The Kliniken Schmieder Konstanz and Gailingen are recognized as MS rehabilitation centers by the German Multiple Sclerosis Society. Prof. Dr. Christian Dettmers is the head of this medical specialty in our hospital and has researched this disease for many years. He reports on new treatment and therapy approaches as well as current developments.
Prof. Dettmers, can you please outline the current treatment options for MS?
Dettmers: The three basic treatment levels in MS include relapse, immune-modulating or course-modifying, and symptomatic treatment. We are pleased that there is now an immune modulation for primary MS. Since last year – for secondary MS also. For both drugs – ocrelizumab and siponimod – the question arises as to which patients can benefit from them. Patients who may benefit most clearly are those who have not been diagnosed with disease progression for long, are rather young, and may still show contrast-enhancing foci in the MRI.
Rethinking the current immune modulation or questioning it from an outside perspective is sometimes a concern of patients in rehabilitation. But it is usually not the main reason for the rehabilitation and is usually ultimately decided and implemented by the neurologists in charge.
The situation is similar with the frequent topic of the extent to which medication can influence symptoms. As part of inpatient treatment, it is often easy to try out whether or to what extent spasticity reacts to medication or to what extent a gait disorder can be improved as a result. Similarly, drug treatment attempts can be made for discomfort and pain. Any existing bladder disorders can be addressed and also treated. In the case of bladder disorders in particular, there is often a great deal of uncertainty as to whether this is conspicuous or not, and, above all, there are very good chances of alleviating this with an attempt at treatment. This also includes a detailed consultation with our urotherapeutic nurse.
What is the central concern in the rehabilitation of patients with MS?
Dettmers: The rehabilitation goals can be as different according to MS manifestation. It is beneficial if patients specify rehabilitation goals as specifically as possible or can develop them together with the treating physicians and therapists: Where is my greatest suffering? What do you think should change? It is good if the patient thinks about this in advance, possibly talking to their relatives or neurologist. The more specific the goal can be stated, the more successfully you can work on the goal in rehabilitation.
The goals can be in the area of hand motor skills, in the area of balance or gait endurance, in the area of attention and memory, or the area of fluent speech. It is often a question of maintaining or restoring the ability to work. Sometimes there are depressive symptoms, or it is difficult to accept the illness.
For many patients, physical and psychological complaints come together. Treating both sides is equally important. This is of particular concern to us, and we are particularly qualified for this: We have two departments in-house that take care of patients with MS with equal competence: the neurological department and the psychotherapeutic department. As far as necessary, both departments contribute their share to the recovery. If there are physical complaints, the focus is often on training balance, strength, endurance, hand function, or thinking/cognition. If the psychological stress caused by the illness is in the foreground, conversations can help under certain circumstances.
The central concern is that the patients can cope with their symptoms and the disease. We want to enable them to live their lives despite a chronic illness. This also includes information, training on various MS-specific topics, social counseling, and exchange with fellow patients.
What is happening in research concerning fatigue syndrome (quick fatigue)?
Dettmers: The now common distinction between fatigue and fatigability is helpful. Fatigue represents the subjective perception of the extent of exhaustion and tiredness, as can often be recorded with questionnaires. Fatigue represents the change in feasibility (performance). It is an organic phenomenon due to impaired nerve conduction. It could be likened to an electrical wire overheating. The nerve cells and the brain don’t work properly anymore. For example, controlling one leg can become increasingly difficult after walking a long distance. Spasticity, foot lifting weakness, or unsteady gait can increase. It is important to realize that both sides often come together in MS: mental and psychological exhaustion and impairment of neuronal conductivity.
As a patient with MS, do you have to fear that the nervous system will be damaged by overexertion due to fatigue? Should you be more careful and avoid exertion?
Dettmers: It is important to realize that exertion cannot damage the nervous system. On the contrary, it is generally recommended that regular physical training be carried out to reduce fatigue. Of course, it’s difficult to be physically active in the evenings when you’re working and struggling with fatigue. Rehabilitation should offer an opportunity to address this and find ways and means of sustaining and promoting one’s health even after rehabilitation.
How will rehabilitation change in the future?
Dettmers: One of the greatest challenges in rehabilitation is making the transfer to everyday life as successful as possible, i.e., achieving a lasting effect. Here, the Kliniken Schmieder are also planning to use digital technologies to continue the training measures and exercises learned at home after discharge. We are excited about this development, which will offer many additional opportunities.