Download PDF
Fortschr Neurol Psychiatr 2005; 73(8): 451-462
DOI: 10.1055/s-2004-830248
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Alternative und komplementäre Therapien der Multiplen Sklerose

Alternative and Complementary Therapies in Multiple SclerosisS.  Schwarz1 , H.  Leweling2 , H.-M.  Meinck3
  • 1Neurologische Klinik, Klinikum Mannheim der Universität Heidelberg, Mannheim
  • 2Medizinische Klinik, Klinikum Mannheim der Universität Heidelberg, Mannheim
  • 3Neurologische Klinik, Klinikum Heidelberg der Universität Heidelberg
Further Information

Publication History

Publication Date:
25 April 2005 (online)

    Permissions and Reprints

Zusammenfassung

Die meisten Patienten mit MS wenden unkonventionelle Therapien an, meist als supplementäre Maßnahmen zu etablierten Behandlungsverfahren. Es existieren nur wenige aussagekräftige klinische Studien zu diesem Thema. Definitionsgemäß ist der Nutzen keiner dieser Therapien bewiesen; allerdings sind auch die möglichen Risiken weitgehend unbekannt. Teilweise beruhen diese Therapien auf nachvollziehbaren pathophysiologischen Überlegungen und experimentellen Ergebnissen, einige sind aber auch als potenziell gefährlich einzustufen. Einflüsse der Ernährung auf Inzidenz und Verlauf der MS sind nicht bewiesen; Hinweise auf günstige Auswirkungen ungesättigter Fettsäuren auf den Krankheitsverlauf der MS existieren jedoch durchaus. In mehreren Therapiestudien konnte andererseits kein Vorteil von ungesättigten Fettsäuren nachgewiesen werden. Die langfristige Einnahme von Vitamin D ist mit einem geringeren Erkrankungsrisiko assoziiert. Für eine nach Krankheitsbeginn einsetzende Therapie mit Vitamin D gibt es noch keine ausreichende Basis. Wegen der hohen Prävalenz von Osteoporose bei MS-Patienten ist die Indikation zur Prävention mit Vitamin D und Calcium großzügig zu stellen. Spekulativ ist die günstige Wirkung einer zusätzlichen Zufuhr diverser Mineralstoffe, Selen, Antioxidanzien, Fischöle oder Vitamine. Cannabinoide werden von vielen Patienten mit MS zur Unterdrückung von Spastik, Ataxie oder Schmerzen angewendet. Kleine Fallserien deuten günstige Effekte von Cannabinoiden auf diese Symptome an. Kontrollierte Studien fanden dagegen keinen positiven Effekt auf die Spastik. Viele Patienten geben eine subjektive Symptombesserung unter Cannabinoiden an, auch wenn objektive Parameter unverändert bleiben. Die hyperbare Oxygenation zeigte in mehreren kleinen Studien heterogene Ergebnisse und kann insgesamt nicht allgemein empfohlen werden. Physikalische Therapieverfahren führen zu einer kurzfristigen Symptomverbesserung; die Langzeiteffekte sind unklar.

Abstract

Most MS patients use unconventional therapies, usually as complementary measures in addition to the conventional treatment. Only a few adequate clinical trials exist in this field. By definition, the efficacy of these therapies is unproven. Moreover, the possible risks are also largely unknown. Some therapies rely on rational pathophysiological considerations, other must be regarded as potentially harmful. The influence of diet on MS is unproven. Possibly, unsaturated fatty acids are beneficial. However, a few randomized trials yielded inconclusive results. Long-term supplementation of Vitamin D is associated with a decreased MS incidence. There is, however, insufficient evidence for an influence of Vitamin D on the course of the disease. Because of the high prevalence of osteoporosis in MS patients, prophylaxis with Vitamin D and Calcium is widely accepted. The effects of various minerals, selenium, antioxidant compounds, fish oil or vitamins remain speculative. Many patients use cannabis to alleviate spasticity and pain. Small series indicated positive effects, but randomized trials were negative for spasticity. However, many patients report subjective improvement under cannabis even if their objective parameters remain unchanged. Hyperbaric oxygenation was the subject of several small studies with heterogeneous results which, overall, do not support its use. Generally, physical therapies are perceived as an established therapy for MS. Short-term effects are probable, whereas the possible favourable long-term effects are unclear.

