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Erschienen in: psychopraxis. neuropraxis 4/2016

01.09.2016 | Neurologie

„Time is brain“ bei der schubförmigen Multiplen Sklerose

Aktuelle Behandlungskonzepte in der Immuntherapie

verfasst von: Prof. Dr. R. Linker, B.-A. Kallmann, C. Kleinschnitz, P. Rieckmann, M. Mäurer, S. Schwab

Erschienen in: psychopraxis. neuropraxis | Ausgabe 4/2016

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Zusammenfassung

Hintergrund

Trotz der diametral unterschiedlichen Zeitskalen, in denen sich die Krankheitsprozesse und -folgen bei der Multiplen Sklerose (MS) und beim ischämischen Schlaganfall manifestieren, zeigen sich konzeptionelle Parallelen zwischen beiden Erkrankungen, die für das Management der MS richtungsweisend sind: Entzündliche Erkrankungsaktivität und konsekutive Neurodegeneration führen zu potenziell irreversibler Gewebeschädigung und damit zu bleibender Behinderung. Dementsprechend sind eine frühzeitige Detektion von Erkrankungsaktivität und eine zeitnahe Intervention bzw. Therapieoptimierung ausschlaggebend für eine Verbesserung der langfristigen Prognose, was sich mit dem in der Akuttherapie des ischämischen Schlaganfalls geprägten Begriff „time is brain“ griffig beschreiben lässt.

