Multiple Sclerosis, MS, Therapy, Immunomodulating Drugs, Occupational Therapy, Physiotherapy

Table of contents:

Multiple Sclerosis, MS, Therapy, Immunomodulating Drugs, Occupational Therapy, Physiotherapy
Multiple Sclerosis, MS, Therapy, Immunomodulating Drugs, Occupational Therapy, Physiotherapy
Video: Multiple Sclerosis, MS, Therapy, Immunomodulating Drugs, Occupational Therapy, Physiotherapy
Video: Rehabilitation in Multiple Sclerosis 2023, February
Anonim

Multiple sclerosis: therapy

Multiple sclerosis (MS) is currently not curable. In many cases, however, the course of the disease can be positively influenced. The aim of the therapy is to maintain the independence and quality of life of those affected for as long and as well as possible. The earlier immunomodulatory treatment is started, the higher the chances of achieving lasting stabilization. The planning, initiation and review of drug therapy is carried out in multiple sclerosis centers (MS centers). Physiotherapy, occupational therapy, neuropsychological care and rehabilitation measures are very important in the treatment of MS.

navigation

  • Continue reading
  • more on the subject
  • Advice, downloads & tools
  • How is therapy for an acute episode carried out?
  • What is long-term basic therapy?
  • ">Symptomatic therapies for MS

">

  • ">">Alternative and Complementary Therapies for MS

">

  • Caution: dangerous therapies
  • Whom can I ask?
  • How are the costs going to be covered?

">

Treatment should always be tailored to the patient and the course of the disease. A comprehensive therapy concept provides:

  • Therapy of an acute illness flare-up,
  • immunomodulating long-term basic therapy to influence the course of the disease,
  • Treatment of the individual symptoms that occur in the course of the disease (drug symptomatic therapies, physical and occupational therapy, neuropsychological training),
  • Rehabilitation,
  • social medical measures, nursing care, possibly changes in lifestyle.

How is therapy for an acute episode carried out?

Glucocorticoids ("cortisone") are usually administered in high doses intravenously for three to five days. They have an immunosuppressive effect and improve the barrier function of the blood-brain barrier. In severe relapses, certain components that contribute to damage to myelin in the brain or spinal cord can be removed from the blood by means of plasmapheresis or immunoadsorption (“blood washing”).

What is long-term basic therapy?

A so-called causally oriented, course-modifying ("immunomodulating") long-term basic therapy is started as early as possible. As soon as a clinically isolated syndrome (KIS / CIS) occurs, a course-modifying therapy can be started under certain circumstances. The aim is to positively influence the course of the disease. The main goals are:

  • Preventing new attacks or reducing their frequency and severity,
  • Extension of the symptom-free intervals,
  • Slowing the progression of disease and disability,
  • Regression of the acute symptoms,
  • Decrease in inflammatory disease activity, ideally a stabilized state "free of disease activity":

    • no relapses or no progression (continuous increase in complaints) and
    • no new foci of inflammation in the MRI.

It is important for the success of the treatment that the patient regularly takes or injects the medication prescribed by the neurologist. Some people find this particularly difficult because a positive therapeutic effect is not "directly noticeable". It can often only be recognized indirectly, for example by the absence or rare occurrence of attacks, a milder severity of attacks or a slower deterioration of symptoms.

The decision as to which therapy is carried out is made jointly by patients and doctors (so-called participatory decision-making).

For the treatment of relapsing multiple sclerosis, a distinction is made between a mild / moderate or a (highly) active form. Various medications are available, the higher effectiveness usually being associated with increased side effects.

Therapy for mild / moderate relapsing MS:

Interferon-beta preparations (injections, sc or im), glatiramer acetate (injections, sc), dimethyl fumarate (capsules) and teriflunomide (tablets) are primarily used at present.

Therapy for (highly) active relapsing MS:

Fingolimod (capsules, daily intake), natalizumab (monthly infusions), alemtuzumab (annual infusions, in hospitals), cladribine (tablets, multiple short-term intake), ocrelizumab (initially two infusions every two weeks, then every six months, in hospitals).

