Question: How can memory deterioration be prevented?

Answer: Cognitive impairment in multiple sclerosis (MS) primarily stems from inflammatory and degenerative processes in the brain. Personalized immunological treatment to prevent inflammation is the first and most critical step in reducing brain tissue damage and preserving cognitive function. Another important element is cognitive activity, such as intellectual work, learning a new language, or engaging in cognitive exercises using specialized software. These activities help maintain cognitive function.

Question: What can be done about digestive system issues like a sense of intestinal immobility, nausea after meals, or incomplete evacuation, and how are they related to MS?

Answer: The digestive system is significantly affected by MS due to the close connection between the central nervous system and the digestive system. Approximately two-thirds of MS patients experience at least one gastrointestinal symptom lasting more than six months. The most common symptoms include swallowing difficulties, heartburn, nausea, poor digestion, diarrhea, constipation, and loss of bowel control.

Initial solutions that can be tried at home include dietary adjustments and lifestyle changes. However, it is essential to consult a doctor for new or persistent symptoms. Advanced medical centers offer an integrated approach, combining neurologists and gastroenterologists, to provide optimal care for patients with these symptoms.

Question: Is hyperbaric oxygen therapy recommended for progressive MS? Is there a treatment to restore myelin? Should biological therapy (Ocrevus) be switched after a period of use?

Answer:

1. Hyperbaric Oxygen Therapy: Currently, there is no valid scientific evidence supporting the benefit of hyperbaric oxygen therapy for MS patients.
2. Myelin Restoration: There are no approved treatments for MS that can regenerate myelin. However, early treatment of the disease to prevent inflammatory activity allows the brain to partially repair damaged myelin. This underscores the importance of achieving early disease stabilization (NEIDA—No Evidence of Disease Activity).
3. Switching Biological Therapy (Ocrevus): There is no need to switch biological therapy like Ocrevus after a specific period if the treatment remains effective and safe for the patient. This means achieving NEIDA and avoiding side effects. For stable patients over many years, particularly those aged 55 and above, de-escalation to a less potent treatment might be considered to reduce the risk of immunosuppression in older age.