Ergebnisse und Diskussion

Bei der MS beinhaltet ein „Time-is-brain“-Konzept den Wert einer frühen Immuntherapie nach Diagnosestellung sowie die Notwendigkeit eines sensitiven strukturierten Monitorings in Verbindung mit frühzeitiger Therapieoptimierung bei Nachweis von Krankheitsaktivität unter Therapie. Das übergeordnete Ziel der Therapie im gesamten Erkrankungsverlauf der MS ist dabei die bestmögliche und anhaltende Kontrolle jeglicher erfassbarer Krankheitsaktivität, insbesondere in der frühen Erkrankungsphase. Im Alltag kann die intersektorale Kooperation in regionalen MS-Netzwerken mit spezialisierten Zentren dazu beitragen, die verfügbaren hochwirksamen Medikamente mit ihren jeweils eigenen Nutzen-Risiko-Profilen optimal einzusetzen und damit die Aussicht auf eine langfristige Stabilisierung der Lebensqualität der MS-Patienten zu erhöhen.
Literatur
1.
Zurück zum Zitat Heesen C, Bohm J, Reich C et al (2008) Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler 14:988–991CrossRefPubMed Heesen C, Bohm J, Reich C et al (2008) Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler 14:988–991CrossRefPubMed
2.
Zurück zum Zitat Feuillet L, Reuter F, Audoin B et al (2007) Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 13:124–127CrossRefPubMed Feuillet L, Reuter F, Audoin B et al (2007) Early cognitive impairment in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 13:124–127CrossRefPubMed
3.
Zurück zum Zitat Amato MP, Hakiki B, Goretti B et al (2012) Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology 78:309–314CrossRefPubMed Amato MP, Hakiki B, Goretti B et al (2012) Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology 78:309–314CrossRefPubMed
4.
Zurück zum Zitat Deloire M, Ruet A, Hamel D et al (2010) Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Mult Scler 16:581–587CrossRefPubMed Deloire M, Ruet A, Hamel D et al (2010) Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Mult Scler 16:581–587CrossRefPubMed
5.
Zurück zum Zitat Trapp BD, Peterson J, Ransohoff RM et al (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338:278–285CrossRefPubMed Trapp BD, Peterson J, Ransohoff RM et al (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338:278–285CrossRefPubMed
6.
Zurück zum Zitat Kuhlmann T, Lingfeld G, Bitsch A et al (2002) Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over time. Brain 125:2202–2212CrossRefPubMed Kuhlmann T, Lingfeld G, Bitsch A et al (2002) Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over time. Brain 125:2202–2212CrossRefPubMed
7.
Zurück zum Zitat Kern S, Kuhn M, Ziemssen T (2013) Chronically ill and unemployed? A review on vocational status in multiple sclerosis. Fortschr Neurol Psychiatr 81:95–103CrossRefPubMed Kern S, Kuhn M, Ziemssen T (2013) Chronically ill and unemployed? A review on vocational status in multiple sclerosis. Fortschr Neurol Psychiatr 81:95–103CrossRefPubMed
8.
Zurück zum Zitat Kobelt G, Berg J, Lindgren P et al (2006) Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry 77:918–926CrossRefPubMedPubMedCentral Kobelt G, Berg J, Lindgren P et al (2006) Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry 77:918–926CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Scalfari A, Neuhaus A, Degenhardt A et al (2010) The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain 133:1914–1929CrossRefPubMedPubMedCentral Scalfari A, Neuhaus A, Degenhardt A et al (2010) The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain 133:1914–1929CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Weinshenker BG, Bass B, Rice GP et al (1989) The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. Brain 112:1419–1428CrossRefPubMed Weinshenker BG, Bass B, Rice GP et al (1989) The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. Brain 112:1419–1428CrossRefPubMed
11.
