Fatigue bei Patienten mit Multipler Sklerose – Pathogenese, Klinik, Diagnostik und Therapie

Zusammenfassung

Fatigue ist ein sehr häufiges und subjektiv stark belastendes Symptom der Multiplen Sklerose (MS). Ausgehend von der Komplexität der pathogenetischen Mechanismen wird im vorliegenden Artikel ein Ansatz zur systematischen diagnostischen Einordnung der Fatigue erarbeitet. Insbesondere durch den Einsatz funktioneller Bildgebungsverfahren konnten in den letzten Jahren wichtige Beiträge zur Differenzierung der verschiedenen klinischen Erscheinungsformen der MS-Fatigue geleistet werden. Durch die verbesserte Einsicht in den Zusammenhang zwischen der Immunpathologie der MS und der Ausbildung von Fatigue rückt die Wechselwirkung zwischen Fatigue und immunmodulierender Basistherapie der MS vermehrt in den Blickpunkt. Auf der Grundlage der aktuell verfügbaren empirischen Daten werden in dieser Arbeit daher nicht nur die medikamentöse, physikalische und psychologische symptomatische Therapie referiert, sondern darüber hinaus wird auch die aktuelle Datenlage zu den Effekten der etablierten sowie der zahlreichen neuen MS-Immuntherapeutika auf die MS-Fatigue dargestellt.

Abstract

Fatigue is a frequent and restricting symptom of multiple sclerosis (MS). Starting from its pathogenetic mechanisms, the article develops an approach to the differential diagnosis of fatigue in MS patients. Over the past years, the use of functional imaging techniques has given important information on the mechanisms of this highly variable clinical picture. Considering our improved understanding of the interdependency of immune pathology and the clinical presentation of neuropsychological disorders, the relationship between immunomodulatory treatments and fatigue is receiving increased attention. Therefore, this article not only reports on the most recent data on pharmacological, physical and psychological interventions in the symptomatic treatment of fatigue, but also puts a special accent on data concerning the interactions between the rapidly growing number of immunomodulatory treatments in MS.

Schlüsselwörter

Multiple Sklerose - Fatigue - immunmodulatorische Therapie

Key words

multiple sclerosis - fatigue - immunomodulatory therapy

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