Multiple Sclerosis
Psychoneuroimmunology of MS
Since its first description psychological stress has been considered a trigger factor for exacerbations but until recently the clinical evidence for a causal relation was week. A recent metaanalysis (Mohr et al., 2004) confirmed the epidemiological evidence. Studies concentrate on the regulation of the immune-endocrine system in MS as f.e. Endocrine and immune reaction to a short-time psychological stress in MS and controls, correlations of dexamethasone-supopression-tests with disease-course, neuropsychological deficits, fatigue syndrome in MS. Functional prolactin tests in MS disease courses. Influence of ß-mimetics on TH-1/TH-2cytokine profiles in MS.
- Heesen C, Gold S, Raji A, Schulz KH, Wiedemann K (2002) Cognitive impairment correlates with hypothalamo-pituitary-adrenal axis dysregulation in multiple sclerosis. Psychoneuroendocrinology 27, 505-517.
- Heesen C, Schulz H, Schmidt M, Gold S, Tessmer W, Schulz KH (2002) Endocrine and cytokine responses to acute psychological stress in multiple sclerosis. Brain Behaviour and Immunity 16(3), 282-287.
- Heesen C, Gold SM, Bruhn M, Mönch A,. Schulz KH (2002) Prolactin stimulation in multiple sclerosis – an indicator of disease subtypes and activity? Endocr. Res. 28, 9-18.
- Heesen C, Gold SM, Sondermann J, Tessmer W, Schulz KH (2002) Oral terbutaline differentially affects cytokine (IL-10, IL-12, TNF, IFNg) release in multiple sclerosis patients and controls. J. Neuroimmunol. 132, 189-195.
- Heesen C, Gold SM, Hartmann S, Mladek M, Reer R, Braumann KM, Wiedemann K, Schulz KH (2003) Endocrine and cytokine responses to standardized physical stress in multiple sclerosis. Brain Behaviour and Immunity 17, 473-481.
- Heesen C, Koehler G, Gross R, Tessmer W, Schulz KH, Gold SM (2005) Fatigue in multiple sclerosis: altered cardiovascular and cytokine responses to cognitive stress. Mult. Scler. 11:51-57.
- Gold SM, Raji A, Huitinga I, Wiedemann K, Schulz KH, Heesen C. (2005) Hypothalamo-pituitary-adrenal axis activity predicts disease progression in multiple sclerosis. J Neuroimmunol. Aug;165(1-2):186-91.
- Gold SM, Mohr DC, Huitinga I, Flachenecker P, Sternberg EM, Heesen C (2005) The role of stress-response systems for the pathogenesis and progression of multiple sclerosis. Trends Immunol. 6: 644-651.
Shared decision making
Patients and health authorities increasingly claim active roles in health care decision making processes. As immune therapies in MS are partially effective MS is a prototypic condition for a shared decision making process. The treatment of acute relapses and the initiation, change or withdrawal of so called disease-modifying treatments are key decisions in MS management. We developed two decision aids following the phased approach of the framework of increasing evidence for complex interventions for these key decisions. In pre-studies we found that 80% of MS patients demand autonomous roles in treatment decisions which contrasts with a poor knowledge of risks. On the other hand MS patients are not disturbed by evidence-based, balanced complex information. MS patients do understand this kind of information and are able to transfer new abilities to other situations. Currently we study the effects of a 4 hour education programme on the relapse management versus an information leaflet in controls in 150 RR MS patients. In a second trial with n= 280 MS patients we study the effects of an evidence-based patient information on immunotherapy on decisional role preference and performance in the patient physician encounter. Results at the end of 2006 will show to which extent patient education with a focus on evidence-based patient information influences participation in the decision making process.
- Heesen C, Kasper J, Segal J, Koepke S, Mühlhauser I (2004). Decisional role preferences, knowledge and information interests in patients with multiple sclerosis. Mult. Scler. 10:643-650.
- Heesen C, Kasper J, Köpke S, Mühlhauser I (2006) Partizipative Entscheidungsfindung bei Multipler Sklerose. In: Härter M, Loh A, Spies C (Hrsg.): Gemeinsam entscheiden – erfolgreich behandeln, DÄV Köln 2005. S. 155-164.
- Heesen C, Segal J, Reich C, Hämäläinen P, Broemel F, Niemann S, Simon U, Gross R, Kasper J. Acceptability of patient information on cognitive symptoms in MS (2006) Acta Neurol. Scand. (in press)
- Köpke S, Heesen C, Kasper J, Mühlhauser I (2004). Steroid treatment for relapses in multiple sclerosis – the evidence urges shared decison making. Acta Neurol. Scand. 110: 1-5.
- Kasper J, Kopke S, Muhlhauser I, Heesen C (2005) Evidence-based patient information about treatment of multiple sclerosis-A phase one study on comprehension and emotional responses. Patient Educ Couns. Aug 9; [Epub ahead of print]
- Steckelberg A, Berger B, Kopke S, Heesen C, Muhlhauser I (2005) [Criteria for evidence-based patient information]Z Arztl Fortbild Qualitatssich.;99(6):343-51
Activity markers in blood and CSF
Apoptosis in MS - association of serum soluble CD95 or CSF DNA fragments (Tunel) with disease course, activity and therapy with glatirameracetate. Cytokines and antagonists (IL-12, IL-1RA) as disease activity markers. Serum Anti-Ganglioside antibodies as differentiation markers for MS disease courses.
- Heesen C, Sieverding F, Gbadamosi J (1999) IL-1ra serum levels in disease stages of MS – a marker for progression? Acta Neurol. Scand. 101: 95-97.
- Heesen C, Sieverding F, Schoser BGH, Hadji B und Kunze K (1999) Interleukin-12 is detectable in sera of multiple sclerosis patients - association with chronic progressive disease course? Eur. J. Neurol. 6: 591-596.
- Heesen C, Ghiorgiu S, Buhmann C, Gbadamosi J, Stürenburg HJ (1999) Apoptosis in multiple sclerosis (MS) - no association of serum CD95 (Fas) or CSF DNA fragments (Tunel) with disease course and activity. Multiple Sclerosis 5: S65
Clinical scoring, quality of life and coping in MS
Development of a quality of life scale (HAQUAMS): Hamburg quality of life scale in MS, validation with EDSS, CAMBS-Score and the MSFC. EUROQUAMS (Eurpean Multicenzter Study on the quality of life in MS) project. Developpement of a MS specific coping questionniare. Coping-intervention. Validation of a new test for objective assessment of lower limb function.
- Heesen C, Schulz KH, Mönch A, Guder U, Kolbeck J, Buhmann C, Gbadamosi J, Schulz H (1999) Impact of multiple sclerosis on patient's life a prospective correlative study of patient self-assessment and standardized quantitative measurements. Multiple Sclerosis 5: S127. 2nd best presentation on the RIMS-meeting
- Heesen C, Schulz H, Schulz KH, Guder U, Kolbeck J, Buhmann C, Gbadamosi J (1999) Quality of life in multiple sclerosis - validation of a short questionnaire for the daily for the routine. Eur. J. Neurol. 6: S99
Clinical phamacological studies
Double-blind placebo controlled trial on modafinil 200mg for treatment of MS fatigue (Sponsor: Cephalon)
Cooperating partners: - K.H. Schulz, Dep. Med. Psychol., UKE
- T. Krieger, Dep. of Immunology, UKE
- K. Wiedemann, C. Otte, Dep. of Psychiatry, UKE
- T. Kucinski, C. Saager, Dep. of Neuroradiology, UKE
- I. Mühlhauser, Dep. of Health Sciences, University of Hamburg
