[Current aspects of therapy conversion for multiple sclerosis]. / Aktuelles zur Therapieumstellung bei Multipler Sklerose.

In recent years the approval of new substances has led to a substantial increase in the number of course-modifying immunotherapies available for multiple sclerosis. Therapy conversion therefore represents an increasing challenge. The treatment options sometimes show complex adverse effect profiles and necessitate a long-term and comprehensive monitoring. This article presents an overview of therapy conversion of immunotherapies for multiple sclerosis in accordance with the recommendations of the Disease-Related Competence Network for Multiple Sclerosis and the German Multiple Sclerosis Society as well as the guidelines on diagnostics and therapy for multiple sclerosis of the German Society of Neurology and the latest research results. At the present point in time it should be noted that no studies have been carried out for most of the approaches for therapy conversion given here; however, the recommendations are based on theoretical considerations and therefore correspond to recommendations at the level of expert consensus, which is currently essential for the clinical daily routine.

Influence of visual cues on gait in Parkinson's disease during treadmill walking at multiple velocities.

OBJECTIVE: To evaluate the interaction of different treadmill-induced gait velocities and visual cues on the gait performance in Parkinson's disease (PD). BACKGROUND: External cuing has been reported to facilitate hypokinetic gait patterns in PD. METHODS: 19 PD-patients and 17 controls volunteered for the study. Gait analyses were conducted using dynamic pressure sensors integrated in a treadmill at a given velocity of 1, 2, 3 or 4 km/h. For each velocity, measurements were performed under three conditions. The first condition was without visual cuing, the remaining two consisted of visual cuing e.g. white stripes put on the treadmill belt 25 or 50 cm apart. RESULTS: Visual cuing lowered the cadence and increased stride length and stride time while maintaining gait velocity in both PD-patients and controls. A significant interaction between this effect of visual cuing and gait velocity was observed. Visual cuing demonstrated a clear velocity-dependency with less influence on cadence, stride length, stride time and coefficient of variation in stride time at higher velocities. At lower velocities visual cuing was more effective in reducing gait variability as assessed by the coefficient of variation in stride time in PD-patients than in controls. CONCLUSION: The current experiment shows that the gait patterns of PD-patients are not rigidly coupled to gait velocity and can be manipulated with visual cuing techniques. Our results suggest that visual cuing can improve the efficacy of treadmill training. Due to an interaction between the effect of visual cuing and gait velocity, the application of visual cues could enhance the efficacy of treadmill training particularly at lower velocities.