Your Brain Health and Medicines for Relapsing-Remitting MS

This article is for people who have relapsing-remitting multiple sclerosis (RRMS), their care partners, and others who want to learn more about treatment. The goal is to help you understand the importance of preserving brain health with medicine and lifestyle changes.

You'll explore

• What happens with RRMS

• What brain health is and what it means for you

• How to preserve your brain health

• The benefits and risks of disease-modifying therapies (DMTs)

• How to talk with your healthcare team to decide about treatment

If you've been diagnosed with RRMS, you have periods of

• Relapse when you have symptoms (also called exacerbations or attacks)

• Remission when you don't have symptoms and your disease seems stable

Disease activity shows up on magnetic resonance imaging (MRI) scans as brain tissue damage called lesions. This damage results in brain tissue loss, which is a normal part of aging -- but which happens faster in people with MS.

Physical symptoms may include:

• Vision problems (blurred, loss of vision)

• Weak, stiff muscles, often with painful spasms

• Tingling or numbness in your arms, legs, body, or face

• Trouble with coordination and balance when walking

• Bladder and bowel control problems

• Dizziness/vertigo that doesn't go away

• Trouble swallowing

• Speech problems

Nonphysical symptoms may include:

• Cognitive changes (decreased concentration and attention, short-term memory loss)

• Emotional problems including anxiety and depression

• Fatigue

Each part of your brain performs specific tasks. When MS damages one part of your brain, another part can take over. Your brain's ability to keep working despite damaged tissue is called neurologic reserve -- an essential part of your brain health.

Keep in mind: MS disease activity can still be happening while you're in remission and feeling fine. So you're still using up valuable neurologic reserve. And when it's used up, the symptoms of MS are likely to get worse.

You can maximize the quality of your life when you preserve your brain health with medicine and these lifestyle choices:

• Avoid smoking -- it may increase brain tissue loss, frequency of relapses, and problems thinking

• Be physically active most days of the week -- talk with your provider about a safe exercise you can do for at least 20 minutes at a time that raises your heart rate

• Stay at a healthy weight -- being overweight or obese may increase brain tissue lesions

• Make healthy food choices -- and limit how much alcohol you drink

• Choose brain-stimulating activities -- try hobbies, reading, learning a new language or musical instrument, or doing puzzles

DMTs can help slow down the changes from MS that damage your brain. In clinical trials, researchers have found that DMTs delay disease progression and disability. They also reduce

• How often you get relapses and their severity

• New areas of disease activity as seen on MRI scans

• The rate of brain volume loss

It's important to start treatment as early as possible -- as soon as you're diagnosed or early in the course of your disease. This can provide greater long-term benefit to your brain health.

DMTs work in different ways. That's a good thing, because if one medicine doesn't work or you can't tolerate the side effects, you can switch to another one that may work better for you. They include

• Self-injectable -- injecting yourself with a needle into a muscle or under your skin

• Oral -- pills

• Infusion -- intravenous or "IV" medicine you get through a needle left in your vein for several hours

• Glatiramer acetate injection (Copaxone^®), glatiramer acetate (Glatopa^®)

• Interferon beta-1a (Avonex^®, Rebif^®)

• Interferon beta-1b (Betaseron^®, Extavia^®)

• Peginterferon beta 1a (Plegridy^®)

How often you give yourself injections varies from once daily to once every 2 weeks.

• Dimethyl fumarate (Tecfidera^®)

• Fingolimod (Gilenya^®)

• Teriflunomide (Aubagio^®)

Depending on the medicine, you take your pills once or twice per day.

• Alemtuzumab (Lemtrada^®)

• Mitoxantrone (Novantrone^®)

• Natalizumab (Tysabri^®)

• Ocrelizumab (Ocrevus^®)

You receive your infusions at a clinic from medical professionals. How often you have infusions varies from 3 to 5 days in a row per year to once every 6 months.

Though you're not likely to have every possible side effect, it's important to discuss the common and more serious side effects with your healthcare provider.

Injectable	Some Common Side Effects
Glatiramer acetate injection	Injection site reactions (redness, pain, swelling), flushing, shortness of breath, rash, chest pain
Interferons	Injection site reactions, flu-like symptoms (chills, fever, muscle pain, fatigue, weakness)

Talk with your provider to learn about the common and serious side effects of these medicines.  

Oral	Some Common Side Effects
Dimethyl fumarate	Flushing, nausea, diarrhea, stomach pain
Fingolimod	Headache, flu, diarrhea, abnormal liver tests, sinusitis, pain, cough
Teriflunomide	Headache, hair thinning, diarrhea, nausea, abnormal liver tests
Infusion	Some Common Side Effects
Alemtuzumab	Rash, headache, fever, nausea, flushing, infections, fatigue, insomnia, hives, thyroid disorders, infusion reactions
Mitoxantrone	Stomach disorders, mouth sores, thinning hair, back pain, and other issues, as well as heart and cancer risks
Natalizumab	Headache, fatigue, joint pain, infections, vaginitis, depression, pain, diarrhea, rash
Ocrelizumab	Infusion reactions, increased risk of infection and certain cancers

Your care team needs to know your needs, preferences, and goals. When discussing your treatment options, think about these factors:

• Your need to continue working

• Family planning (there can be pregnancy risks)

• Your lifestyle and interests

• Other medical conditions you have, including depression and anxiety

• Other medicines you take

• The cost of and insurance coverage for the DMT

• Any unhealthy behaviors you have, such as smoking or being inactive

• How you feel about self-injection

• Your ability to take daily medicine or travel to an infusion center

• Your preference for more benefits versus more safety

Like many people, you may be able to stay on the same medicine for years if it continues working for you. However, if your provider feels that it isn't working well enough for you -- or if you have any problems with taking the medicine -- then it's time to discuss switching medicines. Ask your provider:

• Which DMT do you recommend and why?

• What are the side effects and safety issues for this medicine?

• Will this medicine have any effect on my daily activities?

• How will you monitor me for side effects?

• How long does it take for this medicine to start working?

• Are there other options if I don't want to take this medicine?

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