Literatur

  • 1 Filippini G, Brusaferri F, Sibley W A, Citterio A, Ciucci G, Midgard R, Candelise L. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev 2000 CD001331
    Google Scholar
  • 2 Calabresi P A. Considerations in the treatment of relapsing-remitting multiple sclerosis.  Neurology. 2002;  58 10-22
    PubMedGoogle Scholar
  • 3 Filippini G, Munari L, Incorvaia B, Ebers G C, Polman C, D'Amico R, Rice G P. Interferons in relapsing remitting multiple sclerosis: a systematic review.  Lancet. 2003;  361 545-552
    CrossrefPubMedGoogle Scholar
  • 4 Shakespeare D, Boggild M, Young C. Anti-spasticity agents for multiple sclerosis.  Cochrane Database Syst Rev. 2003;  4 CD001332
    PubMedGoogle Scholar
  • 5 Zollman C, Vickers A. What is complementary medicine?.  Bmj. 1999;  319 693-696
    PubMedGoogle Scholar
  • 6 Multiple Sklerose Therapie Konsensus Gruppe (MSTKG) . Symptomatische Therapie der Multiplen Sklerose.  Nervenarzt. 2004;  75 [suppl1] 2-39
    PubMedGoogle Scholar
  • 7 Schmidt K, Jacobs P A, Barton A. Cross-cultural differences in GPs' attitudes towards complementary and alternative medicine: a survey comparing regions of the UK and Germany.  Complement Ther Med. 2002;  10 141-147
    CrossrefPubMedGoogle Scholar
  • 8 The Cochrane library .Updated Software, Issue I. Oxford: The Cochrane Library 1999
    Google Scholar
  • 9 Eisenberg D M, Davis R B, Ettner S L, Appel S, Wilkey S, Rompay M Van, Kessler R C. Trends in alternative medicine use in the United States, 1990 - 1997: results of a follow-up national survey.  Jama. 1998;  280 1569-1575
    CrossrefPubMedGoogle Scholar
  • 10 Marrie R A, Hadjimichael O, Vollmer T. Predictors of alternative medicine use by multiple sclerosis patients.  Mult Scler. 2003;  9 461-466
    CrossrefPubMedGoogle Scholar
  • 11 Nayak S, Matheis R J, Schoenberger N E, Shiflett S C. Use of unconventional therapies by individuals with multiple sclerosis.  Clin Rehabil. 2003;  17 181-191
    CrossrefPubMedGoogle Scholar
  • 12 Schwartz C E, Laitin E, Brotman S, LaRocca N. Utilization of unconventional treatments by persons with MS: is it alternative or complementary?.  Neurology. 1999;  52 626-629
    CrossrefPubMedGoogle Scholar
  • 13 Page S A, Verhoef M J, Stebbins R A, Metz L M, Levy J C. The use of complementary and alternative therapies by people with multiple sclerosis.  Chronic Dis Can. 2003;  24 75-79
    PubMedGoogle Scholar
  • 14 Winterholler M, Erbguth F, Neundörfer B. Verwendung paramedizinischer Verfahren durch MS-Patienten - Patientencharakterisierung und Anwendungsgewohnheiten.  Fortschr Neurol Psychiatr. 1997;  65 555-561
    PubMedGoogle Scholar
  • 15 Ploeg H M van der, Molenaar M J, Tiggelen C W van. Use of alternative treatments by patients with multiple sclerosis.  Ned Tijdschr Geneeskd. 1994;  138 296-299
    PubMedGoogle Scholar
  • 16 Pucci E, Cartechini E, Taus C, Giuliani G. Why physicians need to look more closely at the use of complementary and alternative medicine by multiple sclerosis patients.  Eur J Neurol. 2004;  11 263-267
    CrossrefPubMedGoogle Scholar
  • 17 Fisher A A, Couteur D G Le. Lead poisoning from complementary and alternative medicine in multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2000;  69 687-689
    CrossrefPubMedGoogle Scholar
  • 18 Winterholler M. Durch den Dschungel der alternativen Heilverfahren.  Aktiv (Zeitschrift der Deutschen Multiple Sklerose Gesellschaft DSMG) abrufbar unter http://www.dsmg.de. 1999;  183 188-110
    PubMedGoogle Scholar
  • 19 Seviton Online Shop .http://www.seviton.de/shop.html accessed 1.7.2004
  • 20 Göbel H H, Walther G, Meuth M. Fresh cell therapy followed by fatal coma.  J Neurol. 1986;  233 242-247
    PubMedGoogle Scholar
  • 21 Casetta I, Invernizzi M, Granieri E. Multiple sclerosis and dental amalgam: case-control study in Ferrara, Italy.  Neuroepidemiology. 2001;  20 134-137
    CrossrefPubMedGoogle Scholar
  • 22 Moreau T, Loudenot V. Dental amalgam and multiple sclerosis: what is the connection?.  Presse Med. 1999;  28 1378-1380
