Multiple Sclerosis

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (brain and spinal cord). The immune system attacks the myelin sheaths (insulating layer) of the nerve fibers, leading to areas of inflammation (lesions). The disease usually appears between the ages of 20 and 40 and affects women more often than men.

Symptoms

The symptoms depend on which areas of the nervous system are affected:

  • Visual disturbances – optic neuritis with deteriorating vision and pain on eye movement
  • Sensory disturbances – tingling, numbness, abnormal sensations
  • Motor disturbances – muscle weakness, spasticity, gait disorders
  • Balance disorders and dizziness
  • Fatigue – pronounced, pathological exhaustion (one of the most common symptoms)
  • Bladder dysfunction – urinary urgency, incontinence
  • Cognitive disturbances – concentration and memory problems
  • Pain – neuropathic pain, trigeminal neuralgia
  • Lhermitte’s sign – electric-shock-like sensation when bending the head forward

Disease courses

  • Relapsing-remitting MS (RRMS) – most common form, relapses with complete or partial recovery
  • Secondary progressive MS (SPMS) – progressive worsening after an initially relapsing course
  • Primary progressive MS (PPMS) – slowly progressive from the outset without relapses

Causes

The exact cause is unknown. It involves an interplay of:

  • Autoimmune reaction – a misdirected immune response against the body’s own myelin
  • Genetic predisposition – increased risk in first-degree relatives
  • Environmental factors – vitamin D deficiency, smoking, EBV infection (Epstein-Barr virus)

Diagnostics

  • Detailed medical history – symptom progression, dissemination in time
  • Neurological examination – assessment of motor function, sensation, coordination, reflexes
  • EEG – for certain questions, e.g. ruling out epileptic seizures in MS
  • Evoked potentials (VEP, SSEP) – measurement of nerve conduction velocity in the central nervous system, detection of subclinical lesions
  • Lumbar puncture – detection of oligoclonal bands in the cerebrospinal fluid
  • Imaging – MRI of the brain and spinal cord (referral)
  • Laboratory tests – ruling out other causes (Lyme disease, vasculitis, vitamin B12 deficiency)

Treatment

Relapse therapy

  • High-dose cortisone pulse therapy (Methylprednisolone i.v.) over 3–5 days
  • If the response is insufficient: escalation with plasmapheresis (referral)

Disease-modifying therapy (immunotherapy)

Depending on the disease course and disease activity:

  • Basic therapy: Interferon-beta, Glatiramer acetate, Dimethyl fumarate, Teriflunomide
  • Escalation therapy: Natalizumab, Fingolimod, Ocrelizumab, Cladribine
  • The choice of therapy is made individually according to the guidelines of the DGN

Symptomatic therapy

  • Physiotherapy for spasticity and gait disorders
  • Drug treatment of spasticity (e.g. Baclofen, Tizanidine)
  • Treatment of fatigue, bladder disorders, pain
  • Occupational therapy and speech therapy as needed
  • Psychological support

Disease monitoring

  • Regular neurological examinations
  • Monitoring of immunotherapy (laboratory values, side effects)
  • Follow-up MRI monitoring (referral)

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Last updated: 2026-07-04