Multiple Sklerose – Diagnose und Behandlung neuropsychologischer Störungen

M. Paulig

doi:10.1055/s-0038-1630031

Nervenheilkunde, Table of Contents

Nervenheilkunde 2005; 24(10): 908-912
DOI: 10.1055/s-0038-1630031

Original Article

Schattauer GmbH

Multiple Sklerose – Diagnose und Behandlung neuropsychologischer Störungen

Multiple sclerosis – diagnosis and treatment of neuropsychological symptoms

M. Paulig

¹Neurologisches Krankenhaus München

› Author Affiliations

Abstract

Zusammenfassung

Neuropsychologische Symptome sind in frühen Krankheitsstadien ein häufiges Phänomen bei Patienten mit einer Multiplen Sklerose und stellen eine Herausforderung für die Therapie dar. Die kognitiven Defizite sind oft klinisch subtil und sie korrelieren nicht mit der physischen Behinderung. Sie benötigen deshalb spezielle diagnostische Aufmerksamkeit einschließlich psychometrischer Testverfahren. Die Einschätzung der Symptome kann schwierig sein, da eine hohe Komorbidität mit Fatigue und Depression besteht, was zu wechselseitiger Beeinflussung der Phänomenologie führen kann. Neuropsychologische Rehabilitationsverfahren einschließlich computergestütztem Training sind empirisch hilfreich. Allerdings ist die Untermauerung durch Studiendaten gegenwärtig spärlich. Symptomorientierte pharmakologische und nicht-pharmakologische (z.B. Psychotherapie) Behandlungsmöglichkeiten bestehen für begleitende depressive Störungen und Fatigue. Die Behandlung mit Immunmodulatoren hat wahrscheinlich einen günstigen Einfluss auf den Verlauf kognitiver Defizite, wenn es auch hierzu nur wenige Daten gibt.

Summary

Neuropsychological symptoms are highly prevalent and a challenge for therapy in patients with multiple sclerosis, even in early stages of the disease. Cognitive deficits are often clinically subtle and they are not correlated with physical impairment. Therefore they need a separate diagnostic attention including psychometric testing. The assessment of syndromes may be difficult since there is a high comorbidity of cognitive disorders with fatigue and depression that reciprocally influence and modify the symptomatology. Neuropsychological rehabilitation including computer assisted cognitive training is empirically helpful however there is currently only a paucity of supporting data from studies. Symptomatic pharmacological and nonpharmacological (e.g. psychotherapy) options exist for the treatment of concomitant depression and fatigue. Immunomodulatory treatment is probably favourable for the course of neuropsychological deficits however this is only confirmed in a few studies.