    PubMedGoogle Scholar
  • 23 Yip H K, Li D K, Yau D C. Dental amalgam and human health.  Int Dent J. 2003;  53 464-468
    PubMedGoogle Scholar
  • 24 Ernst E. Harmless Herbs? A review of the literature.  Am J Med. 1998;  104 170-178
    CrossrefPubMedGoogle Scholar
  • 25 Schwarz S, Knauth M, Schwab S, Walter-Sack I, Bonmann E, Storch-Hagenlocher B. Acute disseminated encephalomyelitis after parenteral therapy with herbal extracts: a report of two cases.  J Neurol Neurosurg Psychiatry. 2000;  69 516-518
    CrossrefPubMedGoogle Scholar
  • 26 Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial.  Arch Fam Med. 1998;  7 541-545
    CrossrefPubMedGoogle Scholar
  • 27 Grimm W, Muller H H. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections.  Am J Med. 1999;  106 138-143
    CrossrefPubMedGoogle Scholar
  • 28 Yale S H, Liu K. Echinacea pupurea therapy for the treatment of the common cold.  Arch Intern Med. 2004;  164 1237-1241
    CrossrefPubMedGoogle Scholar
  • 29 Barrett B P, Brown R L, Locken K, Maberry R, Bobula J A, D'Alessio D. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial.  Ann Intern Med. 2002;  137 939-946
    CrossrefPubMedGoogle Scholar
  • 30 Roesler J, Emmendorffer A, Steinmuller C, Luettig B, Wagner H, Lohmann Matthes M L. Application of purified polysaccharides from cell cultures of the plant Echinacea purpurea to test subjects mediates activation of the phagocyte system.  Int J Immunopharmacol. 1991;  13 931-941
    CrossrefPubMedGoogle Scholar
  • 31 Burger R A, Torres A R, Warren R P, Caldwell V D, Hughes B G. Echinacea-induced cytokine production by human macrophages.  Int J Immunopharmacol. 1997;  19 371-379
    CrossrefPubMedGoogle Scholar
  • 32 Lauer K. Diet and multiple sclerosis.  Neurology. 1997;  49 55-61
    PubMedGoogle Scholar
  • 33 Coo H, Aronson K J. A systematic review of several potential non-genetic risk factors for multiple sclerosis.  Neuroepidemiology. 2004;  23 1-12
    CrossrefPubMedGoogle Scholar
  • 34 Calder P C. Dietary fatty acids and the immune system.  Lipids. 1999;  34 Suppl 137-140
    PubMedGoogle Scholar
  • 35 Harbige L S. Dietary n-6 and n-3 fatty acids in immunity and autoimmune disease.  Proc Nutr Soc. 1998;  57 555-562
    CrossrefPubMedGoogle Scholar
  • 36 Harbige L S. Fatty acids, the immune response, and autoimmunity: a question of n-6 essentiality and the balance between n-6 and n-3.  Lipids. 2003;  38 323-341
    CrossrefPubMedGoogle Scholar
  • 37 Calder P C. Polyunsaturated fatty acids, inflammation, and immunity.  Lipids. 2001;  36 1007-1024
    CrossrefPubMedGoogle Scholar
  • 38 Clausen J, Moller J. Allergic encephalomyelitis induced by brain antigen after deficiency in polyunsaturated fatty acids during myelination. Is multiple sclerosis a nutritive disorder?.  Acta Neurol Scand. 1967;  43 375-388
    PubMedGoogle Scholar
  • 39 Clausen J, Moller J. Experimental allergic encephalomyelitis provoked in rats after developmental lack of polyunsaturated tally acids.  Acta Neurol Scand. 1967;  43 Suppl 31-74
    PubMedGoogle Scholar
  • 40 Meade C J, Mertin J, Sheena J, Hunt R. Reduction by linoleic acid of the severity of experimental allergic encephalomyelitis in the guinea pig.  J Neurol Sci. 1978;  35 291-308
    CrossrefPubMedGoogle Scholar
  • 41 Harbige L S, Layward L, Morris-Downes M M, Dumonde D C, Amor S. The protective effects of omega-6 fatty acids in experimental autoimmune encephalomyelitis (EAE) in relation to transforming growth factor-beta 1 (TGF-beta1) up-regulation and increased prostaglandin E2 (PGE2) production.  Clin Exp Immunol. 2000;  122 445-452
    CrossrefPubMedGoogle Scholar
  • 42 Harbige L S, Yeatman N, Amor S, Crawford M A. Prevention of experimental autoimmune encephalomyelitis in Lewis rats by a novel fungal source of gamma-linolenic acid.  Br J Nutr. 1995;  74 701-715
    PubMedGoogle Scholar