Zurück zum Zitat Tremlett H, Yousefi M, Devonshire V et al (2009) Impact of multiple sclerosis relapses on progression diminishes with time. Neurology 73:1616–1623CrossRefPubMedPubMedCentral Tremlett H, Yousefi M, Devonshire V et al (2009) Impact of multiple sclerosis relapses on progression diminishes with time. Neurology 73:1616–1623CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Hirst C, Ingram G, Pearson O et al (2008) Contribution of relapses to disability in multiple sclerosis. J Neurol 255:280–287CrossRefPubMed Hirst C, Ingram G, Pearson O et al (2008) Contribution of relapses to disability in multiple sclerosis. J Neurol 255:280–287CrossRefPubMed
13.
Zurück zum Zitat Scalfari A, Neuhaus A, Daumer M et al (2013) Early relapses, onset of progression, and late outcome in multiple sclerosis. JAMA Neurol 70:214–222CrossRefPubMed Scalfari A, Neuhaus A, Daumer M et al (2013) Early relapses, onset of progression, and late outcome in multiple sclerosis. JAMA Neurol 70:214–222CrossRefPubMed
14.
Zurück zum Zitat Prosperini L, Gallo V, Petsas N et al (2009) One-year MRI scan predicts clinical response to interferon beta in multiple sclerosis. Eur J Neurol 16:1202–1209CrossRefPubMed Prosperini L, Gallo V, Petsas N et al (2009) One-year MRI scan predicts clinical response to interferon beta in multiple sclerosis. Eur J Neurol 16:1202–1209CrossRefPubMed
15.
Zurück zum Zitat Fisniku LK, Brex PA, Altmann DR et al (2008) Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain 131:808–817CrossRefPubMed Fisniku LK, Brex PA, Altmann DR et al (2008) Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain 131:808–817CrossRefPubMed
16.
Zurück zum Zitat Tintore M, Rovira A, Rio J et al (2006) Baseline MRI predicts future attacks and disability in clinically isolated syndromes. Neurology 67:968–972CrossRefPubMed Tintore M, Rovira A, Rio J et al (2006) Baseline MRI predicts future attacks and disability in clinically isolated syndromes. Neurology 67:968–972CrossRefPubMed
17.
Zurück zum Zitat Lukas C, Knol DL, Sombekke MH et al (2015) Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 86:410–418CrossRefPubMed Lukas C, Knol DL, Sombekke MH et al (2015) Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 86:410–418CrossRefPubMed
18.
Zurück zum Zitat Sumowski JF, Rocca MA, Leavitt VM et al (2014) Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS. Neurology 82:1776–1783CrossRefPubMedPubMedCentral Sumowski JF, Rocca MA, Leavitt VM et al (2014) Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS. Neurology 82:1776–1783CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Fisher E, Rudick RA, Simon JH et al (2002) Eight-year follow-up study of brain atrophy in patients with MS. Neurology 59:1412–1420CrossRefPubMed Fisher E, Rudick RA, Simon JH et al (2002) Eight-year follow-up study of brain atrophy in patients with MS. Neurology 59:1412–1420CrossRefPubMed
20.
Zurück zum Zitat Barkhof F, Jong R de, Sfikas N et al (2014) The influence of patient demographics, disease characteristics and treatment on brain volume loss in Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing-Remitting Multiple Sclerosis (TRANSFORMS), a phase 3 study of fingolimod in multiple sclerosis. Mult Scler 20:1704–1713CrossRefPubMed Barkhof F, Jong R de, Sfikas N et al (2014) The influence of patient demographics, disease characteristics and treatment on brain volume loss in Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing-Remitting Multiple Sclerosis (TRANSFORMS), a phase 3 study of fingolimod in multiple sclerosis. Mult Scler 20:1704–1713CrossRefPubMed
21.
Zurück zum Zitat Coles AJ, Twyman CL, Arnold DL et al (2012) Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial. Lancet 380:1829–1839CrossRefPubMed Coles AJ, Twyman CL, Arnold DL et al (2012) Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial. Lancet 380:1829–1839CrossRefPubMed
22.
Zurück zum Zitat Fisniku LK, Chard DT, Jackson JS et al (2008) Gray matter atrophy is related to long-term disability in multiple sclerosis. Ann Neurol 64:247–254CrossRefPubMed Fisniku LK, Chard DT, Jackson JS et al (2008) Gray matter atrophy is related to long-term disability in multiple sclerosis. Ann Neurol 64:247–254CrossRefPubMed
23.
Zurück zum Zitat Weinshenker BG, Rice GP, Noseworthy JH et al (1991) The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain 114:1045–1056CrossRefPubMed Weinshenker BG, Rice GP, Noseworthy JH et al (1991) The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain 114:1045–1056CrossRefPubMed
