6. Conclusions

The action mechanisms of glucocorticosteroids in the immune system are pleiotropic, induced apoptosis of peripheral blood leucocytes and down-regulation of T-cell activity delayed for

TPE is the removal of circulating antibodies, cytokines, immune complexes and complementary factors, all of which are assumed to be involved in immune-mediated neuroinflammation. IVIG reduces or prevents the activation of inflammatory cells and alters antibody responses. Optimal treatment of relapses increases the chance of limiting or avoiding residual deficits

Sleep disturbance (insomnia) might be one of the side effects of corticosteroid therapy during

Interferons are DMTs that produce major alterations of sleep, mainly by the flulike reaction, fever, headache, alteration of the mood and fatigue. It is imperative to treat these effects to improve the patient's quality of life including finding what time is best to administer the

Specific treatment of symptoms of MS manifestations occasionally interferes with sleep quality, leading to insomnia or drowsiness. The treatments the patient is receiving need to be reviewed

Selective serotonin reuptake inhibitors, while helpful for depressive symptoms, may worsen insomnia. Stimulants and wake-promoting agents, which are commonly used for fatigue, may interfere with sleep initiation if taken during the late afternoon or early evening hours. Antihistamines, which are used as sleep aids by up to 25% of patients with MS, have the potential

Patients suffering from fatigue symptoms are often treated with antidepressants due to the strong association between depression and fatigue. Modafinil, amantadine and aminopyridine are known as fatigue treatment options, although the physician must monitor the real effect on

Medications used to alleviate MS-related symptoms, including over-the-counter medications, also have the potential to interfere with sleep. Given the high frequency use of these medications in this population, the physician should carefully consider screening for these medica-

The first approach includes reviewing the list of drugs being taken by the patient and adjusting doses or suspending them if necessary to avoid interference with other situations of the

patient. In this respect, the multidisciplinary approach to the patient is important.

sleep and adjust the administration schedules so as not to mask the effect on fatigue.

an acute exacerbation in MS. Benzodiazepines are useful during these periods [74].

treatment. The monoclonal antibody Natalizumab could reduce fatigue [37].

7–10 days after a 5-day course of administration [72].

5.2. Disease-modifying therapies

186 Neuroplasticity - Insights of Neural Reorganization

5.3. Symptomatic treatment

in the event of any sleep disturbance.

to worsen RLS, and thereby worsen sleep-onset insomnia.

tions and assessing possible effects on sleep.

5.3.1. Management

which have been related to the progression of disability in MS [72].

Sleep disorders in patients with MS are frequently underdiagnosed. Clinicians caring for patients with MS should routinely screen for sleep disturbances.

All the symptoms are related, many of them share the same pathophysiology where it is not possible to identify the precipitating factor and the perpetuating factor. Sleep disturbances increase the risk of mortality, co-morbidities (cardiac disease, obesity and diabetes) and can contribute to the depression, pain, cognitive impairment and fatigue symptoms which are disabling and worsen the prognosis of multiple sclerosis.

The therapeutic approach to sleep disorders in MS involves pharmacological, rehabilitative, physical, psychological, educational and lifestyle modification interventions. These can be used independently in combination, with combined therapies being more effective.

The list of drugs being taken by the patient should always be reviewed and doses should be adjusted or suspended if necessary to avoid interference with sleeps disorders.
