Intrathecal TCA therapy for multiple sclerosis
This information bulletin is intended primarily for MS patients with primary or secondary chronic progressive MS form and spinal symptoms, ie. With inflammation in the spinal cord or in the brain stem It is based on written surveys of chief medical neurological clinics in hospitals, neurosurgery centers and university institutes, which are known for the treatment of MS patients. The survey was supplemented by personal experiences of participants in a patient's initiative in Northern Germany.
From the responses of 108 and publications clinics is apparent that in addition to the well-known MS therapies have long is a treatment method that in 50-70% of all cases, a suitable - temporary and repeatable - can be expected improvement of symptoms, particularly for complaints such as ambulation, spasticity and bladder problems. It is used by 32% of the responding hospitals regularly or occasionally. The procedure is often used in cases when other treatment measures have not led to improvement of symptoms.
According to some clinics therapy should be started as soon as possible after diagnosis. In appropriate cases and in experienced hands, the experts do see a status. The process was established in 2003 by an expert panel in the "Recommendations for the symptomatic treatment of multiple sclerosis," specially recorded for the treatment of spasticity and of the Multiple Sclerosis Therapy Consensus Group (MSTKG) as a supplement in the journal "The Neurologist" (vol. 75, published in Issue 8, August 2004). Quote: "The intrathecal administration of triamcinolone acetonide crystal suspension is the future possibly another way of treatment of spinal spasticity, having recently been shown that this means an extension of the walking distance, as well as an improvement in EDSS are verifiable and not have serious side effects were too. This therapy should only be conducted within studies or in clinics with specific experience. " Such clinics are listed in the following address list.
When the process is analogous to the known lumbar puncture using atraumatic puncture needles is usually 40 mg, sometimes 80 mg of depot corticosteroid TCA (triamcinolone acetonide, Volon ©-A) was injected into the spinal fluid. TCA is a well-known drug for decades. The treatment requires not only a unique suitability of the patient in an aseptic environment and approach as well as practical experience and skill of the treating physician.
Most eg during a stay in hospital for 3-4 weeks 1-2x per week performed a basic treatment and, in most cases prescribed subsequent downtime of 2-8 hours, thus the uniform distribution of the injected crystal suspension is ensured. Often, the improvements are occurring thereafter (sometimes only 3-4x a year) maintained by an external, single dose at intervals of 4-8 weeks. After the experience TCA is well tolerated, side effects (eg, headache) are rare.
Some hospitals are talking about several thousand routinely performed and treatments of 200 or more TCA injections per year, in all cases without serious complications. Combined intrathecal TCA therapy is known as a recommended treatment with minimal side effects, which is used in some hospitals conducted for decades with good results.
Source: PinC (patient initiative intrathecal cortisone) - Stand 14.07.2005 / Dipl. Hans W. Scheidt leak
Facility Comment of the institution
Department
District Hospital
the University of Regensburg
AG Neuroimmunology,
93053 Regensburg
Intrathecal therapy with Volon ®-A is in our house occasionally performed in patients with severe spinal and significantly advanced symptoms. In our experience, it is seldom in the standard precautionary problems. The therapy is our impression that effective in some patients, usually in the form of a noticeable improvement in spasticity. The therapy is purely symptomatic effect usually only temporary and does not prevent the further progress when the disease is still active. We choose this measure, especially in patients with advanced MS, when other forms of therapy are no longer possible.
Charité University Hospital Berlin,
Department of Neurology,
10098 Berlin
After that offers an intrathecal administration of triamcinolone acetonide (Volon ®-A) and symptomatic (rather than causal) treatment of such patients who suffer regardless of exacerbations in (painful) spasticity of the lower limbs, often associated with bladder dysfunction. The administration of Volon ®-A may, in such cases, perform both in the context of a primary or secondary chronic progressive multiple sclerosis to an objectively defined improvement of spastic gait disorders and pain syndromes .. If successful, we repeat this action, if the practical Durchführbarbeit is given at regular intervals (every 4-8 weeks), and in addition to a causal oriented immunomodulatory therapy (eg, with interferon-beta). This corresponds to the practice in other hospitals.