24.
Zurück zum Zitat Edan G, Kappos L, Montalban X et al (2014) Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT. J Neurol Neurosurg Psychiatry 85:1183–1189CrossRefPubMed Edan G, Kappos L, Montalban X et al (2014) Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT. J Neurol Neurosurg Psychiatry 85:1183–1189CrossRefPubMed
25.
Zurück zum Zitat Hughes S, Spelman T, Trojano M et al (2012) The Kurtzke EDSS rank stability increases 4 years after the onset of multiple sclerosis: results from the MSBase Registry. J Neurol Neurosurg Psychiatry 83:305–310CrossRefPubMed Hughes S, Spelman T, Trojano M et al (2012) The Kurtzke EDSS rank stability increases 4 years after the onset of multiple sclerosis: results from the MSBase Registry. J Neurol Neurosurg Psychiatry 83:305–310CrossRefPubMed
26.
Zurück zum Zitat Weinshenker BG, Rice GP, Noseworthy JH et al (1991) The natural history of multiple sclerosis: a geographically based study. 4. Applications to planning and interpretation of clinical therapeutic trials. Brain 114:1057–1067CrossRefPubMed Weinshenker BG, Rice GP, Noseworthy JH et al (1991) The natural history of multiple sclerosis: a geographically based study. 4. Applications to planning and interpretation of clinical therapeutic trials. Brain 114:1057–1067CrossRefPubMed
27.
Zurück zum Zitat Leray E, Yaouanq J, Le PE et al (2010) Evidence for a two-stage disability progression in multiple sclerosis. Brain 133:1900–1913CrossRefPubMedCentral Leray E, Yaouanq J, Le PE et al (2010) Evidence for a two-stage disability progression in multiple sclerosis. Brain 133:1900–1913CrossRefPubMedCentral
28.
Zurück zum Zitat Confavreux C, Vukusic S, Adeleine P (2003) Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain 126:770–782CrossRefPubMed Confavreux C, Vukusic S, Adeleine P (2003) Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain 126:770–782CrossRefPubMed
29.
Zurück zum Zitat Confavreux C, Vukusic S (2006) Natural history of multiple sclerosis: a unifying concept. Brain 129:606–616CrossRefPubMed Confavreux C, Vukusic S (2006) Natural history of multiple sclerosis: a unifying concept. Brain 129:606–616CrossRefPubMed
30.
Zurück zum Zitat Leray E, Coustans M, Le PE et al (2013) ‚Clinically definite benign multiple sclerosis’, an unwarranted conceptual hodgepodge: evidence from a 30-year observational study. Mult Scler 19:458–465CrossRefPubMed Leray E, Coustans M, Le PE et al (2013) ‚Clinically definite benign multiple sclerosis’, an unwarranted conceptual hodgepodge: evidence from a 30-year observational study. Mult Scler 19:458–465CrossRefPubMed
31.
Zurück zum Zitat Goldschmidt T, Antel J, Konig FB et al (2009) Remyelination capacity of the MS brain decreases with disease chronicity. Neurology 72:1914–1921CrossRefPubMed Goldschmidt T, Antel J, Konig FB et al (2009) Remyelination capacity of the MS brain decreases with disease chronicity. Neurology 72:1914–1921CrossRefPubMed
32.
Zurück zum Zitat Gold R, Hartung HP, Stangel M et al (2012) Therapeutic goals of baseline and escalation therapy for relapsing-remitting multiple sclerosis; Therapeutic goals of baseline and escalation therapy for relapsing-remitting multiple sclerosis. Akt Neurol 39:342–350CrossRef Gold R, Hartung HP, Stangel M et al (2012) Therapeutic goals of baseline and escalation therapy for relapsing-remitting multiple sclerosis; Therapeutic goals of baseline and escalation therapy for relapsing-remitting multiple sclerosis. Akt Neurol 39:342–350CrossRef
33.
Zurück zum Zitat Havrdova E, Galetta S, Hutchinson M et al (2009) Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol 8:254–260CrossRefPubMed Havrdova E, Galetta S, Hutchinson M et al (2009) Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol 8:254–260CrossRefPubMed
34.
Zurück zum Zitat Rotstein DL, Healy BC, Malik MT et al (2015) Evaluation of no evidence of disease activity in a 7-year longitudinal multiple sclerosis cohort. JAMA Neurol 72:152–158CrossRefPubMed Rotstein DL, Healy BC, Malik MT et al (2015) Evaluation of no evidence of disease activity in a 7-year longitudinal multiple sclerosis cohort. JAMA Neurol 72:152–158CrossRefPubMed