  • 43 Bates D, Fawcett P R, Shaw D A, Weightman D. Polyunsaturated fatty acids in treatment of acute remitting multiple sclerosis.  Br Med J. 1978;  2 1390-1391
    PubMedGoogle Scholar
  • 44 Millar J H, Zilkha K J, Langman M J, Wright H P, Smith A D, Belin J, Thompson R H. Double-blind trial of linoleate supplementation of the diet in multiple sclerosis.  Br Med J. 1973;  1 765-768
    CrossrefPubMedGoogle Scholar
  • 45 Paty D W, Cousin H K, Read S, Adlakha K. Linoleic acid in multiple sclerosis: failure to show any therapeutic benefit.  Acta Neurol Scand. 1978;  58 53-58
    PubMedGoogle Scholar
  • 46 Dworkin R H, Bates D, Millar J H, Paty D W. Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials.  Neurology. 1984;  34 1441-1445
    PubMedGoogle Scholar
  • 47 Gibson R A, Lines D R, Neumann M A. Gamma linolenic acid (GLA) content of encapsulated evening primrose oil products.  Lipids. 1992;  27 82-84
    PubMedGoogle Scholar
  • 48 Kris-Etherton P M, Harris W S, Appel L J. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.  Circulation. 2002;  106 2747-2757
    CrossrefPubMedGoogle Scholar
  • 49 Albert C M, Campos H, Stampfer M J, Ridker P M, Manson J E, Willett W C, Ma J. Blood levels of long-chain n-3 fatty acids and the risk of sudden death.  N Engl J Med. 2002;  346 1113-1118
    CrossrefPubMedGoogle Scholar
  • 50 Marchioli R, Barzi F, Bomba E, Chieffo C, Gregorio D di, Mascio R di, Franzosi M G, Geraci E, Levantesi G, Maggioni A P, Mantini L, Marfisi R M, Mastrogiuseppe G, Mininni N, Nicolosi G L, Santini M, Schweiger C, Tavazzi L, Tognoni G, Tucci C, Valagussa F. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione.  Circulation. 2002;  105 1897-1903
    CrossrefPubMedGoogle Scholar
  • 51 Simopoulos A P. Omega-3 fatty acids in inflammation and autoimmune diseases.  J Am Coll Nutr. 2002;  21 495-505
    PubMedGoogle Scholar
  • 52 Zhang S M, Willett W C, Hernan M A, Olek M J, Ascherio A. Dietary fat in relation to risk of multiple sclerosis among two large cohorts of women.  Am J Epidemiol. 2000;  152 1056-1064
    CrossrefPubMedGoogle Scholar
  • 53 Nordvik I, Myhr K M, Nyland H, Bjerve K S. Effect of dietary advice and n-3 supplementation in newly diagnosed MS patients.  Acta Neurol Scand. 2000;  102 143-149
    CrossrefPubMedGoogle Scholar
  • 54 Goldberg P, Fleming M C, Picard E H. Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D.  Med Hypotheses. 1986;  21 193-200
    PubMedGoogle Scholar
  • 55 Bates D, Cartlidge N E, French J M, Jackson M J, Nightingale S, Shaw D A, Smith S, Woo E, Hawkins S A, Millar J H. et al . A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis.  J Neurol Neurosurg Psychiatry. 1989;  52 18-22
    PubMedGoogle Scholar
  • 56 Weinstock-Guttmann B, Baier M, LeeKwen P, Feichter J, Dinehart S, Venkatraman J, Meksawan K, Rensel M, Bochiechio P, Brownscheidle C, Munschauer F, Rudick G. A randomized study of low-fat diet with omega-3 fatty acid supplementation in patients with relapsing-remitting multiple sclerosis (RRMS).  Neurology. 2002;  58 A461-A462
    PubMedGoogle Scholar
  • 57 Deutsche Gesellschaft für Ernährung (DGE) .Tips der Deutschen Gesellschaft für Ernährung e. V. zur Ernährung bei Multipler Sklerose. http://www.dge.de/Pages/navigation/presse/akt1099.htm, accessed 03.05.2004 1999
    Google Scholar
  • 58 Hayes C E, Nashold F E, Spach K M, Pedersen L B. The immunological functions of the vitamin D endocrine system.  Cell Mol Biol. 2003;  49 277-300
    PubMedGoogle Scholar
  • 59 Etten E van, Branisteanu D D, Verstuyf A, Waer M, Bouillon R, Mathieu C. Analogs of 1,25-dihydroxyvitamin D3 as dose-reducing agents for classical immunosuppressants.  Transplantation. 2000;  69 1932-1942
    PubMedGoogle Scholar
  • 60 Cantorna M, Humpal-Winter J, DeLuca H. In vivo upregulation of interleukin-4 is one mechanism underlying the immunoregulatory effects of 1,25-dihydroxyvitamin D3.  Arch Biochem Biophys. 2000;  377 135-138
    CrossrefPubMedGoogle Scholar
  • 61 Cantorna M T, Hayes C E, DeLuca H F. 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis.  Proc Natl Acad Sci. 1996;  93 7861-7864