Psychiatric Hospital Bamberg
Department of Neurology
We do this (note: the Volon © intrathecal therapy in MS) in our house by regularly, but according to the results of Rohrbach et al. mainly in spinal related symptoms, may also reduce pain. I think a refresher treatment only useful for renewed deterioration. The therapy is expected at these institutions to roughly follow the same rules. Limiting I should still say that at long preexisting failures usually no or only a slight improvement can be achieved.
Clinic for Neurology Dietenbronn GmbH,
Academic Teaching Hospital of the University of Ulm
88477 Schwendi
In our house, the MS treatment is performed occasionally with Volon © A. In patients suitable for this purpose, we give 40 mg TCA. We give our patients during a hospital stay 1 - 3 times 40 mg intrathecal TCA approximately every 3 days. These treatments are then repeated at intervals of about 6 weeks. Patients usually report on its own after about 4 weeks, when they notice a decrease in the therapeutic effect. After the injections, we prescribe a waiting time of 2 hours. This method has proven very good for the treatment of massive Paraspastik the legs so prevalent in the symptomatic treatment of MS. In acute exacerbations or florid disease activity and chronic progressive patients us the method, however, appears not to be as effective as. Iv administration of high-dose prednisolone
Academic Teaching Hospital of the University of Tübingen,
Municipal Hospital Sindelfingen, ABTG. Neurology
71065 Sindelfingen
We apply this method routinely for over 20 years. [...] We have regularly TCA (Volon ©-A), meanwhile, certainly in more than 10,000 patients, mainly with MS put into application. Previously, we have convinced ourselves that the electron microscope can be represented crystals of TCA in the medium of the cerebrospinal fluid in the incubator dissolve uniformly and cause radicular syndrome. Complications were not observed. Rarely produces a postpunktioneller headache, but occurs less frequently with co-administration of TCAs. Legeartis applied, so far I could not find any adverse side effects. On the other hand, the combination of TCA and Pulse therapy has a very favorable course of MS, especially in the spinal-onset form. However, we have patients who only received TCA, every 4 to 6 months. Of multiple injections at short intervals, I do not think much, especially since the half-life of TCA is sufficiently long and the substance in the cerebrospinal fluid lingers long proven to have no major systemic side effects.
Ruhr-University Bochum,
St. Joseph's Hospital
Study Center for Multiple Sclerosis
44791 Bochum
We currently treat about 110 patients with predominantly spinal curves of MS with intrathecal Volon-A therapy. The type of treatment was introduced about 18 years ago with us. If the criteria are met, runs from the treatment regimen: 6 x intrathecal therapy with 40 mg Volon-A within 3 weeks (booster treatment); next appropriate safety standards and additional examinations, with a defined therapeutic success are (individually) at a distance of 4 - performed 12 weeks off maintenance treatment . Long-term experience are up to 12 years.
Sauerland clinic Hachen
Neurological specialist clinic especially for multiple sclerosis
59846 Sundern
In the Sauerland clinic Hachen as MS-specialty hospital, this treatment is carried out for years with good results. I even treat MS patients with predominantly spinal symptoms since 1972 with annual injections 100-200, so far without any significant side effects.
Address list of clinics that use the intrathecal TCA treatment regularly or occasionally
(Proficiency: 14.07.2005 / sorted by zip code)
06120 Halle / Saale
Hr. Dr.F.Hoffmann
Städt. Martha-Maria Hospital, Department of Neurology
Tel: 0345-55 91 891
10117 Berlin
Hr. Dr.R.Zschenderlein
Charité, Department of Neurology
Tel: 030-450-572079
