Abstract

The article discusses MS drug treatment strategies according to the Estonian MS treatment guidelines. Treatment falls into 3 categories: treatment of relapses, and treatment with immunomodulatory (disease modifying) and symptomatic drugs. Relapses are treated with i/v methylprednisolone 1 gram for 3–5 days. Corticosteroids shorten the duration and possibly also the severity of relapses, but they do not have a significant impact on long-term recovery. Immunomodulatory drugs are reimbursed in the relapsing remitting form of MS if the patient has had at least 2 relapses during the past 2 years. First choice medications are betainterferons or glatiramer acetate. For persons with MS with an active disease course natalizumab is also recommended but it is not reimbursed. If first line treatment fails cytostatic treatment with mitoxantrone or cyclophosphamide serves as an option. It is very important to start treatment as early as possible to reduce the number of relapses and to slow down the progression of the disease. It is probable that oral drugs for treatment of MS will be available in the future. Symptom management is important for spasticity, fatigue, depression, dysfagia, constipation, and bladder and sexual dysfunction.