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Fortschr Neurol Psychiatr 2012; 80(10): 560-569
DOI: 10.1055/s-0032-1312738
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Morbus Parkinson: Aktuelle Standards in Diagnostik und Therapie

Parkinson’s Disease: Current Standards in Diagnostics and Therapy
L. Timmermann
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
,
C. Eggers
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
,
H. Salimi Dafsari
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
,
K. A. M. Pauls
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
,
M. T. Barbe
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
2   Institut für Neurowissenschaften und Medizin 3, Kognitive Neurologie, Forschungszentrum Jülich
› Author Affiliations
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Publication History

Publication Date:
02 October 2012 (online)

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Zusammenfassung

Das idiopathische Parkinson-Syndrom ist eine klinische Diagnose. Moderne bildgebende und nuklearmedizinische Verfahren erlauben jedoch inzwischen eine sehr frühe Diagnose und eine zusätzliche Sicherheit in der Differenzialdiagnose zwischen atypischen Parkinson-Syndromen und dem idiopathischen Parkinson-Syndrom. Die medikamentöse Therapie in der Frühphase des idiopathischen Parkinson-Syndroms sollte neben der Therapie der Symptome v. a. den Versuch der Modifikation des Krankheitsverlaufs mit einbeziehen. Gerade nach Auftreten von ersten Fluktuationen wird dagegen die kontinuierliche dopaminerge Stimulation in der Therapie immer wichtiger. Sobald die konservativen Optionen ausgeschöpft sind, sind durch die Apomorphin- und die Duodopa-Therapie Optionen mit Pumpen gegeben. Die Tiefe Hirnstimulation im Ncl. subthalamicus hat sich jedoch insbesondere bei jüngeren Patienten mit einem idiopathischen Parkinson-Syndrom als oft sehr erfolgreiche Therapieoption herausgestellt. Gerade bei der Tiefen Hirnstimulation ist die individuelle Abschätzung von Risiken und Möglichkeiten von entscheidender Bedeutung.

Abstract

Idiopathic Parkinson’s disease is still a clinical diagnosis. However, modern imaging and nuclear techniques allow very early diagnosis and lead to higher security in the differential diagnosis between idiopathic Parkinson’s disease and atypical Parkinson syndromes. At early stages of the disease, modification of disease progression and symptom control are key factors of the therapy. Continuous dopaminergic stimulation is even more important at later stages with first fluctuations. In stages where conservative medical options have been exhausted continuous pump therapies with Duodopa and apomorphine are attractive options. Deep brain stimulation in the subthalamic nucleus has turned out in the last years, especially in younger patients, to be a highly successful treatment option. Deep drain stimulation requires, however, a close preoperative work-up and individual consideration of potential effects and side effects.

Schlüsselwörter

Parkinson - Tiefe Hirnstimulation - Apomorphin - L-Dopa

Key words

Parkinson’s disease - deep brain stimulation - apomorphine - Duodopa
 

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