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Multiple Sklerose
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= st e ne chron sche Entzünd che Erkrankung des zentra en Nervensystems d e an mehreren Ste en mu t foka g e chze t g auftreten kann und das
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Mye n a so d e Marksche den der Nervenfasern befä t
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Pathogenese
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Trotz ntens ver Forschung s nd wesent che Aspekte der Pathogenese und Pathophys o og e der Mu t p en Sk erose noch ungek ärt D e MS w rd a s
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Auto mmunerkrankung angesehen Es kommt zur Entstehung von ZNS-Läs onen d e k n sche Ausfa ersche nungen zur Fo ge haben
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Das wesent che Merkma der MS st d e m Geh rn und m Rückenmark verstreut auftretende Entzündung d e durch den Angr ff körpere gener
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Abwehrze en auf d e Mye nsche den der Nerven entsteht

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D e dadurch ausge öste Demye n s erung —> Entmarkung beze chnet man d e degenerat ve Zerstörung der Mye nsche den der Axone des ZNS
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bed ngt zunächst e ne Ver angsamung der Nerven e tgeschw nd gke t danach e nen Untergang der Axone —> Fortsatz e ner Nervenze e Anfäng ch
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kommt es häuf g noch zu Remye n s erungen —>W ederherste ung der beschäd gten Mye nsche de m t g öser Vernarbung
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Ät o og e
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D e Ursache der Mu t p en Sk erose st noch n cht genau gek ärt

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—> Umwe tfaktoren zb V tam n-D-Mange bakter e e und v ra e nfekt onen Übergew cht Rauchen
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D agnost k
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D agnost sche Pr nz p en
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K n sche Verdachtsd agnose e ner chron sch-entzünd chen ZNS-Erkrankung be H nwe sen aus der Anamnese und oder passenden
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neuro og schen Untersuchungsbefunden
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2 Nachwe s entzünd cher ZNS-Läs onen m t ze t cher und ört cher D ssem nat on Streuung m tte s genauer Anamnese MRT- und
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L quord agnost k anhand der McDona d-Kr ter en
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3 Aussch uss von D fferenz a d agnosen nsb anhand der MRT und m tte s Labord agnost k
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Anamnese
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Ze t che Dynam k der Beschwerden Beg nn Dauer und Ver auf der Beschwerden?
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H nwe se auf zurück egende Schübe Ep soden m t Seh- Sens b täts- Koord nat ons- B asenstörungen und Paresen?
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Fam enanamnese Chron sch-entzünd che ZNS- oder rheumato og sche Erkrankungen n der Verwandtschaft?
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Neuro og sche Untersuchung

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MRT
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Aufgrund der ört chen D ssem nat on der ZNS-Läs onen kann d e Mu t p e
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Verfahren Kran e e und sp na e MRT
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Sk erose e n sehr var ab es k n sches Ersche nungsb d haben wenng e ch

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nd kat on
e n ge Befunde verg e chswe se häuf ger vorkommen
Z e Ob ekt v erung zentra er neuro og scher Def z te nk gez e ter —> Erstd agnose
Überprüfung häuf ger MS-Symptome —> A s rege mäß ge Ver aufskontro e
—> Untersuchung der Kopf- Ha sreg on nsb
—> Änderungen der Krankhe tsdynam k
> F ngerper metr sche Ges chtsfe dprüfung
—> Aus therap espez f scher nd kat on
> Prüfung der Oku omotor k

> Untersuchung der Motor k Ges cht Ha s L quord agnost k

> Untersuchung der Sens b tät Ges cht Kopf Ha s —> aborchem sche Untersuchung von Rückenmarksf üss gke t
> Untersuchung der Rachenmotor k nk Untersuchung des Sprechens
B ut- und Ur nd agnost k
—> Neuro og sche Untersuchung der Motor k nsb —> D e B ut- und Ur nd agnost k d ent n cht d rekt der
> Untersuchung des Muske tonus D agnoseste ung e ner MS sondern v e mehr dem Aussch uss oder
der Bestät gung von D fferenz a d agnosen der MS
> Untersuchung der Muske kraft

> Untersuchung der Ref exe Neurophys o og sche D agnost k

> Untersuchung der Sens b tät —> CT MRT EEG

> Koord nat onsprüfung

McDona d-Kr ter en
> Stand- und Gangprüfung —> ermög chen nach Aussch uss von D fferenz a d agnosen m tte s
B dgebung Labor- und L quord agnost k d e D agnoseste ung
Medium Graph
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Schubbehand ung
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Be der Therap e der mu t p en Sk erose muss man zw schen der Therap e der akuten Krankhe tsschübe und e ner Schubprophy axe untersche den
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Z e der Therap e st es akute Beschwerden zu verh ndern und dam t auch das Fortschre ten der Beh nderung m M tte punkt steht es d e
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Lebensqua tät der Pat enten angfr st g hoch zu ha ten

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—> E nen akt ven Schub versucht man m t hochdos erten Stero den z B Methy predn so on zu bekämpfen
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W rkstoff
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bevorzugt Methy predn so on e n künst ches G ukokort ko d Kort ko de Kort son s nd Hormone der Nebenn erenr nde
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Standardtherap e be m akuten MS-Schub Zu assung g t be Überakt v tät des mmunsystems
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Verabre chungsform ntravenöse nfus on üb cherwe se n e ner Dos erung von 000 mg an dre aufe nander fo genden Tagen stat onär oder
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ambu ant
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W rkwe se G ukokort ko de hemmen den Entzündungsprozess und das mmunsystem S e w rken d rekt auf d e be m MS
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Schub vor egende Störung der B ut-H rn-Schranke e n