13347 Berlin
Fri Prof.Dr.J.Haas
Jewish Hospital Berlin, ABTG. Neurology
Tel: 030-4994-2348
15755 Teupitz
Hr. Dr.J.Faiss
Neurological Landesklinik
Tel: 033766-66336
17258 Feldberg (Meckl.-Vorpommern)
Hr: Dr.Chr. Bucka
Clinic on Sheridan Lake, ABTG. Neurology
Tel: 039831-52-0
21677 Stade
Hr. Dr.J.Igloffstein
Same-Hospital, Department of Neurology
Tel: 04141-97-1350/51
22087 Hamburg
Hr. Prof.Dr.T.Weber
St. Mary's Hospital Hamburg, Department of Neurology
Tel: 040-2546-2602
24106 Kiel
Hr. Dr.W.Wabbel
Lubinus Clinic, Anesthesia
Tel: 0431-388281
26702 Emden
Hr. Prof. Dr. Büttner
Hospital of the City of Emden
Phone: 04921-98 13 18
27574 Bremerhaven
Hr. Dr. Odin
Central Hospital Reinkenheide
Tel: 0471 - 299 3419
30559 Hannover (Kirchrode)
Hr. Prof.Dr.F.Heidenreich
Hospital Henriettenstiftung, Neurol. Clinic,
Phone: 0511-289-3
30632 Hannover
Hr. Prof.Dr.J.Bufler
Medical School (MHH), ABTG. Neurology
Tel: 0511-532-2391
35385 Gießen
Hr. Dr.P.Oschmann
University of Giessen, Department of Neurology
Tel: 0641-99 45 306
35789 Weilmünster
Hr. Prof.Dr.C.Hornig
Hospital Weilmünster, Neurology
Phone: 06472-60-292
40225 Dusseldorf
Hr. Prof.Dr.HPHartung
University Hospital Dusseldorf, Neurol.Klinik
Tel: 0211-81-17880
44791 Bochum
Hr. Dr.SKSchimrigk
Ruhr-University, Department of Neurology
Tel: 0234-509-2420
53567 Asbach
Hr. Prof.Dr.D.Pöhlau
Camillus Hospital, ABTG. Neurology
Phone: 02683-59-0
59457 Werl
Hr. S.Kreijenveld
Drs (NL) Sybrandus Kreijenveld
Tel: 02922-97360
59846 Sundern-Hachen
Hr. Dr.M.Heibel
Sauerland clinic Hachen, MS specialist clinic
Phone: 02935-808-0
59846 Sundern-Langenscheid
Hr. Dr.Z.Mir
Clinic Dr. Evers
Phone: 02935-807-0
60488 Frankfurt am Main
Hr. Prof.Dr.RWJanzen
Hospital Northwest
Phone: 069-7601-3246 or -47
61462 Königstein-Falkenstein
Fri Dr.G.Japp
Asklepios Neurology Falkenstein
Phone: 06174-90 60 30
63739 Aschaffenburg
Hr. Prof.Dr.R.Schneider
Hospital, Department of Neurology
Tel: 06021-32-3050
65191 Wiesbaden
Hr. Dr.E.Lensch
German Diagnostic Clinic, Department of Neurology
Tel: 0611-577 321
66280 Sulzbach
Hr. Dr.M.Gawlitza
Knappschaftskrankenhaus, ABTG. Neurology
Tel: 06879-574-1131
66421 Homburg / Saar
Hr. Dr.S.Jung
Saarland University, Department of Neurology
Tel: 06841-1624-129
66821 Neunkirchen / Saar
Hr. Dr.V.Fischer
Municipal Hospital, ABTG. Neurology
Phone: 06821-18 27 01
70191 Stuttgart
Hr. Prof.Dr.H.Wiethölter
Civil Hospital, Department of Neurology
Tel.0711-253-2401
71065 Sindelfingen
Hr. Prof. Dr.ISNeu
Municipal Hospital, ABTG. Neurology
Tel: 07031-98-2361/62
79106 Freiburg
Hr. PD Dr.S.Rauer
University of Freiburg, Department of Neurology
Tel: 0761-270-5308
85540 Munich
Hr. Dr.W.Büchele
District Hospital Munich-Haar ABTG. Neurology
Tel: 089-45 62 37 43
88477 Schwendi
Hr. Prof.Dr.E.Mauch
Clinic for Neurology Dietenbronn
Phone: 07353-989-0
89081 Ulm
Hr. Dr.H.Tumani
University of Ulm, Department of Neurology
Tel: 0731-177-120
93053 Regensburg
Hr. Dr.A.Steinbrecher
District Hospital Regensburg, ABTG. Neurology
Tel: 0941-941-3350
95326 Kulmbach
Hr. Dr. Kirchhoff
Hospital - Dept. of Anaesthesiology and Intensive Care Medicine
Tel: 09221-980
96049 Bamberg
Hr. Prof.Dr.P.Krauseneck
Psychiatric Hospital, Department of Neurology
Tel: 0951 - 954-1201
CH-4031 Basel
Hr: Prof.Dr.L.Kappos
Neurol.-Neurochirurg.Poliklinik, University Hospital Basel
Tel: 0041-61265 44 64
** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **
This information bulletin is intended primarily for MS patients with primary or secondary chronic progressive MS form and spinal symptoms, ie. With inflammation in the spinal cord or in the brain stem It is based on written surveys of chief medical neurological clinics in hospitals, neurosurgery centers and university institutes, which are known for the treatment of MS patients. The survey was supplemented by personal experiences of participants in a patient's initiative in Northern Germany.
