When I recently went through the comments, I came across the following lines from Sas. He/She wrote on 17.01.: “Often we, the severely affected, are simply forgotten and the doctors shrug their shoulders when they utter the word “austherapiert” for the first time. From this point on, you are completely on your own and have to decide for yourself how to proceed.”The word “austherapiert” has occupied me for a long time. How frustrating it must be to be perceived as a patient in this way – the phrase is really terrible. It’s more than understandable that one feels quite abandoned.
But of course, the public discussion mainly revolves around the treatment of early relapsing-remitting MS courses, where considerable progress has indeed been made in drug therapy in recent years. However, it is also clear that modern immunotherapy represents only one aspect of MS therapy – undoubtedly a very interesting and dynamic part, but also only one part.
I think we doctors, especially we neurologists, have much more to offer. Because MS therapy is not automatically equated with drug immunotherapy, but includes much more – specialized physiotherapy, sports and movement, symptomatic therapies of various body disorders and last but not least conversations – are forms of therapy that stand equally alongside immunotherapy and must be individually adapted – with the aim of improving the quality of life of our patients, regardless of the stage of the disease they are in. Therefore, an MS patient can never be “austherapiert”, one can always do something – and one should always do something.
However, one must acknowledge that when looking at different stages of MS, the therapeutic focus shifts. While in the early stages of the disease a lot revolves around inflammation control and thus around immune drugs, this strategy tends to take a back seat in those severely affected. On the contrary, it is often the case here that the benefit-risk assessment usually speaks against immunotherapy – but this does not by any means mean that one should speak of being “austherapiert” when treating a patient with advanced MS. In the later stages, strategies aimed at treating MS symptoms play an important role – and this is therapeutically a very demanding task, which should be devoted at least as much time and intensity as to immunotherapy.
An optimal symptomatic therapy can often only be achieved by trying out and frequent mutual feedback between doctor/therapist and patient. However, the cost carriers give us little leeway for this, both in outpatient care and in acute hospitals. One must clearly state that symptomatic therapy for MS is currently the domain of rehabilitation clinics. Therefore, I always recommend demanding and using this possibility intensively – but of course, it has to be a clinic where both doctors and therapists are familiar with MS.
In addition, it is always astonishing what can be achieved with physiotherapy and regular movement, especially when such therapies lead to “real” social contacts with like-minded people. We recently conducted a study on the effect of hippotherapy on advanced MS and it was astonishing to see how much this group of patients benefited from the measure – especially in terms of mental strength at the end of the intervention. Of course, the thing with the horses was great, but I am quite sure that this effect could also have been achieved by rowing, climbing or chair yoga together. I believe it is crucial that we integrate and communicate the importance and appreciation of such interventions much more firmly into our concept of MS therapy – I think then such “austherapiert” statements will hopefully become increasingly rare.
Many thanks to Sas – and best regards to the readers
