Deprescribing protocols have the potential to improve cognition and reduce falls in people with multiple sclerosis (MS) by carefully reducing or stopping medications that may contribute to cognitive impairment, dizziness, or balance problems. MS is a complex neurological condition often treated with multiple medications, some of which can have side effects that negatively affect brain function and physical stability. By systematically reviewing and adjusting these medications, healthcare providers aim to minimize polypharmacy-related risks while maintaining disease control.
People with MS frequently take a variety of drugs, including disease-modifying therapies, symptomatic treatments, and medications for comorbid conditions. This polypharmacy can increase the risk of adverse effects such as sedation, confusion, and orthostatic hypotension, all of which can impair cognition and increase fall risk. Deprescribing protocols involve a structured approach to identifying medications that may no longer be necessary, are potentially harmful, or could be replaced with safer alternatives. This process requires careful assessment of each drug’s benefits and risks in the context of the individual’s current health status.
Improving cognition through deprescribing is possible because some medications, especially those with sedative properties or anticholinergic effects, can worsen cognitive function. Reducing or stopping these drugs may lead to clearer thinking, better attention, and improved memory. For example, benzodiazepines and certain sleep aids, often prescribed for anxiety or insomnia in MS, can cause drowsiness and cognitive slowing. Deprescribing these under medical supervision can enhance mental clarity.
Regarding falls, many medications can cause dizziness, low blood pressure, or muscle weakness, all of which increase the likelihood of falling. By deprescribing such medications, patients may experience improved balance and coordination. Additionally, reducing the total medication burden can lessen fatigue and improve overall physical function, further decreasing fall risk.
Successful deprescribing in MS requires a multidisciplinary approach involving neurologists, pharmacists, physical therapists, and primary care providers. It also depends on patient education and engagement to ensure adherence and monitoring for withdrawal effects or symptom recurrence. Deprescribing is not about stopping all medications but about optimizing therapy to maximize benefits and minimize harms.
In some cases, adjunct therapies such as oxygen therapy or lifestyle interventions like physical exercise may complement deprescribing efforts by enhancing neurological function and reducing symptoms that contribute to cognitive decline and falls. For example, improved oxygenation can support cellular health in the nervous system, potentially aiding recovery and function.
Overall, while more research is needed to establish standardized deprescribing protocols specifically for MS, the principles of reducing unnecessary or harmful medications hold promise for improving cognition and reducing falls in this population. Careful, individualized medication review and adjustment can lead to better quality of life and safer mobility for people living with MS.
