Is medication for MS necessary for all patients diagnosed?

[Rene-Spector]

  I am a 47 year old female who was diagnosed with MS about 18 months ago. My symptoms were numbness from the my legs up to my chest.  MRI's confirmed the diagnosis and was put on a steroid drip for 3 days and prednisone for 11 days.  The symptoms went away and I have had no other medications.  For approximately 8 months I have had almost constant numbness or tingling in my fingers and when I relax at night, I feel tingling pretty much all over, from head to toes.  I still work full-time (teaching) and have a completely active life, with no problems with fatigue.  My question.... I have just returned from a conference with the MS Society and they pretty much recommend that ANYONE diagnosed with MS should be on either of the betaserons or Copaxine.  My doctor feels like the symptoms I experience do not warrant the aggressiveness of the medications or the exposure to the possible side-effects from the betaserons.  I have to make a decision and I don't know if there is new information that warrants the use, no matter how few the symptoms.  The doctor who spoke at the conference, Dr. Patricia Coyle, New York, seemed to believe the evidence from recent studies shows that all diagnosed patients should begin medications.  Can you  help?
Dear Renee,
Thank you for your question. You are bringing up a very important point regarding the management of MS in the early stages. Two different types of medications were proven to reduce the frequency of relapses by about 30% overall in relapsing-remitting MS patients, and studies are currently in progress to determine if these medications reduce the progression of disability over time. These medications are interferons (Avonex, Betaseron) and Copaxone. They are called "disease-modifying therapies" because they can have an impact on the course of the disease itself. The question is whether all patients, or only a certain category, should be started on one of these treatments as soon as they are diagnosed with MS.
Since they are meant to prevent further problems from occuring, and not to treat existing symptoms, there is a tendency to start disease-modifying therapies as early as possible in the course of the disease. On the other hand, they all are given by injections, and they can have some side effects, which are usually mild however (flu-like symptoms with the interferons, and some skin problems at the sites of injection mainly with Betaseron). Also, it is often difficult to predict the long-term evolution of the disease at the time of diagnosis, and to predict if a disease-modifying treatment will work in a particular patient.
In summary, I can give you our actual position at the Mellen Center for Multiple Sclerosis of the Cleveland Clinic. We offer the possibility to initiate a disease-modifying treatment to most of our newly diagnosed relapsing-remitting MS patients. We strongly recommend it if they had many relapses or severe relapses, and/or if they have already many symptoms at the time of diagnosis, and/or if the MRI shows many lesions. For those who are reluctant to start treatment, we monitor the activity of the disease, by examining them regularly, and by repeating MRI scans every 6 or 12 months. If there is any evidence that the disease is active, we encourage them to start treatment.
I hope my answer helped. You can discuss these issues with your doctor. If you are still hesitant, you can get a second opinion before making a final decision. Remember that this information is disclosed only for the purpose of general medical information.

[CDArmendariz]

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[curtains669]

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