Source:

Dr. HATEM SAMIR M. SHEHATA. 
PROFESSOR OF NEUROLOGY - CAIRO UNIVERSITY

NEVIN M. SHALABY. 
PROFESSOR OF NEUROLOGY - CAIRO UNIVERSITY
 
Dr. LOBNA ELNBIL 
PROFESSOR OF NEUROLOGY- AIN SHAMS UNIVERSITY

It is important, while you check this text, to use this information only to know more about MS but it is crucial for all patients not to try any of these medications without prior consultation and discussion with your physician about the medication that suits your case in particular as every MS is a unique case and personalization of treatment is extremely important for your well-being. 
It is worth mentioning that MS Care society is not responsible for any abuse of the information provided. 

• During attack

    Methylprednisolone (Solu-Medrol) can hasten recovery from an acute     exacerbation of MS. 
    Plasma exchange (plasmapheresis) can be used short term for severe     attacks if     steroids are contraindicated or ineffective. 

• In between attack
• Disease modifying therapy Disease-modifying therapies have shown beneficial effects in patients with relapsing MS, including reduced frequency and severity of clinical attacks. These agents appear to slow the progression of disability and the reduce accumulation of lesions within the brain and spinal cord. The disease-modifying agents for MS (DMAMS) currently approved for use by the US Food and Drug Administration (FDA) include the following:
• INF beta I a(AVONEX) 6 MIU, ONCE WEEKLY
• INF beta 1 a (REBIEF) 12 MIU 3 TIMES WEEKLY
• INF beta 1 b (BETAFERON) 8 MIU EVERY OTHER DAY 
• Glatiramer acetate 20 mg sc daily
• Mitoxantrone   12mg/m2, once every 3 mo iv
• Natalizamab (Tysabri)  300 mg /4 wks
• Peginterferon beta-1a (Plegridy) ] 
• Glatiramer acetate (Copaxone)  
• Fingolimod (Gilenya)  
• Teriflunomide (Aubagio)  
• Dimethyl fumarate (Tecfidera)  
• Alemtuzumab (Lemtrada) 
• Fingolimod, teriflunomide, and dimethyl fumarate are administered orally; natalizumab and mitoxantrone are administered by intravenous infusion; interferon beta-1a (Avonex) is administered intramuscularly; and interferon beta-1a (Rebif), interferon beta-1b, and glatiramer acetate are administered by subcutaneous injection.

Patient lifestyle, patient tolerance, and adverse effects of injections should be considered in the choice of DMAMS. To a certain extent, health-care-provider preference and experience with the medications also play a role in determining which drug is appropriate in a particular situation
 

Treatment of Aggressive MS

• High-dose cyclophosphamide (Cytoxan) has been used for induction therapy to stabilize     aggressive MS. cyclophosphamide (200 mg/kg IV infusion over 4 days) followed by     long-term maintenance therapy with glatiramer was well tolerated and appeared to be     effective in reducing the risk of relapse, disability progression, and new MRI lesions.

         Adverse effects of cyclophosphamide include leukemia, lymphoma, infection, and hemorrhagic cystitis.

• Mitoxantrone.  It   is not indicated in the treatment of patients with primary progressive MS.

Mitoxantrone has a black-box warning for cardiotoxicity. 

Immunomodulatory Therapy for Progressive MS

• Currently, no approved treatments are available for  (PPMS). 
• Patients with secondary progressive MS (SPMS) who experience relapses are sometimes started on a DMAMS approved for relapsing-remitting MS.
• Methotrexate has shown some effectiveness in delaying progression of impairment of the upper extremities in patients with SPMS.
• Mitoxantrone is another treatment option for progressive MS. It is approved for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary (long-term) progressive, progressive relapsing, or worsening relapsing remitting MS, but not for primary progressive MS.