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psychoneuro 2004; 30(7): 375-379
DOI: 10.1055/s-2004-831081
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Neue Therapieansätze bei der Multiplen Sklerose

Ralf Gold1 , Bernd C. Kieseier2 , Hans-Peter Hartung2
  • 1Institut für MS-Forschung, Bereich Humanmedizin und Gemeinnützige Hertie-Stiftung, Universität Göttingen
  • 2Neurologische Klinik und Poliklinik, Universität Düsseldorf
Further Information

Publication History

Publication Date:
04 August 2004 (online)

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Zusammenfassung

Die Pulstherapie mit Glukokortikosteroiden (GS) ist zur Zeit die einzige etablierte Behandlung einer akuten Verschlechterung bei MS, für die auch Studien relativ guten Evidenzgrades vorliegen. Bei Nonresponse mit schweren Ausfallssymptomen kann eine Plasmapherese-Serie erwogen werden. Zur immunmodulatorischen Basistherapie werden heute Interferone und Glatiramerazetat möglichst frühzeitig eingesetzt, um die Erfolgschancen der Langzeittherapie zu erhöhen. Bei hoher Schubfrequenz bzw. sekundär progredientem Verlauf ist Mitoxantron in Deutschland zugelassen. Neuartige Therapieansätze zur Behandlung des Schubs sowie zur Immunmodulation beeinflussen die fehlgeleitete Autoimmunreaktion auf verschiedenen Ebenen über die Induktionsphase der Immunantwort mit Antigenpräsentation und Kostimulation, die Adhäsion und Transmigration von Entzündungszellen und die lokale Zytotoxizität sowie Effektormechanismen. Vielversprechend sind u.a. der inhibierende VLA-4 Antikörper Natalizumab sowie neurotrophe Zytokine wie LIF (leucemia inhibitory factor).

Summary

Corticosteroid-pulse therapy is still the mainstay for the treatment of acute relapses of MS. In patients who fail to respond to steroid pulse therapy, plasmapheresis may lead to rapid and sustained improvement. Immunomodulatory treatment with interferon or glatirameracetate serves as basis for longterm therapy in relapsing-remitting MS. In patients with high relapse-rate or secondary disease progression mitoxantrone can be used in escalating treatment regimens. Novel immunotherapies act at different levels: they target the induction phase with antigen presentation and costimulation, adhesion and transmigration of inflammatory cells and local cytotoxicity. Promising agents include anti-VLA-4 antibodies (natalizumab TM), and neurotrophic cytokines such as LIF (leucemia inhibitory factor).

Key Words

multiple sclerosis - glucocorticosteroid therapy - plasma exchange - mitoxantrone - Natalizumab

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Korrespondenzadresse:

Prof. Dr. Ralf Gold

Institut für MS-Forschung

Waldweg 33

37073 Göttingen

Email: r.gold@med.uni-goettingen.de

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