Aktuelle Neurologie 2012; 39(02): 83-99
DOI: 10.1055/s-0032-1304603
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Differenzialdiagnose der Multiplen Sklerose (MS) – MS Mimicks

Differential Diagnosis of Suspected Multiple Sclerosis (MS) – MS Mimicks
B. F. Décard   *
1   Klinik für Neurologie, St. Josef Hospital, Klinikum der Ruhr-Universität Bochum
,
J. Thöne   *
1   Klinik für Neurologie, St. Josef Hospital, Klinikum der Ruhr-Universität Bochum
,
R. Gold
1   Klinik für Neurologie, St. Josef Hospital, Klinikum der Ruhr-Universität Bochum
› Author Affiliations
Further Information

Publication History

Publication Date:
14 March 2012 (online)

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Zusammenfassung

Die Multiple Sklerose (MS) ist die häufigste neurologische Erkrankung des jungen Erwachsenenalters und führt im Erkrankungsverlauf häufig zu schwerwiegenden und bleibenden Behinderungen. Zu Beginn der Erkrankung stehen autoimmun-entzündliche Prozesse im Vordergrund, die zur Demyelinisierung von Axonen im ZNS führen. Im weiteren Verlauf der Erkrankung schließt sich nach mehreren Jahren in der Regel eine neurodegenerative Phase mit irreversiblem Verlust von Axonen und Neuronen an, die klinisch gekennzeichnet ist durch bleibende oder fortschreitende neurologische Defizite. Neuere Erkenntnisse weisen jedoch daraufhin, dass insbesondere die axonale Schädigung bereits in einer frühen Phase der MS auftritt und hierdurch der weitere Erkrankungsverlauf mitbestimmt wird. Die meisten der neuen Medikamente zur Behandlung der MS haben immunmodulatorische oder immunsuppressive Therapieansätze und konnten ihre Wirksamkeit insbesondere in frühen Erkrankungsphasen, in denen autoimmun-entzündliche Prozesse im Vordergrund stehen, unter Beweis stellen. Um eine adäquate und erfolgreiche Therapie der MS zu initiieren, ist demnach die möglichst rasche Diagnosestellung von großer Bedeutung. Die Erstdiagnose der MS kann heute mithilfe der revidierten McDonald Diagnosekriterien bereits früh im Verlauf der Erkrankung gestellt werden, prinzipiell schon beim ersten Schub. Eine Vielzahl von Krankheitsbildern können jedoch insbesondere zu Erkrankungsbeginn ähnliche Symptomkomplexe und bildmorphologische Korrelate aufweisen und so die Diagnosestellung der MS erheblich erschweren. In der folgenden Übersichtsarbeit werden daher Erkrankungen vorgestellt, die in ihrer klinischen Präsentation oder auch durch die Befunde der laborchemischen, elektrophysiologischen oder bildgebenden Untersuchungen, eine MS vortäuschen können und daher als wichtige Differenzialdiagnosen in Betracht gezogen werden sollten.

Abstract

Multiple sclerosis (MS) is the most frequent neurological disease in young adults and often leads to severe and permanent disabilities in the further course of the disease. In the initial stage of the disease autoimmune-inflammatory processes predominate and lead to demyelination of axons in the CNS. In the further course of the disease a neurodegenerative phase with an irreversible loss of axons and neurons usually follows after several years; this is characterised clinically by persistent or progressive neurological deficits. However, recent research results suggest that especially the axonal damage already occurs in an early phase of MS and that this determines in part the further course of the disease. Most of the new drugs for the treatment of MS have immunomodulatory or immunosuppressive therapeutic actions and have proven their efficacy particularly in the early phase of the disease when autoimmune-inflammatory processes dominate. In order to initiate an adequate and successful therapy it is of great importance that the diagnosis of MS is made as early as possible. According to the revised McDonald criteria (2010) the diagnosis of MS can today be made early in the course of the disease, in principal after the first exacerbation. However, many clinical entities may exhibit similar symptoms or findings on MRI imaging, which makes the diagnosis difficult, especially at the start of the disease course. In the present review we discuss diseases that can mimick MS based on their account of their clinical presentation or through the findings of laboratory chemical, electrophysiological examination and thus must be considered as important differential diagnoses.

Schlüsselwörter

Multiple Sklerose - Differenzialdiagnose - Mimicks - Diagnose - Neuroimmunologie

Keywords

multiple sclerosis - differential diagnosis - mimicks - diagnostics - neuroimmunology
*

* Contributed equally


 

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