Mitoxantrone, azathioprine, cyclophosphamide or cortisone preparations, which are administered into the liquor space at intervals, are only used in very rare exceptional cases. A sufficient effectiveness for the therapy with immunoglobulins (IVIG) could not be proven in clinical studies. For this reason, immunoglobulins are only administered in exceptional situations - for example when there is high disease activity during pregnancy and breastfeeding.

Therapy of primary progressive MS:

As a course-modifying therapy, treatment with the drug ocrelizumab can be carried out in the early stages of the disease.

Symptomatic therapies for MS

Treatment of individual symptoms is carried out regardless of the course of the disease. Impaired body functions should be positively influenced and the quality of life should be improved. This reduces consequential damage and prevents restrictions in social life (e.g. isolation, loneliness) of those affected.

Rapid fatigue ("MS Fatigue")

  • Especially for patients with increased sensitivity to heat: temperature reduction in extreme heat, in exceptional cases, for example, cool clothing (pants and vests in laminate technology);
  • Measures to lower the body temperature (cool showers, application of cool packs, etc.) are effective in the short term;
  • Day structuring: breaks, stress management, rest phases;
  • Drink enough (1.5 to two liters per day), as lack of fluids can increase fatigue (tiredness);
  • Treatment of any depression that may be present;
  • cognitive behavioral therapy;
  • physical training: especially endurance sports such as Nordic walking;
  • Physical therapy;
  • Rehabilitation measures.

Impairment of brain performance (cognitive disorders)

  • Functional training: eg brain jogging, computer-aided exercise programs;
  • Compensation strategies: new learning strategies, memory aids;
  • improved organization of everyday life;
  • Adaptation of the environment to any disabilities, e.g. through the use of certain aids;
  • Relaxation exercises etc.

Speech and swallowing disorders

Speech therapy

Spastic paralysis

  • Physical therapy;
  • Treadmill therapy;
  • motor-assisted powered indoor bicycles;
  • special positioning (“step bed”) and passive movement;
  • Use of splints (dynamic, static) and air-cushion splints;
  • Cold therapy (short-term reduction of spasticity);
  • additional drug therapies:

    • Tablets with antispasmodic substances;
    • in severe cases, botulinum toxin injections into the affected muscles;
    • rarely administration of an antispastic drug into the CSF space (intrathecally) via a pump;
    • Tablets to improve walking ability: the potassium channel blocker fampridine prevents charged potassium particles from escaping from the cells of damaged nerves. It is believed that this allows the electrical impulses to travel further down the nerve to stimulate the muscles, making walking easier.

Urinary bladder dysfunction

  • Oral medication;
  • Injection of botulinum toxin into the bladder wall;
  • repeated (intermittent) self-catheterization, indwelling catheter;
  • Electrical stimulation ("bladder pacemaker");
  • Neuromodulation with implanted electrodes;
  • Aids such as diapers, pads;
  • Pelvic floor exercise;
  • Toilet training: determination of the optimal time to empty your bladder. Use the toilet every two hours, even if there is no urge to urinate. The time intervals are extended, an individual rhythm should settle in.

Defecation disorders

Constipation:

  • adequate hydration,
  • high fiber diet,
  • a lot of movement,
  • Laxatives etc.

Faecal incontinence (can occur later in the disease):

  • Avoidance of gas and drinks that stimulate the intestines (e.g. beans, coffee) or (if possible) medication;
  • Ingestion of source substances (e.g. methyl cellulose);
  • regular targeted purging;
  • possibly use of anal tampons;
  • Regular pelvic floor training or possibly biofeedback-supported training of the sphincter muscle can be helpful;
  • Another option is, for example, sacral nerve electrical stimulation (“bowel pacemaker”);
  • In severe cases, the creation of a colostomy (artificial anus) can have a relieving effect, as faecal incontinence can severely restrict social life.

Note Faecal incontinence and constipation often alternate. Therefore, when treating with drugs that restrict intestinal mobility (e.g. loperamide), the influence on the bowel evacuation disorders must be checked particularly carefully.

