What are the ways for managing multiple sclerosis?

Question

Hello doctor,

I’ve had MS for five years and take Ocrelizumab, but my symptoms, especially stiffness, pain, and fatigue, are getting harder to manage. I also have high blood pressure and chronic migraines, which complicate things. Despite being on Gabapentin and Baclofen, I still struggle daily. Lately, I’ve noticed memory and focus issues. Could this be from MS progression or long-term meds?

My blood pressure is also fluctuating. Could my conditions and treatments be interacting? Should we adjust my meds or explore other therapies? I’m concerned about the long-term effects. Would newer or more advanced treatments help manage MS and my other health issues better? Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing multiple sclerosis (MS) can be incredibly challenging, especially when you're also managing other chronic conditions like high blood pressure and migraines. As symptoms evolve, it's natural to feel overwhelmed or uncertain about what's causing what. Here's a breakdown to help clarify things:

Cognitive issues (memory and focus): Memory or concentration problems may be due to MS progression, medication side effects, or fatigue. An MRI can help assess current disease activity. You might also benefit from cognitive rehabilitation therapy. Be sure to look at lifestyle factors, too, like sleep quality, stress, and possible sleep disorders. If fatigue plays a role, medications like Modafinil or Amantadine may help.
Spasticity, pain, and fatigue: If Baclofen isn't fully effective, increasing the dose or switching to Tizanidine might offer better relief. For nerve pain, adjusting Gabapentin or trying alternatives like Pregabalin, Duloxetine, or low-dose Naltrexone (LDN) may be worth discussing. Also, check your vitamin D and B12 levels; deficiencies can make MS symptoms worse.
Migraines and blood pressure: Frequent migraines may respond to medications like Topiramate or Propranolol (which can also help with BP) or newer CGRP inhibitors. Blood pressure fluctuations could be linked to MS-related autonomic dysfunction or stress. A cardiologist can help manage this more precisely.
MS treatment adjustments: While Ocrelizumab is a strong option, if symptoms are worsening, it may be time to revisit your treatment plan. Your neurologist might consider newer options like BTK inhibitors (currently in clinical trials) or Siponimod if there are signs of secondary progressive MS. If it's been a while since you've done physical or occupational therapy, that could also help with mobility and spasticity.
Long-term health concerns: Ongoing monitoring is important, especially for bone density, infections, and cardiovascular health, given the long-term use of immunosuppressive therapy.
Exploring advanced therapies: Ask your neurologist about newer therapies or clinical trials. Some newer treatments are showing promise in slowing progression and protecting brain function. Regular check-ins with your neurologist (every 3 to 6 months) and working closely with specialists like a cardiologist, pain doctor, or mental health provider can help tailor your care to your changing needs.

I hope this helps you.

Kindly revert back if you have further queries.

Thank you.