Download PDF
Aktuelle Neurologie 2001; 28(1): 31-38
DOI: 10.1055/s-2001-10721
AKTUELLE THERAPIE
Aktuelle Therapie
© Georg Thieme Verlag Stuttgart · New York

Multiple Sklerose: Kritische Betrachtung umstrittener und komplementärmedizinischer Therapien auf der Grundlage aktueller Hypothesen zur Pathogenese

F.  X. Weilbach, P. Rieckmann, R. Gold, K.  V. Toyka
  • Klinische Forschungsgruppe für multiple Sklerose und Neuroimmunologie, Neurologische Klinik und Poliklinik der Julius-Maximilians-Universität Würzburg (Direktor: Prof. Dr. K. V. Toyka)
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die multiple Sklerose (MS) ist die häufigs-te neuroimmunologische Erkrankung, deren Ätiologie bislang noch nicht komplett geklärt ist. Obwohl mittlerweile effektive medikamentöse Therapieverfahren, die den Verlauf der Erkrankung beeinflussen, zur Verfügung stehen, benützen eine Vielzahl von MS-Patienten Therapieangebote der „komplementären Medizin”. In dieser Übersicht werden derzeit im deutschen Sprachraum angewandte alternative Therapieverfahren (Enzymtherapie u. a.) und experimentelle Behandlungsverfahren (Knochenmarktransplantation, Plasmapherese und Cannabis) vorgestellt und vor dem Hintergrund verfügbarer Erkenntnisse zur Pathogenese der MS bewertet.

Multiple Sclerosis: Critical Discussion of Controversial and Complementary Therapies Based on Current Pathogenetic Hypotheses

Multiple sclerosis (MS) represents the most frequent neuroimmunological disease with a still unknown aetiology. Although disease-modifying medications are now available, a significant fraction of MS patients make use of „complementary medicine”. This review summarises currently used complementary (polyenzyme and others) and experimental (bone marrow transplantation, plasmapheresis, and cannabis) therapeutic interventions in MS and evaluates them against the background of available knowledge of the pathogenesis of MS.

