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Nervenheilkunde 2007; 26(12): 1095-1100
DOI: 10.1055/s-0038-1626965
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Multiple Sklerose

Ein UpdateMultiple SclerosisUpdate
M. Paulig
1   Neurologisches Krankenhaus München
› Author Affiliations
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Publication History

Publication Date:
22 January 2018 (online)

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Zusammenfassung

In den letzten Jahren wurden neue Medikamente zur Behandlung der Multiplen Sklerose verfügbar und neue diagnostische Richtlinien herausgegeben. Interessante neue Daten kommen auch von histopathologischen Untersuchungen. Sie verweisen auf heterogene Pathomechanismen, die unter dem Etikett „MS” liegen. Offensichtlich ist die Entzündung nur ein Teil der Pathologie, die auch durch neurodegenerative Prozesse bestimmt wird. Gegenwärtig sind die krankheitsmodifizierenden Medikamente überwiegend beim schubartig remittierenden Verlauf wirksam. Es gibt nur wenig Evidenz bezüglich der sekundären Progression und derzeit keine krankheitsmodifizierende Therapie bei der primär progressiven Form. Deshalb spielen symptomorientierte Behandlungsverfahren bei der MS nach wie vor eine große Rolle.

Summary

Within the last years new drugs for the treatment of Multiple Sclerosis have become available as well as new diagnostic guidelines for MS have been established. Intriguing new data also arise from histopathological studies. They point to heterogenous pathomechanisms that might be hidden behind the label of “MS”. Obviously, inflammation is only one part of the pathology that is also driven by a process of neurodegeneration. Future therapies may focus more individually on the subtypes of the disease. The current disease modifying drugs are predominantly effective during the relapsing remitting course. There is less evidence for the secondary progression and no disease modifying therapy exists for the primary progressive course so far. Symptom-oriented therapies therefore still play an important role in the treatment of MS.

Schlüsselwörter

Multiple Sklerose - Therapie - krankheitsmodifizierende Medikamente - Diagnose

Keywords

Multiple sclerosis - therapy - disease modifying drugs - diagnosis
 

  • Literatur

  • 1 Arnold D. Evidence for neuroprotection and remyelination using imaging techniques. Neurology 2007; 68 (Suppl. 03) S83-90.
    CrossrefPubMedGoogle Scholar
  • 2 Bakshi R, Minagar A, Jainsani Z, Wolinsky J. Imaging of multiple sclerosis: role in neurotherapeutics. Journal of the American Society for Experimental NeuroTherapeutics 2005; 02: 277-303.
    Google Scholar
  • 3 Balcer LJ. et al. Natalizumab reduces visual loss in patients with relapsing multiple sclerosis. Neurology 2007; 68: 1299-304.
    CrossrefPubMedGoogle Scholar
  • 4 Barnett MH, Prineas JW. Relapsing and remitting multiple sclerosis: pathology of the newly forming lesion. Ann Neurol 2004; 55: 458-68.
    CrossrefPubMedGoogle Scholar
  • 5 Comi G. et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 19 357: 1576-82.
    Google Scholar
  • 6 Cree BA. et al. An open label study of the effects of rituximab in neuromyelitis optica. Neurology 2005; 64: 1270-1272.
    CrossrefPubMedGoogle Scholar
  • 7 Durelli L. et al. Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet 2002; 359: 1453-1460.
    CrossrefPubMedGoogle Scholar
  • 8 Goodin DS. et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002; 58: 169-178.
    CrossrefPubMedGoogle Scholar
  • 9 Hartung HP. et al. Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, doubleblind, randomised, multicentre trial. Lancet 2002; 360: 2018-2025.
    CrossrefPubMedGoogle Scholar
  • 10 Hartung HP. Early treatment and dose optimisation BENEFIT and BEYOND. J Neurol 2005; 252 3 iii44-iii50.
    PubMedGoogle Scholar
  • 11 Jacobs LD. et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group N Engl J Med 2000; 343: 898-904.
    Google Scholar
  • 12 Kobelt G. et al. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatr 2006; 77: 918-926.
    CrossrefPubMedGoogle Scholar
  • 13 Lassmann H, Brück W, Lucchinetti CF. The immunopathology of multiple sclerosis: an overview. Brain Pathol 2007; 17: 210-8.
    CrossrefPubMedGoogle Scholar
  • 14 Lennon VA. et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 2004; 364: 2106-12.
    CrossrefPubMedGoogle Scholar
  • 15 Lucchinetti CF, Bruck W, Lassmann H. Evidence for pathogenic heterogeneity in multiple sclerosis. Ann Neurol 2004; 56: 308.
    CrossrefPubMedGoogle Scholar
  • 16 Lucchinetti CF. et al. A role for humoral mechanisms in the pathogenesis of Devic’s neuromyelitis optica. Brain 2002; 125: 1450-1461.
    CrossrefPubMedGoogle Scholar
  • 17 McDonald WI. et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121-127.
    CrossrefPubMedGoogle Scholar
  • 18 Montalban X. The importance of long-term data in multiple sclerosis. J Neurol 2006; 253 (Suppl. 06) vi9-vi15.
    Google Scholar
  • 19 Panitch H. et al. Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCETrial. Neurology 2002; 59: 1496-506.
    CrossrefPubMedGoogle Scholar
  • 20 Pittock SJ. et al. Brain abnormalities in neuromyelitis optica. Arch Neurol 2006; 63: 390-396.
    CrossrefPubMedGoogle Scholar
  • 21 Polman CH. et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006; 354: 899-910.
    CrossrefPubMedGoogle Scholar
  • 22 Polman CH. et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the „McDonald Criteria”. Ann Neurol 2005; 58: 840-846.
    CrossrefPubMedGoogle Scholar
  • 23 Rudick RA. et al. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med 2006; 354: 911-923.
    CrossrefPubMedGoogle Scholar
  • 24 Sayao AL, Devonshire V, Tremlett H. Longitudinal follow-up of „benign” multiple sclerosis at 20 years. Neurology 2007; 68: 496-500.
    CrossrefPubMedGoogle Scholar
  • 25 Sorensen PS. et al. Multiple Sclerosis. Guidelines on use of anti-IFN-beta antibody measurements in multiple sclerosis: report of an EFNS Task Force on IFN-beta antibodies in multiple sclerosis. Eur J Neurol 2005; 12: 817-827.
    CrossrefPubMedGoogle Scholar
  • 26 Sorensen PS, Fazekas F, Lee M. Intravenous immunoglobulin G for the treatment of relapsing-remitting multiple sclerosis: a meta-analysis. Eur J Neurol 2002; 09: 557-63.
    CrossrefPubMedGoogle Scholar
  • 27 Tedeschi G. et al. Brain atrophy and lesion load in a large population of patients with multiple sclerosis. Neurology 2005; 65: 280-285.
    CrossrefPubMedGoogle Scholar
  • 28 Wegner C. et al. Neocortical neuronal, synaptic, and glial loss in multiple sclerosis. Neurology 2006; 67: 960-967.
    CrossrefPubMedGoogle Scholar
  • 29 Weihe W. Therapie-Leitlinien bei MS: Zu wessen Nutzen?. Deutsches Ärzteblatt 2006; 05: 237.
    Google Scholar
  • 30 Wingerchuk DM. et al. Revised diagnostic criteria for neuromyelitis optica. Neurology 2006; 66: 1485-1489.
    CrossrefPubMedGoogle Scholar
  • 31 Zivadinov R. Can imaging techniques measure neuroprotection and remyelination in multiple sclerosis?. Neurology 2007; 68 (Suppl. 03) S72-82.
    CrossrefPubMedGoogle Scholar