ENA young adult suddenly notices numbness in a leg or half of the face, or sees double for several days. The symptoms fade, but an MRI shows “lesions”, and the word “sclerosis” frightens the family. Treatment may or may not have started at home, and the family wants to know whether everything has been done.
Multiple sclerosis treatment in Germany is led by neurologists at university hospitals and specialised centres. This page covers confirming the diagnosis, treating relapses, long-term therapy, rehabilitation and the arrangements for the trip. An overview of the field is on the page on neurology in Germany.
Multiple sclerosis in plain words
Multiple sclerosis is a long-term disease in which the immune system mistakenly attacks the sheath around nerve fibres in the brain and spinal cord. This sheath, myelin, works like insulation on a wire: where it is damaged, signals travel slowly or not at all. Doctors call this loss of myelin demyelination. It causes numbness, weakness, blurred vision, poor balance and fatigue. The inflamed patches are scattered and leave hardened scars — “sclerosis” means hardening.
The disease takes different courses, and the course shapes treatment. Most often it starts as relapsing-remitting MS: symptoms build up over a few days and then settle fully or partly. Years later, in some people it becomes secondary progressive MS, with problems that slowly increase. Less often it progresses steadily from the start — primary progressive MS. Most medicines act against the inflammation that shows as relapses and new lesions, so in the progressive forms the choice is much narrower.
How the diagnosis is confirmed
The diagnosis follows the international McDonald criteria, which combine symptoms, examination and tests rather than a single scan. The basis is an MRI of the brain and spinal cord with contrast, showing which lesions are inflamed now. Next comes analysis of the cerebrospinal fluid, collected by lumbar puncture: a thin needle is inserted between the vertebrae of the lower back, below the end of the spinal cord. The laboratory looks for oligoclonal bands, antibodies made inside the nervous system when it is inflamed. Evoked potentials check how fast signals travel, for example along the optic nerve. Sometimes the diagnosis can be made after the first episode.
Similar MRI changes occur in other inflammatory and vascular brain diseases and in infections, so these are ruled out first. A mistake is costly: in neuromyelitis optica, a related but separate disease, several multiple sclerosis medicines do not help or even trigger severe attacks. Patients travelling from abroad should bring every previous MRI on disc, not just the reports: new lesions show only when scans from different times are compared, and this often tells more than a new scan.
Treatment options for multiple sclerosis
Treatment combines therapy for relapses with long-term therapy that changes the course of the disease. A relapse is usually treated with a short course of high-dose corticosteroids, mostly as a drip over several days, sometimes as tablets. If clear problems remain, such as poor sight or weakness that hinders walking, the neurologist may repeat the course or move on to plasma exchange, which removes plasma with the antibodies that drive inflammation. Immunoadsorption, a related method, filters these antibodies out.
Long-term disease-modifying therapy comes as injections, tablets or infusions of monoclonal antibodies, laboratory-made proteins that target particular immune cells. The choice depends on disease activity, the MRI, pregnancy plans, as some medicines must not be used in pregnancy, and the risk of side effects. Regular blood tests and MRI checks are part of it. As the WHO fact sheet on multiple sclerosis notes, such therapy is started as early as possible. Its aim is fewer relapses and new lesions, to preserve strength, sight and walking; it does not promise a cure.
In very active disease that keeps flaring up despite the strongest medicines, some centres discuss autologous haematopoietic stem cell transplantation: the patient’s own blood-forming stem cells are collected, chemotherapy switches off the immune system, and the returned cells rebuild it. It is not standard care: the German Society of Neurology advises using it within registries and clinical trials, at centres where neurologists and transplant teams work together. A multidisciplinary board decides, and the method suits few patients.
Where patients are treated and rehabilitated
Patients are treated in neurology departments experienced with all groups of medicines and recover in neurological rehabilitation clinics. At Essen University Hospital, the Department of Neurology is headed by its director, Prof. Christoph Kleinschnitz, whose clinical fields include multiple sclerosis. At Helios Klinikum Erfurt, Chief Physician Prof. Andreas Steinbrecher leads neurology and specialises in neuroimmunology and multiple sclerosis; the department has a certified multiple sclerosis centre.
Rehabilitation treats what remains after relapses or builds up over time: spasticity, meaning stiff muscles, fatigue, and problems with walking and balance. Physiotherapists and occupational therapists help restore everyday skills; some symptoms are treated with medicines. At Kliniken Schmieder, rehabilitation for multiple sclerosis is among the fields of Prof. Michael Jöbges, medical director of the Konstanz clinic, and Dr Ioana-Maria Schonder, head of neurorehabilitation in Gailingen. More about neurological rehabilitation is on a separate page.
Frequently asked questions
Where is multiple sclerosis best treated?
There is no single best hospital for everyone, so patients choose by criteria. The German Multiple Sclerosis Society (DMSG) certifies MS centres that continuously care for many patients, treat relapses according to guidelines and contribute data to the German MS Register. All groups of medicines, including the newest ones and infusions, should be available, with MRI and fluid analysis on site. For rehabilitation, a centre experienced in multiple sclerosis is the right choice.
What is the newest medicine for multiple sclerosis?
The newest medicines approved in the EU are BTK inhibitors, which block the enzyme Bruton’s tyrosine kinase. A tablet from this class was approved in June 2026 for adults with secondary progressive MS and no relapses in the last two years; the liver is checked regularly during treatment. Other new approaches, such as CAR-T cell therapy, are still studied only in clinical trials. Newer is not better for everyone: the neurologist chooses the medicine for each patient.
How is multiple sclerosis treated today?
Today multiple sclerosis is treated in three ways. Relapses are calmed with short courses of corticosteroids and, if these are not enough, with plasma exchange. To reduce relapses and new lesions, long-term disease-modifying therapy is given as injections, tablets or antibody infusions matched to disease activity. The third part is symptom treatment and rehabilitation: physiotherapy, occupational therapy, medicines for spasticity and help with fatigue. Neurologist visits and MRI checks accompany all of this.
How AlenMed arranges treatment for multiple sclerosis
AlenMed translates the medical records, sends them to neurologists at partner clinics and arranges the tests, treatment and travel. The records needed are discharge reports, all MRI scans on disc with their reports, cerebrospinal fluid results, a list of medicines with start and stop dates, and descriptions of relapses. The clinic’s neurologist reviews the records and proposes a plan.
The bill covers the neurologist’s consultation and tests: MRI of the brain and spinal cord with contrast, cerebrospinal fluid analysis and evoked potentials. Relapse treatment, if needed, is given on an outpatient or inpatient basis, depending on severity. In long-term therapy a large item is the medicine itself, and as treatment usually continues at home, its availability there is checked in advance. Rehabilitation is billed separately. The total appears in the clinic’s cost estimate (Kostenvoranschlag) after the records are reviewed. AlenMed helps with the visa invitation letter, provides an interpreter at appointments and, for long-term therapy, agrees how monitoring will continue at home. AlenMed’s office is in Munich; partner clinics are all over Germany.
This material is for reference only and is not an offer. The treatment plan is decided by a neurologist at an in-person appointment.
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