Schlüsselwörter

Multiple Sklerose - Neuropsychologie - Kognition

Keywords

Multiple sclerosis - neuropsychology - cognition

Full Text

References

Literatur
1 Abb L, Schaltenbrand G. Statistische Untersuchungen zum Problem der Multiplen Sklerose. II. Mitteilung: Das Krankheitsbild der Multiplen Sklerose. Dtsch Z Nervenheilk 1956; 174: 199-218.
2 Achiron A, Barak Y. Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry 2003; 74: 443-6.
3 Allen DN, Goldstein G, Heyman RA, Rondinelli T. Teaching memory strategies to persons with multiple sclerosis. J Rehabil Res Dev 1998; 35: 405-10.
4 Benedict RH, Carone DA, Bakshi R. Correlating brain atrophy with cognitive dysfunction, mood disturbances, and personality disorder in multiple Sclerosis. J Neuroimaging 2004; 14 (Suppl. 03) 36S-45S.
5 Benedict RH, Weinstock-Guttman B, Fishman I, Sharma J, Tjoa CW, Bakshi R. Prediction of neuropsychological impairment in multiple sclerosis: comparison of conventional magnetic resonance imaging measures of atrophy and lesion burden. Arch Neurol 2004; 61: 226-30.
6 Bequet D, Taillia H, Clervoy P, Renard JL, Flocard F. Psychological and neuropsychological problems in multiple sclerosis. Bull Acad Natl Med 2003; 187: 683-94.
7 Berger A. Eine Statistik über 206 Fälle von multipler Sklerose. Jb Psychiat 1905; 25: 168-88.
8 Calabrese P. Neuropsychologische Defizite bei entzündlichen Erkrankungen des ZNS. In: Sturm W, Herrmann M, Wallesch C-W. (Hrsg) Lehrbuch der klinischen Neuropsychologie. Swets & Zeitlinger Publishers; 2000: 559-70.
9 Calabrese P. Neuropsychologie der mulitplen Sklerose. Akt Neurol 2002; 29 (Suppl. 03) S253-S257.
10 Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 2002; 159: 1862-8.
11 Demaree H, DeLuca J, Gaudino EA, Diamond BJ. Speed of information processing as a key deficit in multiple sclerosis: implications for rehabilitation. J Neurol Neurosurg Psychiatry 1999; 67: 661-3.
12 DeSousa EA, Albert RH, Kalman B. Cognitive impairments in multiple sclerosis: a review. AM J Alzheimers Dis Other Demen 2002; 17: 23-9.
13 Fischer JS, Priore RL, Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, Goodkin DE, Granger CV, Simon JH, Grafman JH, Lezak MD, O’Reilly Hovey KM, Perkins KK, Barilla-Clark D, Schacter M, Shucard DW, Davidson AL, Wende KE, Bourdette DN, Kooijmans-Coutinho MF. Neuropsychological effects of interferon beta-1a in relapsing multiple sclerosis. Multiple Sclerosis Collaborative Research Group. Ann Neurol 2000; 48: 885-92.
14 Fraser C, Stark S. Cognitive symptoms and correlates of physical disability in individuals with multiple sclerosis. J Neurosci Nurs 2003; 35: 314-20.
15 Haase CG, Tinnefeld M, Daum I, Ganz RE, Hauprs M, Faustmann PM. Cognitive, but not mood dysfunction develops in multiple sclerosis during 7 years follow up. Eur Neurol 2004; 52: 92-5.
16 Krupp L, Coyle P, Dosche C, Miller A, Cross AH, Jandorf L, Halper J, Johnson B, Morgante L, Grimson R. Fatigue therapy in multiple sclerosis: results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology 1995; 45: 1956-61.
17 Lyon-Caen O, Jouvent R, Hauser S, Chaunu MP, Benoit N, Widlocher D, Lhermitte F. Cognitive function in recent-onset demyelinating diseases. Arch Neurol 1986; 43: 1138-41.
18 Metz LM, Patten SB, Archibald CJ, Bakker JI, Harris CJ, Patry DG, Bell RB, Young M, Mruphy WF, Stoian CA, Billesberger K, Tillotson I, Peters S, McGowan D. The effect of immunmodulatory treatment on multiple sclerosis fatigue. J Neurol Neurosurg Psychiatry 2004; 75: 1045-7.
19 Piras MR, Magnano I, Canu EDG, Paulus KS, Satta WM, Soddu A, Conti M, Achene A, Solinas G, Aiello I. Longitudinal study of cognitive dysfunction in multiple sclerosis: neurosychological, neuroradiological, and neurophysiological findings. J Neurol Neurosurg Psychiatry 2003; 74: 878-85.
20 Pliskin NH, Hamer DP, Goldstein DS, Towle VL, Reder AT, Noronha A, Arnason BG. Improved delayed visual reproduction test performance in multiple sclerosis patients receiving interferon beta- 1b. Neurology 1996; 47: 1463-8.
21 Plohmann AM, Kappos L, Ammann W, Thordai A, Wittwer A, Huber S, Bellaiche Y, Lechner-Scott J. Computer assisted retraining of attentional impairments in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 1998; 64: 455-62.
22 Poser S, Ritter G. Multiple Sklerose in Forschung, Klinik und Praxis. Stuttgart: Schattauer; 1980
23 Prosiegel M, Michael C. Neuropsychology and multiple sclerosis: diagnostic and rehabilitative approaches. J Neurol Sci 1993; 155 (suppl): 51-4.
24 Rammohan KW, Rosenberg JH, Lynn DJ, Blumenfeld AM, Pollak CP, Nagaraja HN. Efficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. J Neurol Neurosurg Psychiatry 2002; 72: 179-83.
25 Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 1991; 41: 685-91.
26 Rao SM. Neuropsychology of multiple sclerosis. Curr Opin Neurol 1995; 8: 216-20.
27 Rudick RA, Cutter G, Reingold S. The multiple sclerosis functional composite: a new clinical outcome measure for multiple sclerosis trials. Mult Scler 2002; 8: 359-65.
28 Ruggieri RM, Palermo R, Vitello G, Gennuso M, Settipani N, Piccoli F. Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS < or = 3.5. Acta Neurol Scand 2003; 108: 323-6.
29 Ruiz-Pena JL, Pinero P, Sellers G, Argente J, Casado A, Foronda J, Ucles AN, Izquierdo G. Magnetic resonance spectroscopy of normal appearing white matter in early relapsing-remitting multiple sclerosis: correlations between disability and spectroscopy. BMC Neurology 2004; 4: 8 (published online)
30 Sabatini U, Pozzilli C, Pantano P, Koudriavtseva T, Padovani A, Millefiorini E, Di Biasi C, Gualdi GF, Salvetti M, Lenzi GL. Involvement of the limbic system in multiple sclerosis patients with depressive disorders. Biol Psychiatry 1996; 39: 970-5.
31 Seiffer W. Über psychische, insbesondere Intelligenzstörungen bei multipler Sklerose. Arch Psychiat Nervenkr 1905; 40: 252-303.
32 Sfagos C, Papageorgiou CC, Kosma KK, Kodopadelis E, Uzunoglu NK, Vassilopoulos D, Rabavilas AD. Working memory deficits in multiple sclerosis: a controlled study with auditory P600 correlates. J Neurol Neurosurg Psychiatry 2002; 74: 1231-5.
33 Skegg K. Mutiple sclerosis presenting as a pure psychiatric disorder. Psychol Med 1993; 23: 909-14.
34 Solari A, Motta A, Mendozzi L, Pucci E, Forni M, Mancardi G, Pozzilli C. Computer-aided retraining of memory and attention in people with multiple sclerosis a randomized, double-blind controlled trial. J Neurol Sci 2004; 222: 99-104.
35 Staffen W, Mair A, Zauner H, Unterrainer J, Niederhofer H, Kutzelnigg A, Ritter S, Golaszewski S, Iglseder B, Ladurner G. Cognitive function aqnd fMRI in patients with multiple sclerosis: evidenc für compensatory cortical activation during an attention task. Brain 2002; 125: 1275-82.
36 Zarei M, Chandran S, Compston A, Hodges J. Cognitive presentation of multiple sclerosis: evidence for a cortical variant. J Neurol Neurosurg Psychiatry 2003; 74: 872-7.
37 Zimmermann C, Hohlfeld R. „Fatigue“ bei Multipler Sklerose. Nervenarzt 1999; 70: 566-74.
38 Zivadinov R, Sepcic J, Nasuelli D, De Masi R, Bragadin LM, Tommasi MA, Zambito-Marsala S, Moretti R, Bratina A, Ukmar M, Pozzi-Mucelli RS, Grop A, Cazzato G, Zorzon M. A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2001; 70: 773-80.