Patients newly diagnosed with multiple sclerosis (MS) have many questions. Here we try to answer some of the most common concerns.
Will I be able to work?Whether to continue on in your chosen field is completely up to you. Many MS patients continue to work both productively and comfortably in their respective fields. And, provisions of the Americans with Disabilities Act will help ensure that reasonable accommodations are provided in your workplace, which is particularly important if and/or when disease symptoms begin to interfere with the work you're doing.
Can I have children?MS does not affect conception, pregnancy, childbirth or breastfeeding. Furthermore, neither pregnancy nor childbirth has an effect on a woman's level of MS-related disability. It is important, however, that women with MS who are thinking about starting a family talk with their physicians about any prescribed medications that may not be safe for use during conception or pregnancy.
Is pregnancy detrimental to the course of MS?
Overall, pregnancy does not appear to have any adverse effect on the long-term clinical course of MS. However, patients should be aware that the relapse rate decreases significantly during pregnancy, but tends to increase in the post-partum period. Frequent clinical monitoring with your physician is recommended during this time.
What is the best method of delivery?
The best method of delivery is usually based on obstetrical, rather than neurological factors. All forms of anesthesia are safe for MS patients.
Am I less able to conceive?
There is no evidence that MS impairs fertility or leads to an increased number of spontaneous abortions, stillbirths or congenital malformations.
When is the best time to get pregnant?
Studies have shown that patients who are clinically stable 1 year prior to conceiving, and patients with a disability score tend to have fewer exacerbations during the post-partum period.
Can I continue with my MS treatment during pregnancy?
No, none of the disease modifying agents including Copaxone, Betaseron, Avonex, Rebif, Tysabri, Gylenia, Aubagio, Tecfidera, Novantrone, Cytoxan are approved for use during pregnancy. The amount of time off medication before conceiving will depend on the drug been used as well as how active your MS is.
Can I breastfeed? Can I take my MS medications while breastfeeding?
Breastfeeding is not contraindicated in women with MS. Recent studies have shown that exclusive breastfeeding can reduced the risk of postpartum relapses. None of the current MS treatments are considered safe during breastfeeding.
Are my children at a greater risk of developing MS?Yes, although this increased risk of developing MS remains relatively small. The chance that a child of an MS parent will acquire the disease is 1 in 40, as compared to a 1 in 750 chance in the general population.
Will I end up in a wheelchair? Because MS affects each person differently, there is no way to predict the outcome for individual patients. However, statistics indicate that as many as two-thirds to three-quarters of all MS patients never require a wheelchair. Still, choosing to use a mobility device (e.g., cane, motorized scooter or wheelchair) can help MS patients combat fatigue--the most common symptom of MS - by conserving energy while getting from one place to another. While no one likes the idea of using a cane or scooter, such assistive devices make life easier and allow MS patients to maintain independent, active lifestyles.
What is a pseudoexacerbation?Does having one mean my MS is progressing?A pseudoexacerbation is a temporary aggravation of MS symptoms - including muscle weakness, tingling, spasms and vision difficulties - that have previously appeared in the patient. Typically, a pseudoexacerbation lasts 24 hours or less. In the majority of MS patients, a pseudoexacerbation is triggered by a rise in body temperature, which, in turn, may be caused by fever (due to infection), the environment (e.g., sun exposure, a hot bath), or exercise (e.g., mowing the lawn). Once the stressor causing the rise in body temperature is removed, symptoms quickly disappear. Though "pseudo" may seem to imply that the aggravation is "fake," the symptoms are, in fact, very real. It is important to note, however, that unlike a true exacerbation - which involves an actual worsening of the disease that may last from several days to several weeks, or longer - a pseudoexacerbation represents disease flare-up, not disease progression. Pseudoexacerbations occur because the central nervous system doesn't operate as efficiently at higher temperatures, and therefore even the slightest rise in temperature can cause the body to mimic an MS attack. During a pseudoexacerbation, the body is essentially unmasking symptoms of a previous inflammation, causing them to reappear. To prevent a pseudoexacerbation from occurring, MS patients should take care to avoid overexertion, combine exercise with rest, and limit exposure to the sun and other hot environments (e.g., whirlpool baths).
Are there any oral therapies for MS?Currently, all immunomodulating agents (Avonex, Betaseron, Rebif and Copaxone) are injectables. However, some of the immunosuppressant agents (CellCept, Imuran) can be given orally. Immunosuppressants are often used in combination with an immunomodulating agent in patients with more advanced disease symptoms. There are oral medications in the process of being studied.
What is the best immunomodulator for relapsing-remitting MS? All current immunomodulating agents are effective, producing approximately a 30 percent decrease in the relapse rate. So far, there has been no study with a head-to-head comparison of all four drugs available. Therefore, it is impossible to know if any of the agents is better than the others. In order to select the best drug for an individual patient, we take into account several factors, including degree of disease activity and side effect profile, as well as the patient's own preference. Having an open discussion with your MS specialist will help establish the best treatment for you.
Are there any treatments available for secondary-progressive MS?Yes. In the initial phases of the secondary-progressive form of MS, when patients are still having exacerbations, the combination of immunomodulating and immunosuppressive agents can be helpful. No specific treatment has proven effective in the late stages of secondary-progressive MS, however, Lahey is currently participating in a trial.
Are there any therapies available for primary-progressive MS?To date, no treatment has proven effective for patients with this form of MS.
Are there any experimental drugs I can take? Can I participate in research trials?Lahey frequently participates in research trials using experimental or known MS-approved drugs. You can check with one of our MS specialists or nurses about any current research studies that apply to your specific case. We also keep an updated list of all MS research going on around the country.