Alternative und komplementäre Therapien der Multiplen Sklerose

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.

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