Die tiefe Hirnstimulation in der Therapie des idiopathischen Parkinson-Syndroms

Zusammenfassung

Die tiefe Hirnstimulation stellt mittlerweile ein etabliertes therapeutisches Verfahren für Patienten in einem fortgeschrittenen Stadium der Parkinson-Krankheit dar. Der chirurgische Eingriff kommt insbesondere für solche Patienten in Frage, die unter den Langzeitkomplikationen der dopaminergen Therapie leiden und mit konservativen Therapieregimen nicht mehr zufriedenstellend behandelt werden können. Als Zielpunkte der Stimulation stehen heutzutage der Nucleus subthalamicus (STN) und der Globus pallidus internus (GPi) zur Verfügung. Sowohl die STN- als auch die GPi-Stimulation führen zu einer deutlichen Verbesserung der Off-Phasen-Symptome sowie der Dyskinesien; die STN-Stimulation wird jedoch aufgrund einer deutlicheren Reduktion der dopaminergen Medikation und des niedrigeren Energieverbrauches als überlegen angesehen. Allerdings steht eine kontrollierte randomisierte Studie zum Vergleich zwischen STN- und GPi-Stimulation noch aus. Die Stimulation im Nucleus ventralis intermedius (Vim) des Thalamus wird heute beim Morbus Parkinson nur noch selten eingesetzt und kommt nur bei älteren Patienten mit einem im Vordergrund stehenden Ruhetremor und gering ausgeprägten akinetisch-rigiden Symptomen in Betracht.

Summary

During the past years deep brain stimulation (DBS) has been adopted as a promising therapeutic procedure for the treatment of advanced Parkinson’s disease (PD). It is considered a therapeutic approach for those patients who are affected by long term complications of dopaminergic therapy as motor fluctuations and severe dyskinesias. The subthalamic nucleus (STN) and the internal part of the globus pallidus (GPi) are targeted for DBS. Several studies have proved the efficacy of STN-DBS and GPi-DBS in amelioration of off-motor-symptoms and dyskinesia. STN-DBS is considered superior since it allows a marked reduction of antiparkinsonian medication with relatively low energy consumption. However, there is no controlled clinical trial available comparing directly efficacy of STN- and GPi-DBS. Thalamic stimulation in the ventral intermediate nucleus (Vim) should be considered only for older patients with severe tremor but few other parkinsonian symptoms.

Schlüsselwörter

Tiefe Hirnstimulation - Parkinson-Syndrom - Globus pallidus internus - Nucleus subthalamicus

Keywords

Deep brain stimulation - Parkinson’s disease - subthalamic nucleus - globus pallidus internus

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