    CrossrefPubMedGoogle Scholar
  • 62 Nashold F E, Miller D J, Hayes C E. 1,25 dihydroxyvitamin D3 treatment decreases macrophage accumulation in the CNS of mice with experimental autoimmune encephalomyelitis.  J Neuroimmunol. 2000;  103 171-179
    CrossrefPubMedGoogle Scholar
  • 63 Munger K L, Zhang S M, O'Reilly E, Hernan M A, Olek M J, Willett W C, Ascherio A. Vitamin D intake and incidence of multiple sclerosis.  Neurology. 2004;  62 60-65
    CrossrefPubMedGoogle Scholar
  • 64 Fleming J O, Hummel A L, Beinlich B R, Borowski B J, Peebles T, Colburn M, Cook T D, Wendt G J, DeLuca H F. Vitamin D treatment of relapsing-remitting multiple sclerosis (RRMS): a MRI-based pilot study.  Neurology. 2000;  54 A338
    PubMedGoogle Scholar
  • 65 Smelzer S, Zimmerman V, Capriotti T. Osteoporosis risk factors and bone mineral densitiy in women with MS.  Int J MS Care. 2000;  4 17-29
    PubMedGoogle Scholar
  • 66 Herndon R, Mohandas N. Osteoporosis in multiple sclerosis : a frequent, serious, and under-recognized problem.  Int J MS Care. 2000;  2 5
    PubMedGoogle Scholar
  • 67 Nieves J, Cosman F, Herbert J, Shen V, Lindsay R. High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis.  Neurology. 1994;  44 1687-1692
    CrossrefPubMedGoogle Scholar
  • 68 Shabas D, Weinreb H. Preventive healthcare in women with multiple sclerosis.  J Womens Health Gend Based Med. 2000;  9 389-395
    CrossrefPubMedGoogle Scholar
  • 69 Sharts-Hopko N C, Sullivan M P. Beliefs, perceptions, and practices related to osteoporosis risk reduction among women with multiple sclerosis.  Rehabil Nurs. 2002;  27 232-236
    PubMedGoogle Scholar
  • 70 Cosman F, Nieves J, Komar L, Ferrer G, Herbert J, Formica C, Shen V, Lindsay R. Fracture history and bone loss in patients with MS.  Neurology. 1998;  51 1161-1165
    CrossrefPubMedGoogle Scholar
  • 71 Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.  Am J Clin Nutr. 1999;  69 842-856
    CrossrefPubMedGoogle Scholar
  • 72 O'Connor J S, Davis R L, Langworthy O R, Chow B F. B12 metabolism and multiple sclerosis.  Proc Soc Exp Biol Med. 1960;  103 180-183
    PubMedGoogle Scholar
  • 73 Simson G, Herfort A, Krim M, Meyer L M. Effects of vitamin B12 in multiple sclerosis.  Proc Soc Exp Biol Med. 1950;  75 721
    PubMedGoogle Scholar
  • 74 Sandyk R, Awerbuch G I. Vitamin B12 and its relationship to age of onset of multiple sclerosis.  Int J Neurosci. 1993;  71 93-99
    PubMedGoogle Scholar
  • 75 Ghezzi A, Zaffaroni M. Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis.  Neurol Sci. 2001;  22 Suppl 2 117-122
    CrossrefPubMedGoogle Scholar
  • 76 Reynolds E H. Multiple sclerosis and vitamin B12 metabolism.  J Neuroimmunol. 1992;  40 225-230
    CrossrefPubMedGoogle Scholar
  • 77 Simpson C A. Vitamin B12 Levels in the Serum and Cerebrospinal Fluid in Multiple Sclerosis.  J Neurol Neurosurg Psychiatry. 1964;  27 174-177
    PubMedGoogle Scholar
  • 78 Lauer K, Firnhaber W. An evaluation of laboratory investigations in patients with multiple sclerosis.  J Chronic Dis. 1986;  39 767-774
    CrossrefPubMedGoogle Scholar
  • 79 Reynolds E H, Linnell J C. Vitamin B12 deficiency, demyelination, and multiple sclerosis.  Lancet. 1987;  2 920
    PubMedGoogle Scholar
  • 80 Reynolds E H, Linnell J C, Faludy J E. Multiple sclerosis associated with vitamin B12 deficiency.  Arch Neurol. 1991;  48 808-811
    PubMedGoogle Scholar
  • 81 Goodkin D E, Jacobsen D W, Galvez N, Daughtry M, Secic M, Green R. Serum cobalamin deficiency is uncommon in multiple sclerosis.  Arch Neurol. 1994;  51 1110-1114
    PubMedGoogle Scholar
  • 82 Kira J, Tobimatsu S, Goto I. Vitamin B12 metabolism and massive-dose methyl vitamin B12 therapy in Japanese patients with multiple sclerosis.  Intern Med. 1994;  33 82-86
    PubMedGoogle Scholar
  • 83 Wade D T, Young C A, Chaudhuri K R, Davidson D L. A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the “Cari Loder regime”) in the treatment of multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2002;  73 246-249
