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Stellenwert der Uveitis im Rahmen demyelinisierender Erkrankungen des Zentralnervensystems

The role of uveitis in demyelinating diseases of the central nervous system

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Zusammenfassung

Affektionen des visuellen Systems treten im Rahmen vieler neurologischer Erkrankungen auf. Insbesondere demyelinisierende Prozesse des Zentralnervensystems (ZNS) wie die Multiple Sklerose (MS) können mit einer Vielzahl ophthalmologischer Störungen einhergehen. Während die Optikusneuritis (ON) als Symptom dieser Erkrankung gewertet werden kann, scheint es sich bei dem gehäuften Auftreten von Uveitiden bei MS-Patienten eher um die Koinzidenz zweier unabhängiger Erkrankungen im Rahmen einer gemeinsamen Autoimmundiathese zu handeln. Aufgrund des hohen Konversionsrisikos in eine klinisch sichere MS besteht daher bei der isolierten ON bei entsprechender Läsionslast in der magnetresonanztomographischen Darstellung des Neurokraniums die Indikation zur Einleitung einer Frühtherapie mit Interferon-β, während die derzeitige Datenlage bei der Uveitis einen frühzeitigen Einsatz immunmodulatorischer Medikamente nicht rechtfertigt. Da die MS-assoziierte Uveitis dem Auftreten neurologischer Symptome jedoch ebenfalls um Jahre vorausgehen kann und ein Ansprechen auf schubtherapeutische und -prophylaktische Medikamente ähnliche pathogenetische Mechanismen nahe legt, bleibt in weiteren Studien zu prüfen, inwiefern durch magnetresonanztomographische oder immunologische Prädiktoren diejenigen Uveitispatienten identifiziert werden können, bei denen der Einsatz einer immunmodulatorischen Frühtherapie die Entwicklung einer klinisch manifesten MS verzögern oder verhindern kann.

Summary

An involvement of the visual system can be found in many neurologic diseases. Especially demyelinating processes of the central nervous system (CNS) and multiple sclerosis (MS) in particular present with a variety of ophthalmological abnormalities. While optic neuritis (ON) is known to be a positive predictor for the development of MS and can be considered a symptom of the disease, the high frequency of uveitis observed in MS patients seems to occur rather in the context of a general predisposition for autoimmune disorders. However, MS-associated uveitis can precede the onset of neurological symptoms by many years and shows response to treatment with steroids and interferons, suggesting the presence of similar underlying pathogenic mechanisms. Therefore, further studies are warranted in order to reveal whether administration of early immunomodulatory therapy can delay or even prevent the clinical manifestation of MS in a distinct subgroup of patients presenting with uveitis.

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  1. Neurologische Klinik und Poliklinik, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    A.-M. Beyer, B. Rosche &  K.P. Wandinger

  2. Klinik für Augenheilkunde, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Deutschland

    U. Pleyer

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  1. A.-M. Beyer
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  2. B. Rosche
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Correspondence to K.P. Wandinger.

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Beyer, AM., Rosche, B., Pleyer, U. et al. Stellenwert der Uveitis im Rahmen demyelinisierender Erkrankungen des Zentralnervensystems. Nervenarzt 78, 1389–1398 (2007). https://doi.org/10.1007/s00115-007-2297-x

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  • DOI: https://doi.org/10.1007/s00115-007-2297-x

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