35.
Zurück zum Zitat Comi G, Martinelli V, Rodegher M et al (2009) Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet 374:1503–1511CrossRefPubMed Comi G, Martinelli V, Rodegher M et al (2009) Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet 374:1503–1511CrossRefPubMed
36.
Zurück zum Zitat Comi G, De SN, Freedman MS et al (2012) Comparison of two dosing frequencies of subcutaneous interferon beta-1a in patient with a first clinical demyelinating event suggestive of multiple sclerosis (REFLEX): a phase 3 randomised controlled trial. Lancet Neurol 11:33–41CrossRefPubMed Comi G, De SN, Freedman MS et al (2012) Comparison of two dosing frequencies of subcutaneous interferon beta-1a in patient with a first clinical demyelinating event suggestive of multiple sclerosis (REFLEX): a phase 3 randomised controlled trial. Lancet Neurol 11:33–41CrossRefPubMed
37.
Zurück zum Zitat Jacobs LD, Beck RW, Simon JH et al (2000) Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med 343:898–904CrossRefPubMed Jacobs LD, Beck RW, Simon JH et al (2000) Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med 343:898–904CrossRefPubMed
38.
Zurück zum Zitat Kappos L, Freedman MS, Polman CH et al (2007) Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet 370:389–397CrossRefPubMed Kappos L, Freedman MS, Polman CH et al (2007) Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet 370:389–397CrossRefPubMed
39.
Zurück zum Zitat Miller AE, Wolinsky JS, Kappos L et al (2014) Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 13:977–986CrossRefPubMed Miller AE, Wolinsky JS, Kappos L et al (2014) Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 13:977–986CrossRefPubMed
40.
Zurück zum Zitat Rudick RA, Lee JC, Cutter GR et al (2010) Disability progression in a clinical trial of relapsing-remitting multiple sclerosis: eight-year follow-up. Arch Neurol 67:1329–1335CrossRefPubMed Rudick RA, Lee JC, Cutter GR et al (2010) Disability progression in a clinical trial of relapsing-remitting multiple sclerosis: eight-year follow-up. Arch Neurol 67:1329–1335CrossRefPubMed
41.
Zurück zum Zitat Goodin DS, Reder AT, Ebers GC et al (2012) Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNbeta-1b trial. Neurology 78:1315–1322CrossRefPubMedPubMedCentral Goodin DS, Reder AT, Ebers GC et al (2012) Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNbeta-1b trial. Neurology 78:1315–1322CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Shirani A, Zhao Y, Karim ME et al (2012) Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA 308:247–256PubMed Shirani A, Zhao Y, Karim ME et al (2012) Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA 308:247–256PubMed
43.
Zurück zum Zitat Derfuss T, Kappos L (2012) Evaluating the potential benefit of interferon treatment in multiple sclerosis. JAMA 308:290–291CrossRefPubMed Derfuss T, Kappos L (2012) Evaluating the potential benefit of interferon treatment in multiple sclerosis. JAMA 308:290–291CrossRefPubMed
44.
Zurück zum Zitat Prosperini L, Gianni C, Barletta V et al (2012) Predictors of freedom from disease activity in natalizumab treated-patients with multiple sclerosis. J Neurol Sci 323:104–112CrossRefPubMed Prosperini L, Gianni C, Barletta V et al (2012) Predictors of freedom from disease activity in natalizumab treated-patients with multiple sclerosis. J Neurol Sci 323:104–112CrossRefPubMed
45.
Zurück zum Zitat Cohen JA, Khatri B, Barkhof F et al (2015) Long-term (up to 4.5 years) treatment with fingolimod in multiple sclerosis: results from the extension of the randomised TRANSFORMS study. J Neurol Neurosurg Psychiatry (im Druck) Cohen JA, Khatri B, Barkhof F et al (2015) Long-term (up to 4.5 years) treatment with fingolimod in multiple sclerosis: results from the extension of the randomised TRANSFORMS study. J Neurol Neurosurg Psychiatry (im Druck)
46.