From the responses of 108 and publications clinics is apparent that in addition to the well-known MS therapies have long is a treatment method that in 50-70% of all cases, a suitable - temporary and repeatable - can be expected improvement of symptoms, particularly for complaints such as ambulation, spasticity and bladder problems. It is used by 32% of the responding hospitals regularly or occasionally. The procedure is often used in cases when other treatment measures have not led to improvement of symptoms.
According to some clinics therapy should be started as soon as possible after diagnosis. In appropriate cases and in experienced hands, the experts do see a status. The process was established in 2003 by an expert panel in the "Recommendations for the symptomatic treatment of multiple sclerosis," specially recorded for the treatment of spasticity and of the Multiple Sclerosis Therapy Consensus Group (MSTKG) as a supplement in the journal "The Neurologist" (vol. 75, published in Issue 8, August 2004). Quote: "The intrathecal administration of triamcinolone acetonide crystal suspension is the future possibly another way of treatment of spinal spasticity, having recently been shown that this means an extension of the walking distance, as well as an improvement in EDSS are verifiable and not have serious side effects were too. This therapy should only be conducted within studies or in clinics with specific experience. " Such clinics are listed in the following address list.
When the process is analogous to the known lumbar puncture using atraumatic puncture needles is usually 40 mg, sometimes 80 mg of depot corticosteroid TCA (triamcinolone acetonide, Volon ©-A) was injected into the spinal fluid. TCA is a well-known drug for decades. The treatment requires not only a unique suitability of the patient in an aseptic environment and approach as well as practical experience and skill of the treating physician.
Most eg during a stay in hospital for 3-4 weeks 1-2x per week performed a basic treatment and, in most cases prescribed subsequent downtime of 2-8 hours, thus the uniform distribution of the injected crystal suspension is ensured. Often, the improvements are occurring thereafter (sometimes only 3-4x a year) maintained by an external, single dose at intervals of 4-8 weeks. After the experience TCA is well tolerated, side effects (eg, headache) are rare.
Some hospitals are talking about several thousand routinely performed and treatments of 200 or more TCA injections per year, in all cases without serious complications. Combined intrathecal TCA therapy is known as a recommended treatment with minimal side effects, which is used in some hospitals conducted for decades with good results.
Source: PinC (patient initiative intrathecal cortisone) - Stand 14.07.2005 / Dipl. Hans W. Scheidt leak
Facility Comment of the institution
Department
District Hospital
the University of Regensburg
AG Neuroimmunology,
93053 Regensburg
Intrathecal therapy with Volon ®-A is in our house occasionally performed in patients with severe spinal and significantly advanced symptoms. In our experience, it is seldom in the standard precautionary problems. The therapy is our impression that effective in some patients, usually in the form of a noticeable improvement in spasticity. The therapy is purely symptomatic effect usually only temporary and does not prevent the further progress when the disease is still active. We choose this measure, especially in patients with advanced MS, when other forms of therapy are no longer possible.
Charité University Hospital Berlin,
Department of Neurology,
10098 Berlin
After that offers an intrathecal administration of triamcinolone acetonide (Volon ®-A) and symptomatic (rather than causal) treatment of such patients who suffer regardless of exacerbations in (painful) spasticity of the lower limbs, often associated with bladder dysfunction. The administration of Volon ®-A may, in such cases, perform both in the context of a primary or secondary chronic progressive multiple sclerosis to an objectively defined improvement of spastic gait disorders and pain syndromes .. If successful, we repeat this action, if the practical Durchführbarbeit is given at regular intervals (every 4-8 weeks), and in addition to a causal oriented immunomodulatory therapy (eg, with interferon-beta). This corresponds to the practice in other hospitals.
