Bisogna distinguere la terapia delle ricadute dalla terapia che agisce sul decorso della malattia.
– Terapia sintomatica
– Terapia dell’attacco o della poussè
– Terapia modificante la storia naturale della sclerosi multipla
1. Il trattamento sintomatico è rivolto ai sintomi che accompagnano la malattia; per la forma con recidivaesiste un trattamento per le ricadute mentre ormai da vent’anni sono entrati in commercio farmaci che modificano il decorso della malattia, perché se una volta si trattavano solo le ricadute lasciando decorrere naturalmente la malattia, ci si è resi conto, attraverso sperimentazioni prima con IFN e poi con farmaci sempre più nuovi, che invece è importante intervenire più precocemente possibilesul sistema immunitario in modo da influire sull’andamento della malattia limitando la disabilità e l’accumulo di lesioni.
Fatica: è un sintomo molto frequente e invalidante. Spesso dipendente dalla temperatura (fenomeno Uthoff) bisogna consigliare al paziente di fare docce frequenti con acqua fredda, e l’uso di climatizzatore e giubbotti termici. Tra i farmaci l’amantadina. Nei casi in cui ci sia anche la componente depressiva bisogna utilizzare gli SSRI.
Dolore: viene trattato con stabilizzanti di membrana quali antipiepilettici come la carbamazepina, la duloxetina. Si può avere nevralgia trigeminale e si usano gli antiepilettici come farmaci di prima scelta o gli antidepressivi.
Per la spasticità: miorilassanti ad azione centrale personalizzata per os, quali baclofen e tizanidina, e periferica come il dantrolene. Nelle forme di spasticità grave diffusa è stata recentemente introdotta la terapia e con bacoflen intratecale mediante pompa di infusione sottocutanea.
Per problemi sfinterici. Farmaci usati anche per l’ipertrofia prostatica quali oxantosinaper il tremore in mezzo a tanti farmaci antiepilettici valproato. Nelle forme di tremore del 100% può essere indicato l’uso del beta-bloccanti.
Terapia dell’attacco o del poussè
Per ricaduta si intende la comparsa di un nuovo sintomo neurologico o del peggioramento di un sintomo pregresso della durata di almeno 48 h. Se il paziente accusa disturbi parossistici tipo sensazione di scossa, nevralgia trigeminale ecc.., questi devono ripetersi più volte nella giornata per almeno 48h e il paziente deve essere stabile neurologicamente in fase di miglioramento da almeno 30 giorni e non deve avere la febbre. Il trattamento di elezione è la terapia steroidea per e.v. ad alto dosaggio o talvolta per via intramuscolo o per os.
Terapie per modificare la storia naturale della malattia.
Una volta si usavano steroidi a basso dosaggio perché si riteneva che con il loro effetto immunosoppressore potessero in qualche modo ostacolare la progressione della malattia. Si è visto che gli svantaggi erano minori dei vantaggi, anzi si creavano molti casi di cortisone-dipendenza per cui oggi il cortisone a lungo termine non è più utilizzato. Oggi vengono utilizzati farmaci alternativi divisibili in due grandi categorie.
. IMMUNOMODULANTI
. IMMUNOSOPPRESSORI
Un esempio di questi farmaci sono le citochine ad azione antiviraleimmunomodulanti, di cui viene usato l’ IFN beta 1A e 1B di sintesi. Un altro farmaco immunomodulante è il glatiramer acetato o copolimero 1. Da circa 5 anni è commercio in Europa e in Italia il Tisabri o natalizumab, un anticorpo monoclonale immunomodulante dall’azione immunosoppressore molto efficace, che agisce legandosi alla alfa-4-integrina.
Gli immunosoppressori sono una categoria di farmaci che modificano il decorso della malattia. Questi possono essere assunti per via os e per e.v. Tra gli immunosoppressori molto usato è l’azatioprinache si somministra per os, e agisce come antimetabolita inibendo la sintesi delle purine bloccando quindi la sintesi di DNA e RNA necessari alla replicazione dei linfociti. Altri farmaci sono il Mitoxantrone e la Ciclofosfamide che sono immunosoppressori molto forti e che si somministrano per via e.v.e sopprimino i linfociti T.
Le informazioni riportate in questo Sito hanno scopo esclusivamente informativo e non devono in nessun caso sostituire il parere medico/paziente.
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