Multiple sclerosis (MS)

While the causes of multiple sclerosis are unclear, the disease is considered to be an autoimmune condition, i.e. the immune system attacks the body’s own structures without any infection caused by a particular pathogen. Usually, the myelin sheaths (layers surrounding nerve fibres) are damaged in this process, so that a demyelinating disease is present, while the nerve fibres (axons) themselves are more rarely affected. An earlier viral infection as a possible trigger for this defective immune response is being debated.

The basic building blocks of diagnosis are: anamnesis, clinical neurological examination, MRI of the head and, if necessary, of the cervical and thoracic spine, examination of the cerebrospinal fluid (liquor cerebrospinalis) and measurements of the central pathways by means of small electric stimuli. (Visual evoked potentials – VEP, somatosensory evoked potentials – SEP and, if necessary, motor evoked potentials – MEP).

In the treatment of multiple sclerosis, a distinction is made between: treating an acute attack, prevention of attacks and symptomatic treatment.

If the possibility of an infection has been excluded and severe symptoms are present when treating an acute attack, a high-dose intravenous cortisone treatment of 3-5x 1000mg cortisone is used in addition to stomach therapy (e.g. Pantozol) and thrombosis prevention (Heparin s.c.)
If the symptoms do not abate to the required extent within two weeks, a second series of cortisone infusions of up to 5x2000mg maximum is indicated. In exceptional cases, plasmapheresis (blood plasma separation) is necessary.

For the prevention of attacks, an immune modulation therapy is used to suppress the defective autoimmune response. The medications of choice are interferon substances (Rebif, Avonex, Betaferon) or glatiramer acetate (Copaxone), which are administered by self-injection (with a pen injector).
Alternatively, immunosuppressive therapy with Imurek (suppression of the entire immune system by taking tablets) or, in rare cases, an immune globulin therapy (antibody infusions) are possible.

If there are recurring attacks or increasing symptoms despite immune modulation therapy, the immunosuppressive/chemotherapy agent mitoxantrone (Ralenova) or the recombinant humanised anti-alpha-4 integrin antibody natalizumab (Tysabri) may be applied in accordance with regulations.

A symptomatic treatment of disorders that may still be present without having fully resolved is important. First and foremost, physiotherapy for spasticity needs to be considered, if necessary, complemented by medication (antispasmodics). In the case of a speech disorder or swallowing difficulties, improvements may be achieved by speech-language therapy. For bladder symptoms, medication and, if necessary, self-catheterisation are helpful depending on the urological findings. In most cases, a severe course can be prevented by adequate and early treatment.




Reasons why you should come to us:

Diagnosis and treatment of multiple sclerosis is one of our specialties in our neurological practice at EuromedClinic.
All neurological examinations, additionally necessary examination techniques (incl. in-house MRI and radiology) and the cerebrospinal fluid examination are performed without any delays.

Long-term treatment, incl. therapy of acute attacks and, if requested, inpatient admission are possible. Medical consultation on the individual forms of therapy and the introduction to self-injection are provided by an MS nurse in our practice.