    CrossrefPubMedGoogle Scholar
  • 84 Gilgun-Sherki Y, Melamed E, Offen D. The role of oxidative stress in the pathogenesis of multiple sclerosis: The need for effective antioxidant therapy.  J Neurol. 2004;  251 261-268
    CrossrefPubMedGoogle Scholar
  • 85 Wikstrom J, Westermarck T, Palo J. Selenium, vitamin E and copper in multiple sclerosis.  Acta Neurol Scand. 1976;  54 287-290
    PubMedGoogle Scholar
  • 86 Jensen G E, Gissel-Nielsen G, Clausen J. Leucocyte glutathione peroxidase activity and selenium level in multiple sclerosis.  J Neurol Sci. 1980;  48 61-67
    CrossrefPubMedGoogle Scholar
  • 87 Smith D K, Feldman E B, Feldman D S. Trace element status in multiple sclerosis.  Am J Clin Nutr. 1989;  50 136-140
    PubMedGoogle Scholar
  • 88 Mazzella G L, Sinforiani E, Savoldi F, Allegrini M, Lanzola E, Scelsi R. Blood cells glutathione peroxidase activity and selenium in multiple sclerosis.  Eur Neurol. 1983;  22 442-446
    PubMedGoogle Scholar
  • 89 Jensen C, Clausen J. Glutathione peroxidase activity, associated enzymes and substrates in blood cells from patients with multiple sclerosis - effects of antioxidant supplementation.  Acta Pharmacol Toxicol (Copenh). 1986;  59 450-453
    PubMedGoogle Scholar
  • 90 Jimenez-Jimenez F J, Bustos F de, Molina J A, Andres C de, Gasalla T, Orti-Pareja M, Zurdo M, Porta J, Castellano-Millan F, Arenas J, Enriquez de Salamanca R. Cerebrospinal fluid levels of alpha-tocopherol in patients with multiple sclerosis.  Neurosci Lett. 1998;  249 65-67
    CrossrefPubMedGoogle Scholar
  • 91 Zhang S M, Hernan M A, Olek M J, Spiegelman D, Willett W C, Ascherio A. Intakes of carotenoids, vitamin C, and vitamin E and MS risk among two large cohorts of women.  Neurology. 2001;  57 75-80
    PubMedGoogle Scholar
  • 92 Antonovsky A, Leibowitz U, Smith H A. Epidemiologic study of multiple sclerosis in Israel. I. An overall review of methods and findings.  Arch Neurol. 1965;  13 183-193
    CrossrefPubMedGoogle Scholar
  • 93 Berr C, Puel J, Clanet M, Ruidavets J B, Mas J L, Alperovitch A. Risk factors in multiple sclerosis: a population-based case-control study in Hautes-Pyrenees, France.  Acta Neurol Scand. 1989;  80 46-50
    PubMedGoogle Scholar
  • 94 Gusev E, Boiko A, Lauer K, Riise T, Deomina T. Environmental risk factors in MS: a case-control study in Moscow.  Acta Neurol Scand. 1996;  94 386-394
    PubMedGoogle Scholar
  • 95 Bowling A C, Stewart T M. Current Complementary and Alternative Therapies for Multiple Sclerosis.  Curr Treat Options Neurol. 2003;  5 55-68
    CrossrefPubMedGoogle Scholar
  • 96 Evers J. Die Evers-Diät. 13 ed. Stuttgart: Karl F. Haug 2002
    Google Scholar
  • 97 Fratzer U. Multiple Sklerose: Eine neue Therapie vor der Blut-Hirn-Schranke.  Vitaminspur. 1992;  3 142-147
    PubMedGoogle Scholar
  • 98 Hebener O. Fundamente der Hoffnung: Theorie und Therapie der Multiplen Sklerose. Heidelberg: Verlag Medizin und Gesundheit 1998
    Google Scholar
  • 99 Hebener O, Ackermann H, Kappel U, Kramer J. Empirische Untersuchungen zur Progressionsminderung der Multiplen Sklerose durch eine ergänzende bilanzierte Diät. Erfahrungsheilkunde. 2002: 676-681
    Google Scholar
  • 100 Swank R L, Bourdillon R B. Multiple sclerosis: assessment of treatment with a modified low-fat diet.  J Neurochem. 1960;  131 468-488
    PubMedGoogle Scholar
  • 101 Swank R L. Treatment of multiple sclerosis with a low-fat diet.  J Am Diet Assoc. 1960;  36 322-325
    PubMedGoogle Scholar
  • 102 Swank R L, Dugan B B. Effect of low saturated fat diet in early and late cases of multiple sclerosis.  Lancet. 1990;  336 37-39
    CrossrefPubMedGoogle Scholar
  • 103 Somerset M, Campbell R, Sharp D J, Peters T J. What do people with MS want and expect from health-care services?.  Health Expect. 2001;  4 29-37
    CrossrefPubMedGoogle Scholar
