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  • 1
    Electronic Resource
    Electronic Resource
    Intravenöse Immunglobuline in der Therapie der schubförmigen multiplen Sklerose Ein Update (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 361-365 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Multiple Sklerose ; Behandlung ; Intravenöse Immunglobuline ; Key words Multiple sclerosis ; Treatment ; Intravenous immunoglobulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Experimental studies and open clinical trials have suggested intravenous immunoglobulin (IVIg) as a potentially effective treatment of multiple sclerosis (MS). The Austrian Immunoglobulin in Multiple Sclerosis (AIMS) study tested this assumption by examining 148 patients with relapsing-remitting MS in a randomized, double-blind, placebo controlled fashion (75 IVIg, 73 placebo). Monthly administration of IVIg in a dosage of 0.15–0.20 g/kg over a period of 2 years slowed the progression of or even reversed disability as evident in a total of 24% of patients and almost halved the number of relapses in comparison to placebo treatment. Therapeutic efficacy was noted within the first 6 months of treatment and was not correlated to the severity of disability (mild neurological sins without disability to ambulatory with assistance) at study entry. Overall the magnitude of treatment effects of IVIg was comparable to that reported for beta-interferon and copolymer 1. Further ongoing studies will have to clarify the future role of IVIg in the treatment of MS, in particular in the progressive forms of the disease.
    Notes: Zusammenfassung Auf Grund experimenteller Untersuchungen sowie offener Studien wird seit langem die Möglichkeit einer therapeutischen Wirksamkeit von intravenösem Immunglobulin (IVIg) in der Behandlung der Multiplen Sklerose (MS) diskutiert. Die Austrian Immunoglobulin in Multiple Sclerosis (AIMS) Studie überprüfte diese Annahme nun erstmals in Form einer randomisierten, doppelblinden, placebokontrollierten Untersuchung an 148 Patienten mit schubförmiger MS (75 IVIg, 73 Placebo). Monatliche Verabreichung von IVIg in einer Dosierung von 0,15–0,2 g/kg über einen Zeitraum von 2 Jahren führte zu einem signifikant besseren Verlauf der Behinderung, der sich bei insgesamt 24% der Patienten niederschlug, und Krankheitsschübe traten fast nur halb so häufig auf wie unter Placebo. Ein Wirkungseintritt der Behandlung war bereits nach 6 Monaten zu beobachten und vom Schweregrad der Behinderung bei Studienbeginn (geringe neurologische Zeichen ohne Behinderung bis zu gehfähg mit Hilfe) weitgehend unbeeinflußt. Die Größenordnung der beobachteten Therapieeffekte war vergleichbar mit jener, die für Beta-Interferon und Copolymer 1 beschrieben worden ist. Weitere Studien sind bereits angelaufen, um den zukünftigen therapeutischen Stellenwert von IVIg insbesondere auch bei anderen Verlaufsformen der MS abzusichern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050284
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Cardiovascular autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance (1999)
    Springer
    Journal of neurology 246 (1999), S. 578-586 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Autonomic dysfunction ; Orthostatic intolerance ; Sympathetic nervous system ; Power spectrum analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Autonomic dysfunction is frequently observed in patients with multiple sclerosis (MS), but clinical studies disagree on the frequency and type of abnormalities in autonomic function tests. Orthostatic dizziness (OD) has been reported in up to 49% of patients, but the pathophysiological mechanisms are poorly understood. This study investigated cardiovascular reflex tests and their association with OD in patients with MS in order to examine the hypothesis that the sympathetic nervous system is specifically involved in these patients. Forty patients with clinically active relapsing-remitting (n = 27) and secondary progressive MS (n = 13), aged 35.0 ± 8.5 years, were studied by parasympathetic (heart rate responses to the Valsalva maneuver, deep breathing, and active change in posture) and sympathetic function tests (blood pressure responses to active change in posture and sustained handgrip), and by spectral analysis of heart rate variability during rest and during standing. Results were compared to those obtained in 24 healthy volunteers, aged 29.4 ± 7.2 years. A standardized questionnaire was used to evaluate symptoms of orthostatic intolerance. Abnormal responses on at least one cardiovascular reflex test were observed in 40% of MS patients, compared to 17% of the control group, with a statistically significant involvement of the sympathetic vasomotor system. Orthostatic intolerance was reported in 50% of patients (controls: 14%, P 〈 0.006). Subgroup comparison of patients with and without OD suggests that orthostatic intolerance results from impaired sympathetic vasoconstriction. These results provide further evidence that the sympathetic nervous system is involved in patients with MS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050407
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Physikalisches Trauma und multiple Sklerose (1997)
    Springer
    Der Nervenarzt 68 (1997), S. 940-944 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Multiple Sklerose ; Trauma ; Epidemiologie ; Assoziation ; Key words Multiple sclerosis ; Trauma ; Association
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Without a more detailed knowledge of etiology and pathogenesis of multiple sclerosis final conclusions regarding an association between physical trauma and the onset or course of multiple sclerosis cannot be drawn. Only a few prospective studies which are appropriately designed to prove a putative correlation have been published. A critical review of these studies and some case reports, in the light of the current pathophysiological concepts of multiple sclerosis, does not indicate a causal relationship between physical trauma and onset of multiple sclerosis or exacerbations.
