Morbus Parkinson: Aktuelle Standards in Diagnostik und Therapie

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

• Literatur

• 1 Fahn S, Elton RL , the UPDRS Development Committee. The Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne D, et al. (eds) Recent Developments in Parkinson’s Disease. Florham Park, NJ: Macmillan Health Care Information; 1987: 153-163; 293–304
• 2 Oertel WH, Deuschl G, Eggert K et al. Parkinson-Syndrome: Diagnostik und Therapie. In: Diener HC, Putzki N, (ed) Leitlinien für Diagnostik und Therapie in der Neurologie.. Stuttgart: Thieme; 2008: 82-112
• 3 Tolosa E, Wenning G, Poewe W. The diagnosis of Parkinson’s disease. Lancet Neurol 2006; 5: 75-86
• 4 Jokinen P, Brück A, Aalto S et al. Impaired cognitive performance in Parkinson’s disease is related to caudate dopaminergic hypofunction and hippocampal atrophy. Parkinsonism Relat Disord 2009; 15: 88-93
• 5 Benamer TS, Patterson J, Grosset DG et al. Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: the [123I]-FP-CIT study group. Mov Disord 2000; 15: 503-510
• 6 Eggers C, Kahraman D, Fink GR et al. Akinetic-rigid and tremor-dominant Parkinson’s disease patients show different patterns of FP-CIT Single photon emission computed tomography. Mov Disord 2011; 26: 416-423
• 7 Kahraman D, Eggers C, Schicha H et al. Visual assessment of dopaminergic degeneration pattern in (123)I-FP-CIT SPECT differentiates patients with atypical parkinsonian syndromes and idiopathic Parkinson’s disease. J Neurol 2012; 259: 251-260
• 8 Schwarz J. Nuclear medicine imaging in patients with Parkinson’s syndrome: an update. Nervenarzt 2010; 81: 1160-1167
• 9 Rascol O, Schelosky L. 123I-metaiodobenzylguanidine scintigraphy in Parkinson’s disease and related disorders. Mov Disord 2009; 24 (Suppl. 02) 732-S741
• 10 Vlaar AM, Bouwmans A, Mess WH et al. Transcranial duplex in the differential diagnosis of parkinsonian syndromes: a systematic review. J Neurol 2009; 256: 530-538
• 11 Haehner A, Hummel T, Reichmann H. Olfactory dysfunction as a diagnostic marker for Parkinson’s disease. Expert Rev Neurother 2009; 9: 1773-1779
• 12 Doty RL. Olfaction in Parkinson’s disease. Parkinsonism Relat Disord 2007; 13 (Suppl. 03) 225-S228
• 13 Murphy C, Schubert CR, Cruickshanks KJ et al. Prevalence of olfactory impairment in older adults. JAMA 2002; 288: 2307-2312
• 14 Hummel T, Sekinger B, Wolf SR et al. ‘Sniffin’ sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 1997; 22: 39-52
• 15 Olanow CW, Rascol O, Hauser R et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease. N Engl J Med 2009; 361: 1268-1278
• 16 Ondo WG, Sethi KD, Kricorian G. Selegiline orally disintegrating tablets in patients with Parkinson disease and „wearing off“ symptoms. Clin Neuropharmacol 2007; 30: 295-300
• 17 Crosby NJ, Deane KH, Clarke CE. Amantadine for dyskinesia in Parkinson’s disease. Cochrane Database Syst Rev 2003; 2: CD003467
• 18 Rabey JM, Sagi I, Huberman M et al. Rasagiline mesylate, a new MAO-B inhibitor for the treatment of Parkinson’s disease: a double-blind study as adjunctive therapy to levodopa. Clin Neuropharmacol 2000; 23: 324-330
• 19 Merims D, Balas M, Peretz C et al. Rater-blinded, prospective comparison: quetiapine versus clozapine for Parkinson’s disease psychosis. Clin Neuropharmacol 2006; 29 (06) 331-337
• 20 Emre M, Aarsland D, Albanese A et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509-2518
• 21 Timmermann L, Maier F, Eggers C et al. Dementia in morbus Parkinson: reasonable diagnostics and rational therapy. Fortschr Neurol Psychiatr 2010; 78: 513-518
• 22 Barone P, Poewe W, Albrecht S et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson’s disease: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2010; 9: 573-580
• 23 Trenkwalder C, Kies B, Rudzinska M et al. Rotigotine effects on early morning motor function and sleep in Parkinson’s disease: a double-blind, randomized, placebo-controlled study (RECOVER). Mov Disord 2011; 26: 90-99
• 24 Diener HC, Putzki N (Hrsg) Leitlinien für die Diagnostik und Therapie in der Neurologie. 4. überarbeitete Aufl. Stuttgart: Thieme; 2008