  • 104 Page S A, Verhoef M J, Stebbins R A, Metz L M, Levy J C. Cannabis use as described by people with multiple sclerosis.  Can J Neurol Sci. 2003;  30 201-205
    PubMedGoogle Scholar
  • 105 Clark A J, Ware M A, Yazer E, Murray T J, Lynch M E. Patterns of cannabis use among patients with multiple sclerosis.  Neurology. 2004;  62 2098-2100
    CrossrefPubMedGoogle Scholar
  • 106 Hall W, Solowij N. Adverse effects of cannabis.  Lancet. 1998;  352 1611
    CrossrefPubMedGoogle Scholar
  • 107 Killestein J, Hoogervorst E L, Reif M, Kalkers N F, Loenen A C Van, Staats P G, Gorter R W, Uitdehaag B M, Polman C H. Safety, tolerability, and efficacy of orally administered cannabinoids in MS.  Neurology. 2002;  58 1404-1407
    PubMedGoogle Scholar
  • 108 Tramèr M R, Carroll C, Campbell F A, Reynolds D J, Moore R A, McQuay H J. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review.  BMJ. 2001;  323 1-8
    CrossrefPubMedGoogle Scholar
  • 109 Johns A. Psychiatric effects of cannabis.  Br J Psychiatry. 2001;  178 116-122
    CrossrefPubMedGoogle Scholar
  • 110 Wirguin I, Mechoulam R, Breuer A, Schezen E, Weidenfeld J, Brenner T. Suppression of experimental autoimmune encephalomyelitis by cannabinoids.  Immunopharmacology. 1994;  28 209-214
    CrossrefPubMedGoogle Scholar
  • 111 Luthra Y K, Rosenkrantz H. Cannabinoids: neurochemical aspects after oral chronic administration to rats.  Toxicol Appl Pharmacol. 1974;  27 158-168
    CrossrefPubMedGoogle Scholar
  • 112 Pryce G, Ahmed Z, Hankey D J, Jackson S J, Croxford J L, Pocock J M, Ledent C, Petzold A, Thompson A J, Giovannoni G, Cuzner M L, Baker D. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis.  Brain. 2003;  126 2191-2202
    CrossrefPubMedGoogle Scholar
  • 113 Baker D, Pryce G, Croxford J L, Brown P, Pertwee R G, Huffman J W, Layward L. Cannabinoids control spasticity and tremor in a multiple sclerosis model.  Nature. 2000;  404 84-87
    CrossrefPubMedGoogle Scholar
  • 114 Lago E de, Ligresti A, Ortar G, Morera E, Cabranes A, Pryce G, Bifulco M, Baker D, Fernandez-Ruiz J, Marzo V Di. In vivo pharmacological actions of two novel inhibitors of anandamide cellular uptake.  Eur J Pharmacol. 2004;  484 249-257
    CrossrefPubMedGoogle Scholar
  • 115 Petro D J, Ellenberger C Jr. Treatment of human spasticity with delta 9-tetrahydrocannabinol.  J Clin Pharmacol. 1981;  21 413-416
    PubMedGoogle Scholar
  • 116 Brenneisen R, Egli A, Elsohly M A, Henn V, Spiess Y. The effect of orally and rectally administered delta 9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients.  Int J Clin Pharmacol Ther. 1996;  34 446-452
    PubMedGoogle Scholar
  • 117 Wade D T, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms.  Clin Rehabil. 2003;  17 21-29
    CrossrefPubMedGoogle Scholar
  • 118 Ungerleider J T, Andyrsiak T, Fairbanks L, Ellison G W, Myers L W. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis.  Adv Alcohol Subst Abuse. 1987;  7 39-50
    PubMedGoogle Scholar
  • 119 Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial.  Lancet. 2003;  362 1517-1526
    CrossrefPubMedGoogle Scholar
  • 120 Svendsen K B, Jensen T S, Bach F W. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial.  Bmj. 2004;  329 253
    CrossrefPubMedGoogle Scholar
  • 121 Notcutt W, Price M, Miller R, Newport S, Phillips C, Simmons S, Sansom C. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 "N of 1" studies.  Anaesthesia. 2004;  59 440-452
    CrossrefPubMedGoogle Scholar
  • 122 Meinck H M, Schonle P W, Conrad B. Effect of cannabinoids on spasticity and ataxia in multiple sclerosis.  J Neurol. 1989;  236 120-122
    PubMedGoogle Scholar
  • 123 Clifford D B. Tetrahydrocannabinol for tremor in multiple sclerosis.  Ann Neurol. 1983;  13 669-671
    CrossrefPubMedGoogle Scholar
  • 124 Fox P, Bain P G, Glickman S, Carroll C, Zajicek J. The effect of cannabis on tremor in patients with multiple sclerosis.  Neurology. 2004;  62 1105-1109
    PubMedGoogle Scholar
  • 125 James P B. Evidence for subacute fat embolism as the cause of multiple sclerosis.  Lancet. 1982;  1 380-386
