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Therapie der Tagesmüdigkeit bei Patienten mit multipler Sklerose

Treatment of fatigue in patients with multiple sclerosis

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Zusammenfassung

Tagesmüdigkeit, auch Fatigue genannt, ist eines der häufigsten Symptome bei multipler Sklerose und kommt bei 75%–90% der Patienten vor. Zusätzlich wird Tagesmüdigkeit als das störendste Symptom von vielen MS-Patienten angeführt und ist eine der Hauptursachen für Arbeitslosigkeit bei MS-Patienten. Aus diesen Gründen ist die symptomatische Therapie besonders wichtig. Mehrere Substanzgruppen wurden bisher zur Behandlung des Fatigue-Syndroms bei multipler Sklerose eingesetzt. Eine Wirksamkeit konnte für Amantadine und Modafinil erzielt werden. Andere Substanzen, wie Pemoline oder 3,4-Diaminopyridine wurden zur Therapie des Fatigue-Syndroms bei multipler Sklerose getestet, können aber wegen Nebenwirkungen oder fehlender Wirksamkeit nicht empfohlen werden. Neben der medikamentösen Behandlung tragen auch nicht-medikamentöse Therapien, wie aerobes Training, rehabilitative Maßnahmen und möglicherweise auch die Magnetfeldtherapie zur Verbesserung des Fatigue-Syndroms bei. Die vorliegende Übersichtsarbeit faßt die rezente Literatur bezüglich Pathophysiologie, Diagnose und Therapie des häufigsten Symptoms bei multipler Sklerose zusammen.

Summary

Fatigue is the most common symptom of multiple sclerosis. 75%–90% of patients with multiple sclerosis report having fatigue, and 50%–60% describe it as the worst symptom of their disease. Fatigue is significantly associated with reduced quality of life and is also a major reason for unemployment, especially for patients with otherwise minor disability. The mechanisms underlying abnormal levels of fatigue in multiple sclerosis are poorly understood. To date, drug treatment has been only partially successful in alleviating fatigue, and effects vary widely from patient to patient. Amantadine and modafinil showed to be effective in the treatment of fatigue in some studies. Non-pharmacological management of fatigue in multiple sclerosis includes inpatient rehabilitation and endurance training. There is also evidence, that pulsing electromagnetic fields may improve fatigue associated with multiple sclerosis. This paper summarizes the recent literature on pathophysiology, diagnosis and therapy of the most common symptom of multiple sclerosis.

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    Udo A. Zifko

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Zifko, U.A. Therapie der Tagesmüdigkeit bei Patienten mit multipler Sklerose. WMW 153, 65–72 (2003). https://doi.org/10.1046/j.1563-258X.2003.02014.x

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