Der Ophthalmologe

, Volume 103, Issue 7, pp 621–643 | Cite as

Multiple Sklerose

Ein Update mit praktischen Regeln für die ophthalmologische Praxis
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Bei der multiplen Sklerose (MS) handelt es sich um die bei jungen Patienten häufigste chronisch-entzündliche Erkrankung des zentralen Nervensystems, wobei das Erkrankungsbild aufgrund des variablen zeitlichen und örtlichen Auftretens der Entzündungsherde im zentralen Nervensystem klinisch sehr vielgestaltig sein kann. Weil ungefähr ein Drittel aller MS-Patienten eine Neuritis nervi optici als Primärsymptomatik einer MS entwickelt, stellt nicht selten der Ophthalmologe die erste Anlaufstelle für spätere MS-Patienten dar. Daraus leitet sich die Notwendigkeit ab, eine spezielle, an neuen Diagnosekriterien ausgerichtete Frühdiagnostik schon nach dem Auftreten einer ersten Optikusneuritis als einem (okulären) isolierten klinischen Syndrom zu veranlassen. Weil eine signifikante irreversible Zerstörung von Axonen bereits beim ersten Schubereignis festgestellt werden kann, ermöglicht die frühe Diagnostik, durch eine frühzeitige Therapie weitere Schubereignisse zu vermeiden und das Fortschreiten der neurologischen Behinderung zu verlangsamen. Neben neuen therapeutischen Ansätzen werden praktische Regeln für den klinischen Alltag vorgeschlagen, die die Betreuung von Patienten erleichtern sollen.

Schlüsselwörter

Multiple Sklerose Neuritis nervi optici McDonald-Kriterien Frühtherapie Immunmodulatorische Therapie 

Multiple sclerosis

An update with practical guidelines for ophthalmologists

Abstract

Multiple sclerosis (MS) is the most frequent chronic inflammatory disease of the central nervous system. Mostly young adults present with a variety of different symptoms due to the multiple localisations of the inflammatory lesions. Up to one-third of MS patients experience symptoms of optic neuritis as the initial symptom. That is the reason why the ophthalmologist often is the first physician contacted by patients later on diagnosed with MS. Today, it is known that there is already a significant irreversible axonal loss in MS patients progressing from the beginning of the disease. Therefore early, diagnosis and application of available therapeutic options are necessary for the patient’s benefit. The therapeutic aim in early immunomodulatory treatment is to decrease the number of relapses and to slow down the development of clinical disability. This interdisciplinary overview presents guidelines for the clinical routine: how to assess the individual risk of each patient and how to treat the patient in accordance with current pathogenic, diagnostic and therapeutic knowledge.

Keywords

Multiple sclerosis Optic neuritis McDonald criteria Early therapy Immunomodulatory treatment 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.MS-Zentrum DresdenNeurologische Universitätsklinik Carl-Gustav Carus TU Dresden
  2. 2.Universitätsaugenklinik TübingenTübingen

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