PEBC Exam: The Management of Multiple Sclerosis

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Overview of Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive and potentially disabling disease of the central nervous system (brain and spinal cord). The hallmark of MS is the destruction of the protective myelin sheath around nerve fibers by the immune system resulting in the impairment of communication between the brain and the rest of the body.

Symptoms of MS depend on the degree of nerve damage. Some patients with severe Multiple Sclerosis may lose the ability to walk independently while others may experience long periods of remission without any new symptoms. Unfortunately, there is no cure for MS. All available treatments help lessen the frequency of relapses and potentially delay the progression of physical disability. Canada has the fifth highest worldwide prevalence of MS, affecting 240 out of every 100,000 people. Relapsing-remitting MS (RRMS) is the most common type of MS, affecting 85 to 90 percent of patients.

Common symptoms may include:

• Numbness/weakness of limbs and/or trunk affecting typically on one side of the body at a time
• Unsteady gait, tremors, or lack of coordination
• Electric-shock sensations occurring with certain neck movements, mostly bending the neck forward known as Lhermitte sign
• Memory impairment

Vision symptoms may include:

• Partial or complete loss of vision often with pain affecting typically one eye at a time
• Blurred vision
• Double vision

Treatments

For many years, there were limited treatments available in Canada and they were all given by intramuscular or subcutaneous injection. Recently, three new oral drugs have been approved by Health Canada; these more patient-friendly oral drugs have changed the landscape of Multiple Sclerosis treatment in Canada.

 

Summary of MS Drugs in Canada
Name	Drug Administration
Interferon   beta-1a (Avonex or Rebif)	Injection
Interferon   beta-1b (Betaseron or Extavia)	Injection
Glatiramer   acetate (Copaxone)	Injection
Natalizumab (Tysabri)	Infusion
Alemtuzumab (Lemtrada)	Infusion
Fingolimod (Gilenya)	Oral
Dimethyl fumarate (Tecfidera)	Oral
Teriflunomide (Aubagio)	Oral

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