• 25 Garcia Ruiz PJ, Sesar Ignacio A, Ares Pensado B et al. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease with motor fluctuations: a multicenter study. Mov Disord 2008; 23: 1130-1136
• 26 Katzenschlager R, Hughes A, Evans A et al. Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson’s disease: a prospective study using single-dose challenges. Mov Disord 2005; 20: 151-157
• 27 De Gaspari D, Siri C, Landi A et al. Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2006; 77: 450-453
• 28 Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol 2009; 8: 464-474
• 29 Kurth MC, Tetrud JW, Tanner CM et al. Double-blind, placebo-controlled, crossover study of duodenal infusion of levodopa/carbidopa in Parkinson’s disease patients with ‘on-off’ fluctuations. Neurology 1993; 43: 1698-1703
• 30 Nyholm D, Askmark H, Gomes-Trolin C et al. Optimizing levodopa pharmacokinetics: intestinal infusion versus oral sustained-release tablets. Clin Neuropharmacol 2003; 26: 156-163
• 31 Nyholm D, Nilsson Remahl AI, Dizdar N et al. Duodenal levodopa infusion monotherapy vs. oral polypharmacy in advanced Parkinson disease. Neurology 2005; 64: 216-223
• 32 Eggert K, Schrader C, Hahn M et al. Continuous jejunal levodopa infusion in patients with advanced parkinson disease: practical aspects and outcome of motor and non-motor complications. Clin Neuropharmacol 2008; 31: 151-166
• 33 Devos D. Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord 2009; 24: 993-1000
• 34 Deuschl G, Schade-Brittinger C, Krack P et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355: 896-908
• 35 Hilker R, Benecke R, Deuschl G et al. Deep brain stimulation for Parkinson’s disease. Consensus recommendations of the German Deep Brain Stimulation Association. Nervenarzt 2009; 80: 646-655
• 36 Charles PD, Van Blercom N, Krack P et al. Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 2002; 59: 932-934
• 37 Fasano A, Romito LM, Daniele A et al. Motor and cognitive outcome in patients with Parkinson’s disease 8 years after subthalamic implants. Brain 2010; 133: 2664-2676
• 38 Follett KA, Weaver FM, Stern M et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med 2010; 362: 2077-2091
• 39 Lyons KE, Koller WC, Wilkinson SB et al. Long term safety and efficacy of unilateral deep brain stimulation of the thalamus for parkinsonian tremor. J Neurol Neurosurg Psychiatry 2001; 71: 682-684
• 40 Stefani A, Lozano AM, Peppe A et al. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson’s disease. Brain 2007; 130 (06) 1596-1607
• 41 Ferraye MU et al. Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson’s disease. Brain 2010; 133 (01) 205-214
• 42 Voges J, Kiening K, Krauss JK et al. Neurosurgical standards in deep brain stimulation: consensus recommendations of the German Deep Brain Stimulation Association. Nervenarzt 2009; 80: 666-672
• 43 Hamani C, Lozano AM. Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg 2006; 84: 248-251
• 44 Mallet L, Schüpbach M, N’Diaye K et al. Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior. Proc Natl Acad Sci U S A 2007; 104: 10661-10666
• 45 Coenen VA, Honey CR, Hurwitz T et al. Medial forebrain bundle stimulation as a pathophysiological mechanism for hypomania in subthalamic nucleus deep brain stimulation for Parkinson’s disease. Neurosurgery 2009; 64: 1106-1114 ; discussion 1114–1115
• 46 Voon V, Kubu C, Krack P et al. Deep brain stimulation: neuropsychological and neuropsychiatric issues. Mov Disord 2006; 21 (Suppl. 14) S305-S327
• 47 Voon V, Krack P, Lang AE et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain 2008; 131 (10) 2720-2728
• 48 Wojtecki L, Vesper J, Schnitzler A. Interleaving programming of subthalamic deep brain stimulation to reduce side effects with good motor outcome in a patient with Parkinson’s disease. Parkinsonism Relat Disord 2011; 17: 293-294
• 49 Parkinson-Study-Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001; 345: 956-963
• 50 Ebersbach G, Ebersbach A, Edler D et al. Comparing exercise in Parkinson’s disease – the Berlin LSVT(R)BIG study. Mov Disord 2010; 25 (12) 1902-1908
• 51 Sapir S, Spielman J, Ramig LO et al. Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 2007; 50: 899-912