In a retrospective nonrandomized study published in April in the European Journal of Hospital Pharmacy , for example, oral steroids were just as effective as IV steroids, and 79 percent of patients preferred taking the medication orally. In this medical procedure, also known as apheresis, plasma exchange, or PLEX, whole blood is removed from a large vein and separated into the cellular components and plasma, according to the Neurological Institute at Cleveland Clinic in Ohio.
A study published in Multiple Sclerosis and Related Disorders in January found that plasma exchange was relatively safe and effective, with complete recovery in Intravenous immunoglobin IVIG can be used to treat relapses, though it is typically considered a second- or third-line treatment.
Immunoglobin is the term for the fraction of plasma that contains antibodies. In IVIG, a mixture of antibodies is delivered intravenously with the aim of treating the relapse by stimulating some parts of the immune system while suppressing other parts. Acthar gel repository corticotropin injection , another second-line therapy, was found to be a more effective alternative to steroids for treating flares compared with IVIG or plasmapheresis, according to a study published in September in Neurology and Therapy conducted by Mallinckrodt, the company that manufactures the gel.
Acthar stimulates the production of the steroid hormones cortisol , corticosterone, and aldosterone, which help the body respond to stress. In the study, Acthar successfully treated MS relapses in In an analysis sponsored by Mallinckrodt , Acthar was found to be more cost-effective than PLEX or IVIG, although all three therapies are considerably more expensive than steroid treatment.
Bebo says. Evidence supports the effectiveness of these medications, including a study that tracked the effectiveness of nine different oral and injectable DMTs, published online in April in ClinicoEconomics and Outcomes Research.
Investigators found that people who were adherent to the medications reduced the likelihood of relapse by 42 percent and hospitalization by 52 percent. A poster presentation at the Consortium of Multiple Sclerosis Centers in June also found increased incidence of relapses when people stopped taking their disease-modifying therapy for more than two months.
That group had nearly 28 percent more relapses, 25 percent more emergency department visits, and 40 percent more hospitalizations compared with people who continued to take their medication. Some people regain total function after a flare, while in others the recovery may be only partial.
A variety of types of rehabilitation specialists — including physical therapists, speech language pathologists, occupational therapists, and cognitive specialists — can play an important role in helping you regain physical and mental function after a flare.
Additional reporting by Becky Upham. By subscribing you agree to the Terms of Use and Privacy Policy. Health Topics. Health Tools. Multiple Sclerosis. It must also occur in the absence of infection, or other cause. Most exacerbations last from a few days to several weeks or even months. Exacerbations relapses are caused by inflammation in the central nervous system CNS. The inflammation damages the myelin, slowing or disrupting the transmission of nerve impulses and causing the symptoms of MS.
In the most common disease course in MS — called relapsing-remitting MS — clearly defined acute exacerbations are followed by remissions as the inflammatory process gradually comes to an end. The good news is that not all exacerbations require treatment. Corticosteroids are not believed to have any long-term benefit on the disease. For more information about these medications, including usage, side effects and precautions, go to the Managing Relapses section of the Medications page.
The goal of a rehabilitation program is to restore or maintain functions essential to daily living. Rehabilitation can be especially useful soon after an exacerbation to help you get back on track. They also provide evaluation and treatment of speech and swallowing difficulties and problems with thinking and memory that may have appeared or worsened during the exacerbation. Memory problems are the worst.
People can see my physical limitations right now, but not the brain fog that is taking a toll on me cognitively. My kids arrive home from school. A few months ago, I was coaching their soccer teams. My 6 year old cuddles up and sits on my lap. He usually has a lot to say. Not today, however. We just quietly watch cartoons together.
The home health nurse arrives at the house. Home health is really my only option for getting treatment because I am in no condition to leave the house right now. Earlier, they tried to reschedule me for tomorrow, but I told them that it was critical that I start my treatment as soon as possible. My only priority is to do whatever I can to put this MS relapse back in its cage. There is no way I am going to wait another day.
This is going to be a five-day infusion. The nurse will set it up tonight, but my wife will have to switch the IV bags for the next four days. This means that I will have to sleep with an IV needle stuck deep in my vein.
I watch the needle go into my right forearm. It makes me sad inside that my arm is deadweight, but I try to feign a smile.
The nurse talks to my wife and answers some last-minute questions before she says goodbye and leaves the house. A metallic taste takes over my mouth as the medicine starts to race through my veins. The IV continues to drip as I recline my chair and close my eyes. Tomorrow will be a repeat of today, and I need to harness all the strength I can muster to fight this MS relapse again tomorrow.
Matt Cavallo is a patient experience thought leader who has been a keynote speaker for healthcare events across the United States. He is also an author and has been documenting his experiences with the physical and emotional challenges of MS since You can connect with him on his website , Facebook page, or Twitter.
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