Multiple sclerosis disease and therapy vivantes

Multiple Sclerosis: Disease and TherapyThe knowledge about multiple sclerosis (MS) and its therapy has been multiplied by research in the past decades: The more individualized the treatment of the chronic inflammatory neurological autoimmune disease, also known as encephalomyelitis disseminata, is, the better it is for the patients.

In order to be able to offer personalized therapy to MS patients, most of whom are young, special expertise and specialization is required. Senior Physician Dr. Dieter Bahr heads the MS outpatient clinic at Vivantes Klinikum Neukolln. Reports in this interview about his experience with the disease multiple sclerosis. Dieter Bahr is head of the MS outpatient clinic at Vivantes Klinikum Neukolln. Shares his experience with multiple sclerosis disease in this interview.

Multiple Sclerosis: What kind of disease is it??

Multiple sclerosis has very different manifestations – what exactly happens in the body?

The disease can be thought of as an overreaction of the body triggered by the immune system, in which antibodies and other messenger substances are directed against the body's own substances and ties. In the past, it was thought that only the myelin sheath, which surrounds the nerves like the sheathing of a cable, was affected. Today it is known that the nerve fibers themselves are also attacked and become inflamed at an early stage. This can lead to a variety of symptoms, for example

– visual disturbances, – sensory disturbances, – paralysis, – balance disturbances, – speech disturbances or – also a bladder weakness.

Determining the strength of MS inflammatory activity

MS is still not curable: Isn't that very discouraging for a person affected by MS, but also for the doctors who treat them??

We take a lot of time for the patients right from the beginning to find out how strong the disease activity is, i.e. how quickly the MS develops, or whether it is rather the impairments in everyday life that predominate and have to be treated. Although the disease cannot yet be cured, in many cases it can now be controlled so well with medication that there are no new attacks of the disease and one can then concentrate entirely on alleviating the symptoms.

Multiple sclerosis disease and therapy vivantes

Dr. Dieter Bahr, MS expert

How fast multiple sclerosis develops and what symptoms it causes depend on what?

We still know little about these. At the beginning of the disease it is often difficult to classify the further course, and not in every case stronger therapies are necessary.

Studies on multiple sclerosis

How lifestyle, i.e. diet, sport, stress, affects the development of MS, even without medication, is currently being investigated in a very interesting study in which we are participating as a focal center: The patients learn strategies and enter the data on a web-based platform. Then the results show up in MRI controls, i.e. magnetic resonance imaging, and clinical examinations.

A second study is about how patients deal with MS relapses and symptoms. You will be trained to better understand your own body and to perceive warning signals. Not all symptoms need to be treated immediately with medication.

Multiple sclerosis and its disease activity

How MS usually progresses?

We observe two main forms of progression:

– A gradual course, also called progressive, is rarer. – More frequent is an episodic course of the disease in relapses, which are especially prominent in the early phase of the disease.

The inflammatory reaction in the central nervous system is particularly active. Even before it becomes noticeable to the patient himself, it may already be visible on MRI. The disease activity is decisive for the treatment.

Here we need to intervene in time to prevent residual and progressive impairments. These are predominantly young patients who are living their lives to the fullest. There are many other ies and questions to be discussed besides the drugs in this phase.

MS therapy: from cortisone to plasmapheresis

To what extent does the treatment differ in these courses??

It is always necessary to weigh up when, how and how intensively to treat with medication. The cortisone used in relapse therapy, specifically: Glucocorticosteroids, treats the acute symptomatology. In particularly severe cases, for example when a visual disorder threatens to lead to blindness, we wash out the immune reaction from the bloodstream. This is called plasmapheresis.

In the long term, we use drugs that interfere with the immune system to varying degrees. The possibilities have multiplied and revolutionized in the last few years, which is why we are available with our specialist expertise to provide guidance and advice. If, on the other hand, the inflammatory activity is low or – as is often the case – becomes lower during the course of the disease, we concentrate on symptomatic treatment.

multiple sclerosis disease and therapy vivantes

Multiple sclerosis: slowing down disease relapses

Symptomatic treatment sounds like giving free rein to the disease itself. Is that so?

One must not underestimate the suffering of those affected: If the disease progresses very slowly, it can be very important for the quality of life to take care of the symptoms. If, for example, a patient has to go to the toilet thirty times a day because of bladder weakness, remedial action is crucial to prevent this.

But we can also influence movement disorders, pain or concentration problems. We cooperate here with our partners. We agree on the further procedure together.

If disease relapses are not immediately visible, how can they be slowed down??

Magnetic resonance imaging (MRI) is very important not only for diagnosis, but also for assessing the course of the disease and its activity. We can see the foci of inflammation and also the extent of tie and brain atrophy.

Ongoing MS examinations and laboratory value checks

In addition, our patients are regularly examined and their laboratory values are checked in order to ensure that they are in good health

– to check the effectiveness of our measures, – to recognize new symptoms in time and – to counteract possible side effects of the drugs.

As an MS center of excellence, they have better possibilities than classic neurology departments?

Of course, due to the high number of cases, namely more than 400 patients per year, and our competent team, which is very familiar with the disease, we have very good conditions for an individual treatment. Also close networking with specialist departments such as

– the Institute for Neuroradiology, – the Clinic for Ophthalmology, – Urology and – the Pelvic Floor Center, but also external partners such as – the German Multiple Sclerosis Society

ensures a high quality of care. Due to the close cooperation, we can always coordinate our interdisciplinary approach.

We are often consulted by people with MS for a second opinion and advise young people who are particularly affected by MS. Our specialties also include neuropediatrics, which enables the examination of children in whom the diagnosis is particularly complex.

Dr. Dieter Bahr works in the special outpatient clinic for multiple sclerosis at Vivantes Klinikum Neukolln. On the website of the MS outpatient clinic you can inform yourself about the medical services and see on which days of the week an appointment can be made.

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