Zurück zum Zitat Spelman T, Kalincik T, Zhang A et al (2015) Comparative efficacy of switching to natalizumab in active multiple sclerosis. Ann Clin Transl Neurol 2:373–387CrossRefPubMedPubMedCentral Spelman T, Kalincik T, Zhang A et al (2015) Comparative efficacy of switching to natalizumab in active multiple sclerosis. Ann Clin Transl Neurol 2:373–387CrossRefPubMedPubMedCentral
47.
Zurück zum Zitat Rio J, Nos C, Tintore M et al (2006) Defining the response to interferon-beta in relapsing-remitting multiple sclerosis patients. Ann Neurol 59:344–352CrossRefPubMed Rio J, Nos C, Tintore M et al (2006) Defining the response to interferon-beta in relapsing-remitting multiple sclerosis patients. Ann Neurol 59:344–352CrossRefPubMed
48.
Zurück zum Zitat Rio J, Castillo J, Rovira A et al (2009) Measures in the first year of therapy predict the response to interferon beta in MS. Mult Scler 15:848–853CrossRefPubMed Rio J, Castillo J, Rovira A et al (2009) Measures in the first year of therapy predict the response to interferon beta in MS. Mult Scler 15:848–853CrossRefPubMed
49.
Zurück zum Zitat Sormani MP, Bruzzi P (2013) MRI lesions as a surrogate for relapses in multiple sclerosis: a meta-analysis of randomised trials. Lancet Neurol 12:669–676CrossRefPubMed Sormani MP, Bruzzi P (2013) MRI lesions as a surrogate for relapses in multiple sclerosis: a meta-analysis of randomised trials. Lancet Neurol 12:669–676CrossRefPubMed
50.
Zurück zum Zitat Kinkel RP, Simon JH, O’Connor P et al (2014) Early MRI activity predicts treatment nonresponse with intramuscular interferon beta-1a in clinically isolated syndrome. Mult Scler Relat Disord 3:712–719CrossRefPubMed Kinkel RP, Simon JH, O’Connor P et al (2014) Early MRI activity predicts treatment nonresponse with intramuscular interferon beta-1a in clinically isolated syndrome. Mult Scler Relat Disord 3:712–719CrossRefPubMed
51.
Zurück zum Zitat Giovannoni G, Turner B, Gnanapavan S et al (2015) Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Dis 4:329–333CrossRef Giovannoni G, Turner B, Gnanapavan S et al (2015) Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Dis 4:329–333CrossRef
52.
Zurück zum Zitat Freedman MS, Selchen D, Arnold DL et al (2013) Canadian MS Working Group updated recommendations. Can J Neurol Sci 40:307–323CrossRefPubMed Freedman MS, Selchen D, Arnold DL et al (2013) Canadian MS Working Group updated recommendations. Can J Neurol Sci 40:307–323CrossRefPubMed
53.
Zurück zum Zitat Stangel M, Penner IK, Kallmann BA et al (2015) Development of a multifactorial model to monitor treatment response and disease course in relapsing remitting multiple sclerosis; Multiple Sclerosis Decision Model (MSDM): development of a multifactorial model to monitor treatment response and disease course in relapsing remitting multiple sclerosis. Akt Neurol 40:486–493 Stangel M, Penner IK, Kallmann BA et al (2015) Development of a multifactorial model to monitor treatment response and disease course in relapsing remitting multiple sclerosis; Multiple Sclerosis Decision Model (MSDM): development of a multifactorial model to monitor treatment response and disease course in relapsing remitting multiple sclerosis. Akt Neurol 40:486–493
54.
Zurück zum Zitat Maurer M, Dachsel R, Domke S et al (2011) Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS. Eur J Neurol 18:1036–1045CrossRefPubMed Maurer M, Dachsel R, Domke S et al (2011) Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS. Eur J Neurol 18:1036–1045CrossRefPubMed
55.
Zurück zum Zitat Rio J, Comabella M, Montalban X (2011) Multiple sclerosis: current treatment algorithms. Curr Opin Neurol 24:230–237CrossRefPubMed Rio J, Comabella M, Montalban X (2011) Multiple sclerosis: current treatment algorithms. Curr Opin Neurol 24:230–237CrossRefPubMed
Metadaten
Titel
„Time is brain“ bei der schubförmigen Multiplen Sklerose
Aktuelle Behandlungskonzepte in der Immuntherapie
verfasst von
Prof. Dr. R. Linker
B.-A. Kallmann
C. Kleinschnitz
P. Rieckmann
M. Mäurer
S. Schwab
Publikationsdatum
01.09.2016
Verlag
Springer Vienna
Erschienen in
psychopraxis. neuropraxis / Ausgabe 4/2016
Print ISSN: 2197-9707
Elektronische ISSN: 2197-9715
DOI
https://doi.org/10.1007/s00739-016-0332-z

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