Multiple Sclerosis: Therapy

General measures

Fall prevention (see below “Fall propensity/prevention/measures for fall prevention”).
Nicotine restriction (refraining from tobacco use).
- Improves the prognosis in terms of the degree of disability.
- Has an impact on the time to transition to secondary chronic progression (SPMS): each additional year of smoking after diagnosis accelerates time to SPMS conversion by 4.7
Avoidance of passive smoking
Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight
- BMI ≥ 25 → participation in a medically supervised weight loss program.
- Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
Avoidance of psychosocial stress:
- Stress – stressful events are discussed as risk factors.

Stem cell transplantation (more specifically, hematopoietic stem cell transplantation; HSCT; hematopoietic stem cell transplantation) – In the HALT-MS trial, 19 of 24 patients were still found to have no evidence of disease activity (NEDA) three years after autologous stem cell therapy. In the meantime, additional patients developed MRI lesions, so the NEDA rate after five years is likely to be around 60%. One patient died of massive liver necrosis and sepsis as a result of the initial immunoablation.
In a retrospective cohort study of MS patients who had received autologous stem cell transplantation, a 5-year probability of progression-free survival was determined to be 46%. Eight of 281 patients (2.8 percent; 95 percent confidence interval 1.0-4.9 percent) died in the first hundred days after transplantation.
Transcranial magnetic stimulation (TMS): procedure with which an electric current is generated painlessly through the intact skull in the brain tissue by means of fluctuating magnetic fields (approx. 1 Tesla strong pulsed magnetic fields), thereby triggering neuronal action potentials; 3 times a week for 20 minutes each for 6 weeks – to reduce the symptoms of a chronic fatigue state in patients with multiple sclerosis (MS); verum group showed a significant decrease in fatigue.

Spasticity

Ataxia (disorders of coordination of movements).

If no improvement can be achieved with drug therapy, deep brain stimulation (THS; synonyms: deep brain stimulation; thalamic stimulation; English : deep brain stimulation, DBS) can be used.

Fatigue

For fatigue (fatigue), non-drug therapy methods should be used in the first place; these include:

Cognitive disorders

Bladder dysfunction

Behavioral therapy – micturition diary, check the amount of drinking.
Pelvic floor training
Biofeedback procedures
Intermittent self-catheterization for insufficient bladder emptying.
Sacral invasive neuromodulation for the reduction of incontinence symptoms.
Reconstructive surgical procedures may be performed on a case-by-case basis if all measures fail

Sexual dysfunction

Cognitive behavioral therapy
For erectile dysfunction (ED), intracavernosal application (erectile tissue injection) of prostaglandins may be tried

The following vaccinations are advised, as infections can trigger (cause) relapses:

Note

Since MS patients should also receive a good vaccination protection, it is advised to refresh the vaccination protection if possible before starting MS therapy.
Caution is advised when vaccinating with live vaccines due to reduced immunocompetence under MS therapeutics!
Live vaccines are contraindicated in the first three months after high-dose corticosteroid therapy, as well as during therapy with immunosuppressive MS therapeutics.

Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grains, vegetables).
Observance of the following special dietary recommendations:
- Reduction of consumption of animal fats and meat.
- Diet rich in:
  - Dietary fiber
    - Short-chain fatty acids propionate and butyrate, formed within fermentation processes of intestinal bacteria, have anti-inflammatory/anti-inflammatory effects (if necessary, also supply of peroral propionate); stimulate regulatory cells of the immune system and increase the number of these cells; in this way, they positively influence intestinal-mediated immune regulation (microbiome) in people with multiple sclerosis (MS)
  - Vitamins (B12, D)
  - Omega-3 fatty acids (marine fish)
  - L-tryptophan; L-phenylalanine
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Endurance training (cardio training) and strength training (muscle training).
Regular endurance exercise has a neuroprotective effect and even promotes neurogenesis; regular strength training could counteract progressive brain atrophy, according to one study: by magnetic resonance imaging (MRI), it was shown that the intervention group had less brain atrophy than the comparison group after 6 months.
Yoga – improvement of fatigue (tiredness), balance and spatiotemporal gait parameters.
Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
Detailed information on sports medicine you will receive from us.

Muscle spasticity, in particular, responds to physical therapy and regularly performed exercises and stretches.

Psychotherapy if necessary
Detailed information on psychosomatics (including stress management) can be obtained from us.