Coordination and balance disorders (atactic movement disorders)

  • Physiotherapy and occupational therapy (coordination exercises, stabilization with aids),
  • Local application of ice, for example before a meal or a signature, to reduce the trembling of the hands,
  • Relaxation techniques,
  • Surgical therapy with the insertion of a pacemaker in a certain area of ​​the brain: this is rarely an option.

Sexual dysfunction

  • Cognitive behavioral therapy.
  • Men: In case of erectile dysfunction, therapy with so-called phosphodiesterase inhibitors (e.g. sildenafil) can be tried. The effect of injecting prostaglandins into the erectile tissue of the penis has not yet been tested in clinical studies in multiple sclerosis patients.
  • Women: During sexual intercourse, pain and a dry vagina may occur due to improper lubrication. These can be reduced by using lubricants during sexual intercourse or hormone-containing creams.

Pain

Exact clarification of the cause of the pain is a prerequisite for successful treatment. This requires interdisciplinary cooperation between neurologists, physiotherapists, occupational therapists, psychologists and nurses.

Chronic pain can occur as the disease lasts longer. They are often caused by foci of inflammation in the spinal cord and the resulting increased muscle tension (spasticity, cramps) in the arms and legs. The treatment is also interdisciplinary.

For seizure-like pain in the face that often lasts only seconds (symptomatic trigeminal neuralgia), medicinal and certain surgical treatments (thermocoagulation, balloon compression, decompression) and radiation (gamma knife) can be considered.

Alternative and Complementary Therapies for MS

In addition to recognized treatments whose effectiveness has been scientifically proven, many MS patients are interested in so-called alternative or complementary therapies. The information on the effects of most of these methods is not sufficiently evidence-based. If you still want to use a complementary method, this should be done in consultation with the neurologist. Some non-drug treatments can subjectively improve well-being, for example relaxation techniques.

Clinical studies have shown that enzyme preparations, high-pressure oxygen therapy and amalgam removal have no effect on the course of the disease.

Caution: dangerous therapies

Various dangerous - and in some cases very expensive - methods are offered for the treatment of MS, and health and financial warnings must be given against them. There is also insufficient evidence for positive effects of these treatments. For example, the recommendation to widen the veins, which are supposed to effect the outflow of blood from the brain and spinal cord (“chronic cerebrospinal venous insufficiency”), is very problematic. A positive effect could not be proven, this treatment is potentially dangerous and expensive. Immune augmentation (reinforcement of the immune reaction), fresh cell therapy, and bee and snake venom therapy are classified as dangerous. These methods can cause infections or, in particular, severe allergic reactions up to circulatory failure.

Note Autologous stem cell therapies are currently the subject of intensive research. After intensive pretreatment, certain stem cells of the patient are administered into the blood or rarely intrathecally (into the spinal canal). These therapies can be associated with serious side effects and their effectiveness has not yet been adequately verified. Treatment outside of studies is strongly discouraged.

Whom can I ask?

The earlier an MS is recognized, the better the chances of influencing the course of the disease positively. Therefore, if you experience symptoms that indicate a neurological dysfunction (e.g. muscle weakness, visual disturbances, dizziness, numbness), you should immediately consult your family doctor or a neurologist to clarify the cause.

When symptoms

  • occur suddenly,
  • deteriorate rapidly,
  • fever or
  • develop severe headaches
  • focal or generalized epileptic seizures or
  • Disturbances of consciousness occur,

the emergency doctor should be contacted immediately or a hospital should be visited.

How are the costs going to be covered?

All necessary and appropriate therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

For certain drug or non-drug treatments (eg long-term basic therapy, physical therapy), approval from the health insurance provider responsible (medical service - "chief physician") may be required. In some cases, costs are only covered once the disease has reached a certain extent. For certain services (e.g. inpatient stays, aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “cash prescription”. For more information about the respective provisions, please contact your health insurance provider, for exampleon your social security website.

Note The costs for treatment with ocrelizumab are not yet covered by the health insurance companies of the main association.

Popular by topic