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Multiple Sklerose

Rehabilitation und Langzeitverlauf

Multiple sclerosis

Rehabilitation and long-term course

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Zusammenfassung

Hintergrund

Die multiple Sklerose (MS) ist eine komplexe Erkrankung mit heterogener Pathologie und sehr variablem klinischem Verlauf. Durch den progredienten multisystemischen Befall des zentralen Nervensystems entstehen komplexe Störungsbilder und Behinderungen. Trotz medikamentöser krankheitsmodifizierender Therapien und symptomatischer Behandlungen ist bei einem Großteil der Betroffenen der Langzeitverlauf geprägt von zunehmenden Einschränkungen in den Funktionen, Alltagsaktivitäten und in der Lebensqualität. Rehabilitative Maßahmen zielen darauf ab, Symptome und Funktionsdefizite zu verbessern und deren Auswirkungen auf die persönlichen Aktivitäten und soziale Partizipation zu minimieren.

Fragestellung

Betrachtet wird der Stellenwert rehabilitativer Interventionen bei MS.

Methoden

Es erfolgte eine spezifische PubMed-Literaturrecherche.

Ergebnisse

Der positive Effekt verschiedener rehabilitativer Interventionen und multidisziplinärer Rehabilitationsprogramme ist durch kontrollierte Studien gut belegt. Die Langzeitprognose der Erkrankung ist sehr variabel und wird durch verschiedene Einflussfaktoren bestimmt, wobei die Voraussage des Krankheitsverlaufes im Einzelfall aufgrund der hohen intra- und interindividuellen Variabilität und häufig unvorhersehbaren Veränderung der Krankheitsaktivität weiterhin sehr schwierig ist.

Schlussfolgerungen

Rehabilitative Maßnahmen sollten bereits im frühen Krankheitsverlauf eingeleitet werden, um die Funktionen und die Leistungsfähigkeit möglichst lange zu erhalten und drohenden Behinderungen entgegenzuwirken. Die Wahl der Interventionen und das Setting sind abhängig von krankheitsspezifischen und persönlichen Faktoren sowie den konkreten Zielsetzungen. Mono- bzw. oligosyndromatische leichte Funktionsdefizite in einer frühen Krankheitsphase können durch gezielte monodisziplinäre ambulante Interventionen angegangen werden, während bei zunehmender Schwere und Komplexität der Behinderungen bei Fortschreiten der Erkrankung eine intensive multidisziplinäre Rehabilitation notwendig ist.

Abstract

Background

Multiple sclerosis (MS) is a highly complex disabling disease with variable pathology and clinical course. Progressive multisystemic involvement of the central nervous system leads to complex functional disturbances and disabilities. Despite disease-modifying therapies and pharmacological symptomatic treatment, the majority of MS patients develop progressive impairments in functions, activities and quality of life in the long-term. Rehabilitation interventions aim at improving symptoms and functional deficits and reducing the negative impact on activities and social participation.

Objectives

To evaluate the impact and value of rehabilitation interventions in MS.

Methods

Specific literature search in PubMed.

Results

Good evidence exists for a positive effect of various rehabilitation interventions and multidisciplinary programs. Long-term prognosis is very variable and depends on various influencing factors. Due to an often unpredictable change of disease activity and the high variability, accurate prediction of long-term prognosis in individual MS cases is still challenging.

Conclusion

Rehabilitation measures should be considered in an early phase of the disease for maintaining functional abilities and reducing the risk of progression of disabilities. Assignment to specific interventions and setting of rehabilitation depend on disease-specific and personal factors and specific goals. Monosyndromic or oligosyndromic impairments in the early phases of the disease can be approached by targeted monodisciplinary ambulatory interventions, whereas more severe and complex disabilities generally necessitate a more intensive multidisciplinary rehabilitation.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Beer und J. Kesselring geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Neurologie und Neurorehabilitation, Rehabilitationszentrum, 7317, Valens, Schweiz

    S. Beer & J. Kesselring

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  1. S. Beer
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  2. J. Kesselring
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Correspondence to S. Beer.

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Beer, S., Kesselring, J. Multiple Sklerose. Ophthalmologe 111, 715–721 (2014). https://doi.org/10.1007/s00347-013-2988-6

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  • DOI: https://doi.org/10.1007/s00347-013-2988-6

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