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Nervenheilkunde 2006; 25(06): 452-458
DOI: 10.1055/s-0038-1626741
Originaler Artikel
Schattauer GmbH

Von der Neuroinflammation zur Neurodegeneration

Ein Paradigmenwechsel bei der Multiplen SkleroseFrom neuroinflammation to neurodegeneration – a change of paradigm in multiple sclerosis
J. Dörr
1   Institut für Neuroimmunologie, Charité Universitätsmedizin Berlin
2   HELIOS Klinikum Berlin Buch
,
F. Zipp
1   Institut für Neuroimmunologie, Charité Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
19 January 2018 (online)

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Zusammenfassung

Während die Multiple Sklerose (MS) über mehr als 100 Jahre als Prototyp einer entzündlich-demyelinisierenden Erkrankung des Zentralnervensystems galt, wurde in den letzten Jahren deutlich, dass auch neurodegenerative Prozesse eine ganz entscheidende Rolle in der MS-Pathogenese spielen. Moderne histopathologische und bildgebende Verfahren zeigen schon frühzeitig im Krankheitsverlauf eine signifikante Schädigung neuronaler und axonaler Strukturen nicht nur in den typischen Entmarkungsherden, sondern auch in morphologisch völlig normal erscheinender weißer und grauer Substanz. Die kumulative Zerstörung neuronaler und axonaler Strukturen scheint hauptverantwortlich für die Entstehung eines permanenten neurologischen Defizits zu sein. Damit kann die MS nicht länger als isolierte Erkrankung der weißen Substanz betrachtet werden, sondern betrifft vielmehr das gesamte Zentralnervensystem. Hieraus ergibt sich zwangsläufig die Notwendigkeit, neben den etablierten immunmodulatorischen Therapieverfahren frühzeitig und konsequent eine neuroprotektive und/oder neuroregenerative Behandlung durchzuführen. Voraussetzung hierfür ist ein besseres Verständnis der neurodegenerativen Mechanismen und die Entwicklung suffizienter neuroprotektiver Therapiestrategien.

Summary

For overa century multiple sclerosis was regarded as the prototype of an inflammatory demyelinating disease of the central nervous system. During recent years however, it became increasingly evident that neurodegenerative processes also play a major role in the pathogenesis of the disease. Up-to-date histopathological and radiological techniques demonstrate early and significant destruction of both neuronal and axonal structures not only within the typical demyelinating patches but also in morphological completely normal appearing white and grey matter. These neurodegenerative processes are probably the underlying course for the development of a permanent neurological impairment. Thus, MS can no longer be regarded as an isolated white matter disease but involves the whole central nervous system. This perception calls for an early and consequent neuroprotective and/or neuroregenerative treatment in addition to the established immunomodulatory treatments. The prerequisite for such therapeutic strategies however is a better comprehension of the mechanisms underlying neurodegeneration.

Schlüsselwörter

Multiple Sklerose - Neurodegeneration - Axonverlust - Neuroprotektion

Keywords

Multiple sclerosis - neurodegeneration - axonal loss - neuroprotection
 

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