    Notes: Zusammenfassung Ohne exaktere Kenntnisse der Ätiologie und Pathogenese der multiplen Sklerose können endgültige Aussagen über eine mögliche Assoziation zwischen physikalischen Traumata und Beginn und Verlauf der MS nicht getroffen werden. Nur wenige prospektive Studien, die methodisch geeignet sind, einen solchen Zusammenhang nachzuweisen, sind publiziert. Nach kritischer Wertung der vorliegenden Studien und Fallberichte ergibt sich vor dem Hintergrund des aktuellen pathophysiologischen Verständnisses der multiplen Sklerose kein Anhalt für einen kausalen Zusammenhang zwischen physikalischen Traumata und Entstehung einer multiplen Sklerose oder Auslösung von Krankheitsschüben.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050220
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Remyelinisierungsförderung als zukünftiges Therapieprinzip der Multiplen Sklerose? (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 841-850 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Multiple Sklerose ; Remyelinisierung ; Wachstumsfaktoren ; Transplantation ; Intravenöse Immunglobuline ; Key words Multiple sclerosis ; Remyelination ; Growth factors ; Transplantation ; Intravenous immunoglobulins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Multiple sclerosis (MS), the most common neurological autoimmune disorder diagnosed in young adults, is characterised by the repeated occurrence of demyelinating lesions within the central nervous system (CNS). Promotion of remyelination in the brain and spinal cord constitutes a potential strategy for therapeutic intervention in MS and other demyelinating diseases. Three different principles are known to promote remyelination in the CNS of different animal models: Application of growth factors, transplantation of myelin-forming cells and intravenous immunoglobulin (IVIg) therapy. However, the systemic application of growth factors could be limited by effects on unaffected tissue. For successful transplantation we still have the problem of homologous cells not tolerated by a immunological different organism. Currently the required combination of growth factors needed to cultivate human homologous cells is not known, so that cells suitable for transplantation are still not available. Nevertheless, there is increasing evidence for beneficial effects of IVIg therapy on the promotion of remyelination in humans. In this review we summarise recent findings on the regulation of myelin sheath development and oligodendrocyte differentiation, and discuss the presented strategies in the context of possible clinical application for the therapy of MS.
    Notes: Zusammenfassung Bei der multiplen Sklerose als chronisch demyelinisierender Erkrankung des Zentralnervensystems (ZNS) werden derzeit 3 Verfahren zur Remyelinisierungsförderung untersucht: Die Gabe von Wachstumsfaktoren, die Transplantation myelinbildender Zellen und die Applikation von intravenösen Immunglobulinen (IVIg). Im Tiermodell führen diese Prinzipien zu Remyelinisierungen in experimentell akut demyelinisierten Arealen des ZNS und verbessern z.T. die Leitfähigkeit der Axone. Die systemische Therapie mit Wachstumsfaktoren könnte v.a. durch Wirkungen auf gesunde Gewebe limitiert sein. Bei Transplantationen stellt sich das Problem der Immunogenität von homologen Zellen, da noch keine nicht immunogenen Zellinien zur Verfügung stehen. Auch ist die zur Kultivierung und Vermehrung von humanen Oligodendrozyten und deren Vorläuferzellen benötigte Kombination von Wachstumsfaktoren nicht bekannt. Beim Menschen gibt es wachsende Evidenzen für eine remyelinisierungsfördernde Potenz von IVIg. Zum Beweis dieser Wirkung sind weitere kontrollierte Studien nötig und werden momentan durchgeführt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050352
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    Paper (German National Licenses)
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