    PubMedGoogle Scholar
  • 126 Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database Syst Rev 2004 CD003057
    Google Scholar
  • 127 Oriani G, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C. Long-term hyperbaric oxygen in multiple sclerosis: a placebo-controlled, double blind trial with evoked potential studies.  J Hyperbaric Med. 1990;  5 237-245
    PubMedGoogle Scholar
  • 128 Fischer B H, Marks M, Reich T. Hyperbaric-oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study.  N Engl J Med. 1983;  308 181-186
    PubMedGoogle Scholar
  • 129 Kleijnen J, Knipschild P. Hyperbaric oxygen for multiple sclerosis. Review of controlled trials.  Acta Neurol Scand. 1995;  91 330-334
    PubMedGoogle Scholar
  • 130 Neiman J, Nilsson B Y, Barr P O, Perrins D J. Hyperbaric oxygen in chronic progressive multiple sclerosis: visual evoked potentials and clinical effects.  J Neurol Neurosurg Psychiatry. 1985;  48 497-500
    PubMedGoogle Scholar
  • 131 Tibbles P M, Edelsberg J S. Hyperbaric-oxygen therapy.  N Engl J Med. 1996;  334 1642-1648
    CrossrefPubMedGoogle Scholar
  • 132 Fuller K J, Dawson K, Wiles C M. Physiotherapy in chronic MS: a controlled trial.  Clin Rehabil. 1996;  10 195-204
    PubMedGoogle Scholar
  • 133 Wiles C M, Newcombe R G, Fuller K J, Shaw S, Furnival-Doran J, Pickersgill T P, Morgan A. Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2001;  70 174-179
    CrossrefPubMedGoogle Scholar
  • 134 Petajan J H, Gappmaier E, White A T, Spencer M K, Mino L, Hicks R W. Impact of aerobic training on fitness and quality of life in multiple sclerosis.  Ann Neurol. 1996;  39 432-441
    CrossrefPubMedGoogle Scholar
  • 135 Freeman J A, Langdon D W, Hobart J C, Thompson A J. The impact of inpatient rehabilitation on progressive multiple sclerosis.  Ann Neurol. 1997;  42 236-244
    CrossrefPubMedGoogle Scholar
  • 136 Freeman J A, Langdon D W, Hobart J C, Thompson A J. Inpatient rehabilitation in multiple sclerosis: do the benefits carry over into the community?.  Neurology. 1999;  52 50-56
    PubMedGoogle Scholar
  • 137 Oken B S, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, Hugos C, Kraemer D F, Lawrence J, Mass M. Randomized controlled trial of yoga and exercise in multiple sclerosis.  Neurology. 2004;  62 2058-2064
    CrossrefPubMedGoogle Scholar
  • 138 Husted C, Pham L, Hekking A, Niederman R. Improving quality of life for people with chronic conditions: the example of t'ai chi and multiple sclerosis.  Altern Ther Health Med. 1999;  5 70-74
    PubMedGoogle Scholar
  • 139 Hernandez-Reif M, Field T, Field T, Theakston H. Multiple sclerosis patients benefit from massage therapy.  J Bodywork Movement Ther. 1998;  2 168-174
    PubMedGoogle Scholar
  • 140 Siev-Ner I, Gamus D, Lerner-Geva L, Achiron A. Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study.  Mult Scler. 2003;  9 356-361
    CrossrefPubMedGoogle Scholar
  • 141 Laufens G, Poltz W, Prinz E, Reimann G, Schmiegelt F. Alternierende Laufband-Vojta-Therapie bei stark gehbehinderten Patienten mit multipler Sklerose.  Phys Rehab Kur Med. 2004;  14 134-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 142 Laufens G, Poltz W, Prinz E, Reimann G, Schmiegelt F. Verbesserung der Lokomotion durch kombinierte Laufband-/Vojta-Physiotherapie bei ausgewählten MS-Patienten.  Phys Rehab Kur Med. 1999;  9 187-189
    PubMedGoogle Scholar
  • 143 Johnson S K, Frederick J, Kaufman M, Mountjoy B. A controlled investigation of bodywork in multiple sclerosis.  J Altern Complement Med. 1999;  5 237-243
    PubMedGoogle Scholar
  • 144 Schwartz C E, Fox B H. Who says yes? Identifying selection biases in a psychological intervention study of multiple sclerosis.  Soc Sci Med. 1995;  40 359-370
    CrossrefPubMedGoogle Scholar

PD Dr. med. Stefan Schwarz

Neurologische Universitätsklinik · Klinikum Mannheim der Universität Heidelberg

Theodor-Kutzer Ufer 1-3

68135 Mannheim

Email: s.schwarz@neuro.ma.uni-heidelberg.de

      >