienced by people with a range of different diagnoses and so the specialist you will see may also have clients who are recovering from injury, dealing with the effects of stroke or living with another neurological condition.

A comprehensive neurological physiotherapy assessment will look at:

  • A person’s posture, movement, and balance,
  • The way they adapt and stay safe,
  • How they use energy and are their involvement in physical activity.

The assessment will identify any specific areas of risk, weakness, stiffness, spasticity/ muscle tension and cramps, pain and sensory changes.

It will also look at any factors influencing your problems and the way different symptoms or difficulties are connected. For example:

  • constipation can trigger cramps and reduce core control for balance. In the same way, reduced movement and mobility can cause constipation;
  • A swollen leg will make leg muscles difficult to move and balance with, whilst an inactive leg tends to swell.

The assessment will look into whether a person’s current physical problem is due to their MS or something else. For example, not being able to lift a foot could be due to a muscle not receiving a message from the brain to move, or could be due to stiffness in the muscle itself caused by an old injury or as a result of spasticity causing a stiff calf.

Once the reasons behind an individual’s difficulties are understood in a holistic and connected way, the physiotherapist can create a management plan to tackle these issues and optimise a person’s function for health and wellbeing and overall quality of life.

Co-morbidities is the term used for other conditions or illnesses that someone with MS has that are not linked to their MS. These are common among people with MS. The most common co-morbidities include:

  • depression,
  • anxiety,
  • raised lipid levels in the blood,
  • Hypertension, and
  • chronic lung disease.

Having other conditions alongside MS can make treating a person’s MS more complicated or can change the decisions that individual will make about what medicines and treatments are right for them. Co-morbidities can also make someone’s experience of disability feel more challenging to them.

Assessing and managing any co-morbidities our clients have is part of our holistic approach to MS management. We know that this complete understanding and care can have a real and positive impact on how people experience their MS, their health in general, and their quality of life.

We know that lifestyle can really impact how someone experiences their MS, and that little changes can make big differences long-term. From sleep and stress to nutrition and movement, we can help to identify those seemingly unrelated things that can help someone gain control over their MS.

Being diagnosed with MS can be a challenging time in someone’s life, both for the individual with MS and their family. Learning to adapt and think differently about goals in life can help make sure they are achievable, though perhaps by different routes. This mental flexibility can be hard; having some support can help that journey.

Psychological support can also be helpful for specific areas of MS. Some symptoms are cognitive or behavioural, like emotional lability, whilst common co-morbidities include depression and anxiety, and different types of mental health support might be helpful to those experiencing any or all of these things.

The team is ready to listen, understand and co-create a bespoke treatment plan for anyone living with MS. Contact us now to schedule an appointment.