- Researchers investigated how early treatment for multiple sclerosis (MS) affects health outcomes.
- They found that earlier treatment is linked to a lower risk of disability later on.
- Seeking diagnosis and early treatment for MS at the onset of symptoms could improve patient quality of life.
Multiple sclerosis (MS) is an autoimmune inflammatory condition that occurs when the body’s immune system damages the myelin sheaths that cover and protect nerve cells.
Symptoms of MS include loss of balance, numbness or tingling, and weakness. Around
While there is currently no cure for MS, there are treatments to help manage symptoms. Research
Understanding more about how treating MS at different stages affects disability could improve treatment strategies for the condition and improve the quality of life among patients.
Recently, researchers examined health outcomes among patients who began taking treatment for MS sooner or later after symptom onset.
They found that patients who took treatment within the first 6 months of experiencing symptoms had a lower risk of disability than those who began treatment later on.
The study was published in Neurology.
For the study, the researchers included 580 MS patients with an average age of 34 years at the beginning of the study. Around 70% of participants were women, and all had received at least one treatment after a first episode of MS symptoms such as tingling, numbness, and muscle weakness.
They were categorized into three groups according to when they began treatment after symptom onset:
- 0–6 months
- 6–16 months
- more than 16 months.
The researchers then monitored their disability levels and brain scans for an average of 11 years. Disability scores ranged from zero to 10.
Ultimately, the earliest treatment group had a 45% lower risk of developing a disability score of three by the end of the study than those treated latest.
A score of three indicates the ability to walk unassisted but having a moderate disability in one of eight areas, such as motor function, vision, or thinking skills, or mild disability in three or four areas.
They further found that patients treated soonest were 60% less likely to progress to the next stage of the condition, called secondary progressive MS than people treated the latest.
They additionally found that those treated earliest were 50% more likely to remain at stable levels of the condition a year after initial treatment than the latest treatment group.
Medical News Today spoke with Dr. Barbara Giesser, neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, about how early treatment may reduce the risk of disability later on.
She noted that MS is an ongoing process and that nerve damage accumulates over time, even in between clinical attacks. By starting treatment earlier, patients may be able to prevent or minimize further damage.
MNT also spoke with Dr. Amy Yu, director of the Multiple Sclerosis and Neuroinflammation Center with Marcus Neuroscience Institute, part of Baptist Health, at Bethesda Hospital East, also not involved in the study.
“I always counsel my patients that the goal of the treatment now is to maintain their level of function exactly as they are now and allow patients to live their life to their fullest potential,” said Dr. Yu.
“If patients are noticing a decline in their function, I want to know because there may be a treatment that is better than their current one. MS is a very different disease compared to 20–30 years ago due to the disease-modiying treatments (DMT) we have available to us today,” she noted.
When asked about the best treatment options for MS, Dr. Yu noted that arriving at an accurate diagnosis beforehand is key. She noted that currently, no single test can diagnose MS alone and that many other disorders should be ruled out first to ensure the MS diagnosis is accurate.
Tests required for accurate diagnosis typically include:
- blood tests, some of which require specialized labs for analysis
- MRI imaging of the brain, cervical spine, and thoracic spine
- lumbar puncture for cerebrospinal fluid analysis.
After diagnosis, Dr. Yu cautioned that there is no single best treatment for MS as it manifests differently among patients. This means that treatments should be personalized for individuals according to factors including:
- how many MS plaques are seen on the MRI
- level of disability
- age
- family planning concerns
- other medical conditions
- whether there is a history of frequent infections
- patient preference for the route of administration, that is oral, by injection, or via infusions.
“We aim for strict adherence to DMT, and the more thought that goes into DMT selection, the greater chances of a patient doing well on a DMT and remaining adherent to therapy,” she noted.
MNT spoke with Dr. Howard Pratt, a board-certified psychiatrist and medical director at Community Health of South Florida, who was also not involved in the study, about its limitations.
He noted that while earlier treatment gives more opportunity to prevent late-stage symptoms, compliance with medication is not something that can be guaranteed.
“A lot of life can get in the way of treatment, so it becomes harder to extrapolate from this study, and be sure that its findings speak to the case for all of the general public,” he explained.
“Other studies have suggested that early treatment with higher efficacy disease-modifying therapies may be more effective than treatment with lower efficacy agents. In this study, the early-treated patients were mostly treated with low-to-moderate efficacy medications, but still had lower disability than the later-treated groups. This requires further study,” Dr. Giesser added.
“Probably the best thing anyone can do to avoid [the] risk of MS is to stop smoking if they do, given that it is a huge risk factor,” said Dr. Pratt. “And maintaining a balanced diet rich with vitamin D is also important.”
Dr. Giesser noted that studies suggest that healthier diets, such as the Mediterranean diet, are linked to less disability and may reduce the risk for other complications, including heart disease, atherosclerosis, and diabetes, that can further reduce neurologic health.
Dr. Yu added that the above factors should be maintained even if someone has been diagnosed with MS. She emphasized that overall brain health is also important, and that this includes:
- adequate and good quality sleep
- avoiding a sedentary lifestyle
- ensuring adequate regular exercise
- a healthy well-balanced diet
- avoiding sugary or processed foods
- stress management techniques.
“Most important is being on a DMT and being honest with your physician about any intolerance or missed doses. There are many treatment options available and there if we need to change DMT for any reason, we have options, but patients have to be honest and open with their physician.”
– Dr. Amy Yu