MS Drugs, Prognosis & Pregnancy-related issues

Drugs:

• Patients must understand that the ABCR immunomodulatory drugs are preventive, not curative. Early treatment is thus essential.
• Patients should avoid exposure to extreme heat.
• The impact of stress on MS exacerbations is thought to be minimal or noncontributory, and trauma has no demonstrated impact on the disease course.

Prognosis:

• If untreated, more than 30% of patients with MS will develop significant physical disability within 20-25 years from onset. This prognosis is changing for these patients with the advent of new treatments.
• Male patients with PPMS have the worst prognosis, responding less favorably to treatment and rapidly accumulating disability. The higher incidence of spinal cord lesions in PPMS is also a factor in the rapid development of disability.
• Less than 5-10% of patients have a clinically milder MS phenotype, in which no significant physical disability accumulates despite several decades passing since onset (sometimes in spite of multiple new lesions by MRI). Detailed examination of these patients in many instances reveals some degree of cognitive deterioration.
• The physician should remind patients that early treatment with some agents may help counteract the progressive brain atrophy seen on MRI.

Pregnancy:

• For the patient with MS who wants to become pregnant, ABCR drugs should be discontinued.
• If the patient becomes pregnant during treatment, the drug should be discontinued immediately.
• The treatment can be resumed a few weeks after delivery or after the patient finishes her period of lactation.