The management of multiple sclerosis benefits from new drug treatments. But it must often be accompanied by rehabilitation.
- Multiple sclerosis, an autoimmune disease, affects more than 110,000 people in France
- It frequently occurs between the ages of 30 and 40
- MS treatments rely on immunomodulators or immunosuppressants
You do not die from multiple sclerosis, even if this disease can seriously degrade the quality of life. But there is no cure either! Whether multiple sclerosis is in its most frequent form, ie by flare-ups followed by periods of remission, or whether it is progressive, its development can be stopped or at least slowed down. But the damage caused by this auto-immune disease which destroys myelin, the sheath which surrounds and protects the nerve fibers by thus degrading the role of the latter in the proper transmission of nerve signals, is irremediable once they are installed.
The drug arsenal has evolved
However, the management of patients with multiple sclerosis has greatly improved over the past twenty years. Firstly because the drug arsenal has evolved, then because these patients are much better oriented towards rehabilitation structures which make it possible to limit the effects of MS, in particular when it causes muscle loss or motor difficulties.
Since the destruction of the myelin at the origin of the disease is caused by an autoimmune reaction, i.e. when the immune system attacks the body’s functions inappropriately, the main treatments are aimed at to counter this process. “In the management of multiple sclerosis, we are fortunate to have many disease-modifying treatments which are immunomodulators or immunosuppressants.“, explains Laure Michel, neurologist at the University Hospital of Rennesa facility where four specialists work specifically on MS.
Act on the immune system
Acting on the functioning of the immune system means acting on certain populations of white blood cells. “ We currently have a panel of about ten molecules that offer different mechanisms of action on immune cells“, specifies Laure Michel. Not all patients respond to the same treatments and these can also be changed or adapted according to the evolution of the disease.
“There are two main categories, adds Laure Michel, basic treatments, called first line, which have a rather modulating action on the immune system and whose long-term tolerance profile, over 20 or 30 years, is very well known. , which is important in a chronic disease that will evolve over more than 30 or 40 years”. Multiple sclerosis occurs most often in fairly young subjects, precisely around 30 or 40 years old with a very high female predominance which reaches 70 to 75%. But these immunomodulatory treatments have a relatively moderate effectiveness. “There is a fairly high percentage of patients for whom they are not going to be enough“, recognizes Laure Michel.
Contraindications
So there is another category of treatments based on more recent molecules which seem to have a much higher efficiency. On the other hand, their long-term tolerance profile is less known – they have not been used for enough time to give reliable indications on this point – and above all they can be totally contraindicated in certain situations, in particular for pregnant women. . However, because of the average age at which the disease occurs and the female predominance, these cases of pregnancy with multiple sclerosis are ultimately quite numerous. “But starting from the start with these treatments makes it possible to better control the disease“, insists Laure Michel.
Rehabilitation organizations
Whatever the follow-up of patients with these treatments, due to the chronic nature of the disease, it is a matter of long-term management for which drugs are not “not quite enoughts”, as suggested by Laure Michel who insists on the importance of all the other actors in this care. ” For our patients, many things are put in place with the help of our educational partners and we often quickly offer contact with a rehabilitation organization.“, specifies the neurologist from Rennes. MS is indeed still often linked either to a physical handicap or to effects such as chronic fatigue which require adapted aids.
“Adaptation to the effects of fatigue (it remains one of the major symptoms of the disease), meeting with other patients, support from physiotherapists, sophrologists, psychologists, even if you only have an extremely slight disability , having rehabilitative care, monitoring of all the effects of the disease, this helps to have a comfortable life”assures Laure Michel.