Literatur

  • 1 Schwartz C E, Laitin E, Brotman S. et al . Utilisation of unconventional treatments by persons with MS: Is it alternative of complementary?.  Neurology. 1999;  52 626-629
    CrossrefPubMedGoogle Scholar
  • 2 Wang Y, Hashimoto S, Ramsum D. et al . A pilot study of the use of alternative medicine in multiple sclerosis patients with special focus on acupuncture (abstract).  Neurology. 1999;  52, Suppl 2 A550
    PubMedGoogle Scholar
  • 3 Hartung H P, Gonsette R. and the MIMS study group . Mitoxantrone in progressive multiple sclerosis (MS): a placebo-controlled, randomized, observer-blind European phase III multicenter study-clinical results (Abstract OR 207).  Multiple Sclerosis. 1998;  4 325
    PubMedGoogle Scholar
  • 4 Rieckmann P, Toyka K V. Escalating immunotherapy of multiple sclerosis. Austrian-German-Swiss Multiple Sclerosis Therapy Consensus Group (MSTCG).  Eur Neurol. 1999;  42 121-127
    CrossrefPubMedGoogle Scholar
  • 5 Weilbach F X, Gold R. New treatments in multiple sclerosis: What is on the horizon.  CNS Drugs. 1999;  11 133-157
    PubMedGoogle Scholar
  • 6 Hohlfeld R. Biotechnological agents for the immunotherapy of multiple sclerosis. Principles, problems and perspectives.  Brain. 1997;  120 865-916
    CrossrefPubMedGoogle Scholar
  • 7 Khatri B O. Experience with use of plasmapheresis in chronic progressive multiple sclerosis: the pros.  Neurology. 1988;  38 50-52
    PubMedGoogle Scholar
  • 8 Weiner H L, Dau P C, Khatri B O. et al . Double-blind study of true vs. sham plasmapheresis in patients being treated with immunosuppression for acute attacks of multiple sclerosis.  Prog Clin Biol Res. 1990;  337 283
    PubMedGoogle Scholar
  • 9  The Canadian Cooperative Multiple Sclerosis Study Group. The Canadian cooperative trial of cyclophosphamide and plasma exchange in progressive multiple sclerosis.  Lancet. 1991;  337 441-446
    PubMedGoogle Scholar
  • 10 Weinshenker B G, O'Brien P C, Petterson T M. et al . A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease.  Ann Neurol. 1999;  46 878-86
    CrossrefPubMedGoogle Scholar
  • 11 Burt R K, Burns W, Hess A. Bone marrow transplantation for multiple sclerosis.  Bone Marrow Transplant. 1995;  16 1-6
    PubMedGoogle Scholar
  • 12 van Gelder M, van Bekkum D W. Effective treatment of relapsing experimental autoimmune encephalomyelitis with pseudoautologous bone marrow transplantation.  Bone Marrow Transplant. 1996;  18 1029-34
    PubMedGoogle Scholar
  • 13 van Gelder M, van Bekkum D W. Treatment of relapsing experimental autoimmune encephalomyelitis in rats with allogeneic bone marrow transplantation from a resistant strain.  Bone Marrow Transplant. 1995;  16 343-51
    PubMedGoogle Scholar
  • 14 Burt R K, Burns W H, Miller S D. Bone marrow transplantation for multiple sclerosis: returning to Pandoras box.  Immunol Today. 1997;  18 559-61
    CrossrefPubMedGoogle Scholar
  • 15 Burt R K, Traynor A E, Cohen B. et al . T cell-depleted autologous hematopoietic stem cell transplantation for multiple sclerosis: report on the first three patients.  Bone Marrow Transplant. 1998;  21 537-541
    CrossrefPubMedGoogle Scholar
  • 16 McAllister L D, Beatty P G, Rose J. Allogeneic bone marrow transplant for chronic myelogenous leukemia in a patient with multiple sclerosis.  Bone Marrow Transplant. 1997;  19 395-7
    CrossrefPubMedGoogle Scholar
  • 17 Fassas A, Anagnostopoulos A, Kazis A. et al . Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first results of a pilot study.  Bone Marrow Transplant. 1997;  20 631-638
    CrossrefPubMedGoogle Scholar
  • 18 Kelly P, Staunton H, Lawler M. et al . Multifocal remitting-relapsing cerebral demyelination twenty years following allogeneic bone marrow transplantation.  J Neuropathol Exp Neurol. 1996;  55 992-998
    PubMedGoogle Scholar
  • 19 Jeffery D R, Alshami E. Allogeneic bone marrow transplantation in multiple sclerosis (abstract).  Neurology. 1998;  50, Suppl 4 A147
    CrossrefPubMedGoogle Scholar
  • 20 Euler H H, Marmont A M, Bacigalupo A. et al . Early recurrence or persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation (see comments).  Blood. 1996;  88 3621-3625
    PubMedGoogle Scholar
  • 21 Openshaw H, Stuve O, Antel J P. et al . Multiple sclerosis flares associated with recominant granulcyte colony-stimulating factor.  Neurology. 2000;  54 2147-2150
    CrossrefPubMedGoogle Scholar
  • 22 Haase C G, Hohlfeld R. Knochenmark- und Stammzelltransplantation bei multipler Sklerose.  Nervenarzt. 1999;  70 178-181
    CrossrefPubMedGoogle Scholar
  • 23 Comi G, Kappos L, Clanet M. et al . Guidelines for autologous blood and marrow stem cell transplantation in multiple sclerosis: a consensus report written on behalf of the European Group for Blood and Marrow Transplantation and the European Charcot Foundation.  BMT-MS Study Group J Neurol. 2000;  247 376-82