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Nebenw rkungen Magenbeschwerden Übe ke t und Erbrechen Unruhe und Sch afstörungen psych sche Störungen
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Unverträg chke tsreakt onen Be D abet kern Gefahr von erhöhten entg e senden B utzuckerwerten Das R s ko e nes
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ep ept schen Anfa s kann be Pat enten d e dazu ne gen erhöht werden G e ches g t für das Thrombose-R s ko nsbesondere
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für Pat enten m t Paresen Lähmungen

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W cht g E ne Dauertherap e m t G ukokort ko den so te wegen mög cher schwerw egender n cht rückgäng g zu machender
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Nebenw rkungen verm eden werden Zu d esen Nebenw rkungen können B uthochdruck D abetes Osteoporose asept sche
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Knochennekrose Zerstörung des Knochengewebes Magengeschwüre Thrombose Wundhe ungsstörungen Hautschäden

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Muske erkrankungen und Erkrankungen des per pheren Nervensystems zäh en

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D e P asmapherese PE B utwäsche
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nd kat on Opt on zur Behand ung des akuten MS-Schubs wenn d e Kort son-Stoß-Therap e n cht w rkt und d e Gefahr besteht dass zum
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Be sp e schwere Sehstörungen m t B ndhe t oder Arm- bzw Be n ähmungen bestehen b e ben eska erende Schubtherap e
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Behand ung D e Behand ung erfo gt n der Rege stat onär n e nem MS-Zentrum über zehn Tage kann m Ausnahmefa aber auch
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ambu ant durchgeführt werden Über d e Ha s- oder Armvene w rd B ut aus dem Körper entnommen und n e ner Zentr fuge
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das f üss ge P asma von den B utze en getrennt Das P asma w rd ersetzt entweder durch fremdes P asma oder
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humanes A bum n und d eses gewaschene B ut w rd dann dem Pat enten w eder zugeführt D eser Vorgang dauert rund zwe
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b s v er Stunden und w rd n der Rege w rd fünfma w ederho t wobe zw schen den e nze nen Behand ungen ewe s e n Tag
Pause egen so te

W rkwe se M t der P asmapherese so en aus dem B ut ene schäd chen Bestandte e entfernt werden d e zur Schäd gung des Mye ns
be tragen

Nebenw rkungen Neben den R s ken w e s e auch be m B utspenden bestehen – k e ner B uterguß n sehr se tenen Fä en Nervenschäd gung und
Venenentzündung – können n se ten Fä en Kre s aufreakt onen auftreten Be e nem Te der Pat enten kommt es zu
Nebenw rkungen durch das ger nnungshemmende M tte das dem B ut zugesetzt w rd Me stens w rd d e B utwäsche aber
sehr gut vertragen

W cht g Für d e angfr st ge mmuntherap e st d e P asmapherese-Behand ung n cht gee gnet A bum n st e n wasser ös ches E we ß
Prote n das hauptsäch ch m B utp asma vorkommt Das Komp ement s nd E we ße d e m mmunsystem an der Abwehr
von M kroorgan smen bete gt s nd aber auch ze zerstörende E genschaften haben können

Medium Graph
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Dauerhafte Med kat on

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beta- nterferone Avonex® Betaferon® Extav a® P egr dy® Reb f®
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nd kat on Avonex® Betaferon® Extav a® und Reb f® können e ngesetzt werden be Pat enten m t schubförm g ver aufender Mu t
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p er Sk erose und be Pat enten m t erstma gem demye n s erendem Ere gn s m t akt vem entzünd chem Prozess
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Zusätz ch können Betaferon® und Extav a® gegeben werden be Pat enten m t sekundär progred enter Mu t p er Sk erose
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be denen noch Schübe auftreten

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P egr dy® w rd angewendet zur Behand ung von erwachsenen Pat enten m t schubförm g rem tt erender Mu t p er
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Sk erose RRMS
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Zur Anwendung be K ndern und Jugend chen ge ten Reb f® ab dem 2 Lebens ahr Betaferon® und Extav a® ab dem 2
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Lebens ahr und Avonex® ab dem 6 Lebens ahr a s s cher P egr dy® so unter 8 Jahren n cht gegeben werden
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W rkwe se
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Beta- nterferone gre fen modu erend ns feh gesteuerte mmunsystem e n S e tragen zum Sch eßen der B ut-H rn-
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N cht gee gnet be für Schwangerschaft St ze t Überempf nd chke t gegenüber rekomb nanten Beta- nterferonen Vors cht st geboten be
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Nebenw rkungen D e häuf gste Nebenw rkung st das Auftreten gr ppeähn cher Symptome w e Kopfschmerzen Muske schmerzen
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Schütte frost oder F eber D ese Beschwerden f nden s ch zu Beg nn der Therap e m t Beta- nterferonen häuf g und
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nehmen n der Rege m t Fortsetzung der n ekt onen ab Vor a em be subkutaner unter d e Haut App kat on kann es
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e ner oka en Reakt on an der n ekt onsste e kommen D ese kann von entzünd cher Rötung Schmerz und Juckre z b s zu
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oka er Entzündung und Nekrosen re chen Be Pat enten m t vorbekannter Depress on kann e ne Beta- nterferon-Therap e
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Unter nterferonen f nden s ch häuf g Neutropen en Verr ngerung der Leukozytenzah Thrombopen en Verr ngerung der
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B utp ättchen und Erhöhungen der Transam nasen Ge egent ch f nden s ch Lymphopen en Redukt on der Lymphozyten
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Unter e ner Therap e m t nterferon-beta können s ch anha tende neutra s erende Ant körper NAbs gegen das
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Med kament entw cke n d e m t e nem Ver ust an W rksamke t e nhergehen können
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