09. März 2020

The Multiple Sclerosis Centre: Person-centred care and research at the highest level

The prospects for people diagnosed with multiple sclerosis have significantly improved in recent years thanks to new therapies. If the “disease with many faces” has been recently diagnosed, those affected by it these days can hope to lead a largely normal life with little or no impairment.

 

For those with a longer history of multiple sclerosis (MS), there is now justified hope that further progression can be prevented or at least slowed down. Clinical researchers at the Neurology Clinic and Outpatient Clinic at University Hospital Basel (USB) were and are key to the development of almost all the therapies that are now available for multiple sclerosis. But with all the positives of this progress, there is still a long way to go. New treatments should be implemented in the most targeted and low-risk way possible. It is important to record the progression of the disease as exactly and comprehensively as possible so that treatment can be adjusted at the right time. Any issues must be recognised in good time and symptoms must be alleviated as far as possible. It is therefore important to use the expertise of different medical disciplines and specialists.

This is exactly what the MS Centre aims to do because the foundation of a centre at University Hospital Basel always takes a patient-centred approach: “Which specialists from which disciplines does the patient need?” Several specialists are required for multiple sclerosis because the disease can affect the entire body due to multiple damage to the central nervous system.

Neurologists play a leading role in treatment: they diagnose the disease and initiate disease-modifying treatment. The Multiple Sclerosis Centre now has over a dozen types of medications for this purpose, which are used according to the needs of the patient in question. Many infusion treatments are also carried out within this framework in the day-patient section of the Neurology Outpatient Clinic. This service is in such high demand that space is slowing running out. We are fortunately able to use the newly established private treatment rooms for infusions.

One of the areas that collaborates with the MS Centre is the Eye Clinic, because multiple sclerosis can often affect vision. Not surprisingly, one of the first documented descriptions of the disease comes from a 19th century Scottish ophthalmologist.

Urology and gynaecology specialists also play an important role. Because – besides their expertise in treating micturition disorders – it is important to remember that MS patients are often still young when they are diagnosed and want to have a fulfilling sex life and possibly also have children.
The choice of therapy is extremely important when it comes to helping patients to quickly regain a high quality of life after a relapse or in cases where patients have been suffering from the disease for a long time.

For Dr Jens Kuhle, Head of the Multiple Sclerosis Centre, the close cooperation between the different disciplines is the key added value of the MS Centre. “Of course, we have also worked together in an interdisciplinary manner before, but having a centre enables us to define and establish structures, processes and procedures with even more precision. The resulting high standards are pretty evident.” Professor Tobias Derfuss, Head of the Neurology Outpatient Clinic, points out that there were and are specialists in other clinics of the hospital who are interested in MS and are now officially designated as contact persons.

Neurology remains the hub and focal point. “We have increasingly moved away from making specialists rotate through different departments with a view to ensuring patients have familiar points of contact.” This aspect of having a person patients can trust is also an important part of care: for MS patients who need to visit USB for infusions on a regular basis and over long periods of time, it is much nicer if they know the people who treat them.

The senior consultants are impressed by the readiness and commitment from both nurses and doctors. As Jens Kuhle puts it: “Motivation is enormously high.
Employees are going above and beyond, particularly with regard to patient education – they are even prepared to offer courses for patients in the evening.” “And they are doing this on their own initiative,” adds Tobias Derfuss.

Yet despite all efforts, multiple sclerosis cannot yet be cured. After decades of intensive research, it is still not clear what causes it. But the question of how MS arises and the ongoing search for suitable biomarkers for diagnosis, progress monitoring and
individualised treatment are not the only things on researchers' minds. Patients respond to the available medications to varying extents.

Why does one medication work for one patient but not for another? Researchers hope to find the answers from a diverse range of studies, particularly from the large-scale multicentre Swiss MS cohort study, which has examined over 1,300 patients across Switzerland in a standardised manner for over seven years.

MS researchers at University Hospital Basel have also been at the forefront of international research for years now. Continuing this research at the highest international level will remain an important task at the new Multiple Sclerosis Centre.

 

Multiple sclerosis is an autoimmune, chronic inflammatory disease of the central nervous system, the causes of which are still not fully understood. MS is associated with areas of inflammation in the brain and spinal cord and damages the affected nerve cells. The inflammation results from misdirected immune system activity. Different symptoms and complaints arise depending on the location of the inflammation. In the early stages of the disease, there are often visual disturbances, sensory disturbances, clumsiness, weakness and increased susceptibility to exhaustion. The progression of multiple sclerosis varies greatly from person to person. As the diseases progresses, existing symptoms may become worse and new symptoms may occur. These days, many forms of the disease are very amenable to treatment.