    CrossrefPubMedGoogle Scholar
  • 24 Kappos L, Radu E W, Haas J. et al . Deoxyspergualine in MS: a second interim analysis of the European multicentre study (Abstract).  J Neurol. 1995;  242, Suppl 2 S 23
    PubMedGoogle Scholar
  • 25 Kappos L, Radu E W, Haas J. et al . European multicentre trial +/-deoxyspergualine (DSG) versus placebo: results of the first interim analysis (Abstract).  J Neurol. 1994;  241, Suppl 2 S27
    PubMedGoogle Scholar
  • 26 Wirguin I, Mechoulam R, Breuer A. et al . Suppression of experimental autoimmune encephalomyelitis by cannabinoids.  Immunopharmacology. 1994;  28 209-14
    CrossrefPubMedGoogle Scholar
  • 27 Baker D, Pryce G, Croxford J L. et al . Cannabinoids control spasticity and tremor in a multiple sclerosis model.  Nature. 2000;  404 84-87
    CrossrefPubMedGoogle Scholar
  • 28 Petro D J, Ellenberger  C. Treatment of human spasticity with delta 9-tetrahydrocannabinol.  J Clin Pharmacol. 1981;  21 413S-416S
    PubMedGoogle Scholar
  • 29 Meinck H M, Schonle P W, Conrad B. Effect of cannabinoids on spasticity and ataxia in multiple sclerosis.  J Neurol. 1989;  236 120-2
    PubMedGoogle Scholar
  • 30 Weilbach F X. Marihuana als Medizin bei MS? Der ärztliche Beirat der DMSG nimmt kritisch Stellung.  AKTIV. 1998;  181 14-16
    PubMedGoogle Scholar
  • 31 Targoni O S, Tary-Lehmann M, Lehmann P V. Prevention of murine EAE by oral hydrolytic enzyme treatment.  J Autoimmun. 1999;  12 191-198
    CrossrefPubMedGoogle Scholar
  • 32 Desser L, Rehberger A, Kokron E. et al . Cytokine synthesis in human peripheral blood mononuclear cells after oral administration of polyenzyme preparations.  Oncology. 1993;  50 403-7
    PubMedGoogle Scholar
  • 33 Baumhackl U, Fordermair S. Enzyme therapy in multiple sclerosis. A preliminary report on a multicenter study.  Allgemeinmedizin. 1990;  19 169-172
    PubMedGoogle Scholar
  • 34 de-Smet P A, Pegt G W, Meyboom R H. Acute circulatory shock following administration of the non-regular enzyme preparation Wobe-Mugos.  Ned Tijdschr Geneeskd. 1991;  135 2341-2344
    PubMedGoogle Scholar
  • 35 Kiessling W R. Anaphylactic reaction in enzyme therapy of multiple sclerosis.  Fortschr Neurol Psychiatrie. 1987;  55 385-6
    PubMedGoogle Scholar
  • 36 Liu F J, Zhang Y X, Lau B H. Pycnogenol enhances immune and haemopoietic functions in senescence- accelerated mice.  Cell Mol Life Sci. 1998;  54 1168-1172
    CrossrefPubMedGoogle Scholar
  • 37 Dworkin R H, Bates D, Millar J HD. et al . Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials.  Neurology. 1984;  34 1441-1445
    PubMedGoogle Scholar
  • 38 Lauer K. Diet and multiple sclerosis.  Neurology. 1997;  49, Suppl 2 S55-S61
    PubMedGoogle Scholar
  • 39 Clausen J, Jensen G E, Nielsen S A. Selenium in chronic neurologic diseases. Multiple sclerosis and Batten's disease.  Biol Trace Elem Res. 1988;  15 179-203
    PubMedGoogle Scholar
  • 40 Korpela H, Kinnunen E, Juntunen J. et al . Serum selenium concentration, glutathione peroxidase activity and lipid peroxides in a co-twin control study on multiple sclerosis.  J Neurol Sci. 1989;  91 79-84
    CrossrefPubMedGoogle Scholar
  • 41 Bangsi D, Ghadirian P, Ducic S. et al . Dental amalgam and multiple sclerosis: a case-control study in Montreal, Canada.  Int J Epidemiol. 1998;  27 667-71
    CrossrefPubMedGoogle Scholar
  • 42 Mertin J, McDonald W I. Hyperbaric oxygen for patients with multiple sclerosis.  Br Med J. 1984;  288 957-960
    PubMedGoogle Scholar
  • 43 James P B. Evidence for subacute fat embolism as the cause of multiple sclerosis.  Lancet. 1982;  1 380-386
    PubMedGoogle Scholar
  • 44 James P B. Oxygen for multiple sclerosis.  Lancet. 1983;  1 1161-1162
    PubMedGoogle Scholar
  • 45 Kleijnen J, Knipschild P. Hyperbaric oxygen for multiple sclerosis. Review of controlled trials.  Acta Neurol Scand. 1995;  91 330-4
    PubMedGoogle Scholar
  • 46 Toshniwal P K, Zarling E J. Evidence for increased lipid peroxidation in multiple sclerosis.  Neurochem Res. 1992;  17 205-7
    CrossrefPubMedGoogle Scholar
  • 47 Nieper H A. Klinische Untersuchungen der Kalzium-Transport-Substanzen.  Ärztl Forsch. 1966;  20 127-140
    PubMedGoogle Scholar
  • 48 Lublin F D, Oshinsky J R, Perreault M, Siebert K. Effect of honey bee venom on EAE (abstract).  Neurology. 1998;  50, Suppl 4 A424
    PubMedGoogle Scholar
  • 49 Pette M, Hartung H P, Toyka K V. Immune augmenting therapy as treatment of multiple sclerosis. Warning regarding a potentially toxic alternative treatment method.  Nervenarzt. 1994;  65 878-890
    PubMedGoogle Scholar

Dr. F. X. Weilbach

Neurologische Universitätsklinik und Poliklinik der Julius-Maximilians-Universität Würzburg

Josef-Schneider-Straße 11

97080 Würzburg

Email: f.weilbach@mail.uni-wuerzburg.de

      >