Psychiatric Hospital Bamberg
Department of Neurology
We do this (note: the Volon © intrathecal therapy in MS) in our house by regularly, but according to the results of Rohrbach et al. mainly in spinal related symptoms, may also reduce pain. I think a refresher treatment only useful for renewed deterioration. The therapy is expected at these institutions to roughly follow the same rules. Limiting I should still say that at long preexisting failures usually no or only a slight improvement can be achieved.
Clinic for Neurology Dietenbronn GmbH,
Academic Teaching Hospital of the University of Ulm
88477 Schwendi
In our house, the MS treatment is performed occasionally with Volon © A. In patients suitable for this purpose, we give 40 mg TCA. We give our patients during a hospital stay 1 - 3 times 40 mg intrathecal TCA approximately every 3 days. These treatments are then repeated at intervals of about 6 weeks. Patients usually report on its own after about 4 weeks, when they notice a decrease in the therapeutic effect. After the injections, we prescribe a waiting time of 2 hours. This method has proven very good for the treatment of massive Paraspastik the legs so prevalent in the symptomatic treatment of MS. In acute exacerbations or florid disease activity and chronic progressive patients us the method, however, appears not to be as effective as. Iv administration of high-dose prednisolone
Academic Teaching Hospital of the University of Tübingen,
Municipal Hospital Sindelfingen, ABTG. Neurology
71065 Sindelfingen
We apply this method routinely for over 20 years. [...] We have regularly TCA (Volon ©-A), meanwhile, certainly in more than 10,000 patients, mainly with MS put into application. Previously, we have convinced ourselves that the electron microscope can be represented crystals of TCA in the medium of the cerebrospinal fluid in the incubator dissolve uniformly and cause radicular syndrome. Complications were not observed. Rarely produces a postpunktioneller headache, but occurs less frequently with co-administration of TCAs. Legeartis applied, so far I could not find any adverse side effects. On the other hand, the combination of TCA and Pulse therapy has a very favorable course of MS, especially in the spinal-onset form. However, we have patients who only received TCA, every 4 to 6 months. Of multiple injections at short intervals, I do not think much, especially since the half-life of TCA is sufficiently long and the substance in the cerebrospinal fluid lingers long proven to have no major systemic side effects.
Ruhr-University Bochum,
St. Joseph's Hospital
Study Center for Multiple Sclerosis
44791 Bochum
We currently treat about 110 patients with predominantly spinal curves of MS with intrathecal Volon-A therapy. The type of treatment was introduced about 18 years ago with us. If the criteria are met, runs from the treatment regimen: 6 x intrathecal therapy with 40 mg Volon-A within 3 weeks (booster treatment); next appropriate safety standards and additional examinations, with a defined therapeutic success are (individually) at a distance of 4 - performed 12 weeks off maintenance treatment . Long-term experience are up to 12 years.
Sauerland clinic Hachen
Neurological specialist clinic especially for multiple sclerosis
59846 Sundern
In the Sauerland clinic Hachen as MS-specialty hospital, this treatment is carried out for years with good results. I even treat MS patients with predominantly spinal symptoms since 1972 with annual injections 100-200, so far without any significant side effects.
Address list of clinics that use the intrathecal TCA treatment regularly or occasionally
