How can MS treatment effectiveness be improved?

Question

Hello doctor,

I received the laboratory results for my 35-year-old sister with MS, and I have some questions. Her oligoclonal bands show four unique bands, and her CSF pressure is 25 cm H2O, and her neurofilament light chain levels are elevated. The neurologist mentioned these findings but did not provide much explanation. Additionally, her MRI shows new lesions despite her being on Tecfidera for the past eight months.

Does this indicate that her treatment may not be effective?
Should we consider adjusting her medication?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Thank you for sharing your sister’s laboratory results and MRI findings. Let’s go over them:

Oligoclonal bands: The presence of unique oligoclonal bands in the cerebrospinal fluid (CSF) is a sign of inflammation in the central nervous system, commonly associated with multiple sclerosis (MS).
CSF pressure: A CSF pressure of 25 cm H2O is slightly elevated (normal range is 6 to20 cm H2O), which may indicate inflammation in the brain or spinal cord.
Elevated neurofilament light chain (NfL): Elevated levels of neurofilament light chain suggest active axonal damage or nerve injury, a sign of disease progression or inflammation in MS. It is a useful biomarker for assessing disease activity and treatment response.
New MRI lesions: The presence of new lesions on the MRI while on Tecfidera indicates ongoing disease activity, suggesting that the current treatment may not be adequately controlling her multiple sclerosis (MS).

Given these findings, it seems that Tecfidera may not be effective for her. I recommend discussing a switch to a more potent medication with your neurologist. Options like Ocrelizumab, Natalizumab, or Alemtuzumab are generally more effective at reducing inflammation and preventing new lesions.

Additionally, regular monitoring of neurofilament light chain (NfL) levels can help track her response to any new treatment.

Encourage her to maintain a healthy diet, engage in regular exercise, stay hydrated, and manage stress to support her overall well-being.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.