The topic of travel must be considered individually, people who already have restrictions due to the disease will choose their destination and accommodation with a view to their individual restrictions and will also have very specific questions. But what if people have the diagnosis but otherwise have no or only minor disabilities and are therefore physically able to travel without restrictions. Here, there is sometimes uncertainty and I am often asked the question “Am I really able to travel without restrictions, can/may I travel anywhere?” Some thoughts on this situation.
In principle, a person with multiple sclerosis can go anywhere they want without significant restrictions. However, when choosing a travel destination, one should ask oneself how well one can tolerate heat. The so-called Uthoff’s phenomenon, which occurs at high outside temperatures and can cause certain neurological stimuli or signs of failure to become noticeable again (e.g. blurred vision in the case of past optic neuritis), is not dangerous, but it can be annoying and spoil the holiday. In such cases, places and countries with a moderate climate probably offer more relaxation.
The concern of many MS sufferers is an acute relapse during vacation. A relapse does not necessarily have to be a reason to cancel the vacation. On the one hand, cortisone does not necessarily have to be given in the case of mild relapse symptoms (sensitive symptoms), on the other hand, cortisone can be given without problems in countries with good medical care. However, one should avoid direct sun exposure during cortisone therapy (and for a few days afterwards) as the double influence on the immune system (cortisone + UV radiation) can promote the development of herpes infections (cold sores, shingles). In any case, as a person affected by MS, one should invest in appropriate foreign health insurance – not only because of the coverage in case one has to cancel the trip, but also because the costs for medical services in some countries (e.g. the USA) are very expensive.
Of course, there are many attractive travel destinations where the medical care is not (comprehensively) comparable to ours. Here, as a person affected by MS, you might not necessarily want to make use of medical services in the event of a relapse. Should one therefore as a person affected by MS for example refrain from the backpacking tour in Southeast Asia? Not necessarily, if you act wisely and plan ahead – i.e. deal with the issue beforehand and inform yourself about possible help. And just in case, you can carry cortisone in tablet form in your travel pharmacy. With approx. 40 mg Dexamethasone/day, you can certainly carry out an adequate relapse therapy with tablets. Although we generally recommend high-dose intravenous cortisone for relapse treatment, in such a special situation you can also achieve your goal with oral therapy. Therefore, talk to your neurologist before such a trip.
Of course, one should also not forget to carry one’s medication on holiday. In the case of tablet preparations, this is now relatively easy, injection preparations, on the other hand, require a somewhat greater effort. Here, for air travel, one should think about a doctor’s certificate in order to be allowed to carry these medicines (because of the needles) in hand luggage. For longer trips or when travelling as an individual tourist (backpacking), such injection therapy can pose a hurdle (think of the amount of glatiramer acetate for 3 weeks or the requirement for cooling with some preparations). But before you send your therapy on holiday – which is not in the spirit of a consistent MS therapy – you should also talk to your neurologist here about how to solve this problem in advance and also not create a therapeutic gap on holiday. Under certain circumstances, one might even consider changing the therapy.
Remember, if you use a cannabis preparation for medical reasons (e.g. Sativex), to carry a medical certificate. There are countries where even possession of cannabis is severely punished – with an appropriate certificate, you can save yourself a lot of trouble.
Another important question is whether travel to certain countries is ruled out with an MS therapy. Basically, Europe and the USA do not pose a problem, but there are two problems with more exotic destinations: 1) vaccinations, such as yellow fever, may be necessary, which can cause problems for MS patients 2) in distant countries one could possibly be confronted with disease pathogens that our immune system only knows insufficiently and therefore reacts insufficiently with certain therapies. Interferons or glatiramer acetate certainly do not pose a problem, but in my view caution is advisable when treating with fingolimod (Gilenya), rituximab or alemtuzumab (Lemtrada). For teriflunomide (Aubagio) and fumaric acid (Tecfidera), there is too little experience to give a recommendation here.
Therefore, even as an unaffected MS sufferer, one should pay attention to a few things when traveling, but the disease should not dictate life. Travel opens up new horizons and is good for the quality of life – therefore, one should not let oneself be too much disturbed and try to realize one’s goals – a little willingness to take risks does not harm either. But it certainly doesn’t hurt to inform oneself sufficiently in advance and to consult with one’s neurologist. Then nothing stands in the way of an adventurous journey.