(Proficiency: 14.07.2005 / sorted by zip code)
06120 Halle / Saale
Hr. Dr.F.Hoffmann
Städt. Martha-Maria Hospital, Department of Neurology
Tel: 0345-55 91 891
10117 Berlin
Hr. Dr.R.Zschenderlein
Charité, Department of Neurology
Tel: 030-450-572079
13347 Berlin
Fri Prof.Dr.J.Haas
Jewish Hospital Berlin, ABTG. Neurology
Tel: 030-4994-2348
15755 Teupitz
Hr. Dr.J.Faiss
Neurological Landesklinik
Tel: 033766-66336
17258 Feldberg (Meckl.-Vorpommern)
Hr: Dr.Chr. Bucka
Clinic on Sheridan Lake, ABTG. Neurology
Tel: 039831-52-0
21677 Stade
Hr. Dr.J.Igloffstein
Same-Hospital, Department of Neurology
Tel: 04141-97-1350/51
22087 Hamburg
Hr. Prof.Dr.T.Weber
St. Mary's Hospital Hamburg, Department of Neurology
Tel: 040-2546-2602
24106 Kiel
Hr. Dr.W.Wabbel
Lubinus Clinic, Anesthesia
Tel: 0431-388281
26702 Emden
Hr. Prof. Dr. Büttner
Hospital of the City of Emden
Phone: 04921-98 13 18
27574 Bremerhaven
Hr. Dr. Odin
Central Hospital Reinkenheide
Tel: 0471 - 299 3419
30559 Hannover (Kirchrode)
Hr. Prof.Dr.F.Heidenreich
Hospital Henriettenstiftung, Neurol. Clinic,
Phone: 0511-289-3
30632 Hannover
Hr. Prof.Dr.J.Bufler
Medical School (MHH), ABTG. Neurology
Tel: 0511-532-2391
35385 Gießen
Hr. Dr.P.Oschmann
University of Giessen, Department of Neurology
Tel: 0641-99 45 306
35789 Weilmünster
Hr. Prof.Dr.C.Hornig
Hospital Weilmünster, Neurology
Phone: 06472-60-292
40225 Dusseldorf
Hr. Prof.Dr.HPHartung
University Hospital Dusseldorf, Neurol.Klinik
Tel: 0211-81-17880
44791 Bochum
Hr. Dr.SKSchimrigk
Ruhr-University, Department of Neurology
Tel: 0234-509-2420
53567 Asbach
Hr. Prof.Dr.D.Pöhlau
Camillus Hospital, ABTG. Neurology
Phone: 02683-59-0
59457 Werl
Hr. S.Kreijenveld
Drs (NL) Sybrandus Kreijenveld
Tel: 02922-97360
59846 Sundern-Hachen
Hr. Dr.M.Heibel
Sauerland clinic Hachen, MS specialist clinic
Phone: 02935-808-0
59846 Sundern-Langenscheid
Hr. Dr.Z.Mir
Clinic Dr. Evers
Phone: 02935-807-0
60488 Frankfurt am Main
Hr. Prof.Dr.RWJanzen
Hospital Northwest
Phone: 069-7601-3246 or -47
61462 Königstein-Falkenstein
Fri Dr.G.Japp
Asklepios Neurology Falkenstein
Phone: 06174-90 60 30
63739 Aschaffenburg
Hr. Prof.Dr.R.Schneider
Hospital, Department of Neurology
Tel: 06021-32-3050
65191 Wiesbaden
Hr. Dr.E.Lensch
German Diagnostic Clinic, Department of Neurology
Tel: 0611-577 321
66280 Sulzbach
Hr. Dr.M.Gawlitza
Knappschaftskrankenhaus, ABTG. Neurology
Tel: 06879-574-1131
66421 Homburg / Saar
Hr. Dr.S.Jung
Saarland University, Department of Neurology
Tel: 06841-1624-129
66821 Neunkirchen / Saar
Hr. Dr.V.Fischer
Municipal Hospital, ABTG. Neurology
Phone: 06821-18 27 01
70191 Stuttgart
Hr. Prof.Dr.H.Wiethölter
Civil Hospital, Department of Neurology
Tel.0711-253-2401
71065 Sindelfingen
Hr. Prof. Dr.ISNeu
Municipal Hospital, ABTG. Neurology
Tel: 07031-98-2361/62
79106 Freiburg
Hr. PD Dr.S.Rauer
University of Freiburg, Department of Neurology
Tel: 0761-270-5308
85540 Munich
Hr. Dr.W.Büchele
District Hospital Munich-Haar ABTG. Neurology
Tel: 089-45 62 37 43
88477 Schwendi
Hr. Prof.Dr.E.Mauch
Clinic for Neurology Dietenbronn
Phone: 07353-989-0
89081 Ulm
Hr. Dr.H.Tumani
University of Ulm, Department of Neurology
Tel: 0731-177-120
93053 Regensburg
Hr. Dr.A.Steinbrecher
District Hospital Regensburg, ABTG. Neurology
Tel: 0941-941-3350
95326 Kulmbach
Hr. Dr. Kirchhoff
Hospital - Dept. of Anaesthesiology and Intensive Care Medicine
Tel: 09221-980
96049 Bamberg
Hr. Prof.Dr.P.Krauseneck
Psychiatric Hospital, Department of Neurology
Tel: 0951 - 954-1201
CH-4031 Basel
Hr: Prof.Dr.L.Kappos
Neurol.-Neurochirurg.Poliklinik, University Hospital Basel
Tel: 0041-61265 44 64
** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **
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