Download PDF
Nervenheilkunde 2008; 27(05): 403-412
DOI: 10.1055/s-0038-1627324
Original- und Übersichtsarbeiten - Original and Review Articles
Schattauer GmbH

Tiefe Hirnstimulation bei der Parkinsonschen Krankheit

Deep brain stimulation in patients with Parkinson‘s disease
J. Herzog
1   Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
,
G. Deuschl
1   Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
,
J. Volkmann
1   Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
› Author Affiliations
Further Information

Publication History

Eingegangen am: 21 September 2008

angenommen am: 05 January 2008

Publication Date:
20 January 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die tiefe Hirnstimulation des Nucleus subthalamicus (STNStimulation) ist eine hocheffektive Therapieoption zur Behandlung von Patienten mit Morbus Parkinson. Die STNStimulation führt zu einer deutlichen Verbesserung der OFF-Phasen-Symptome um etwa 50% und der hypokinetischen Fluktuationen und Dyskinesien um ca. 70%. Darüber hinaus kann unter der STN-Stimulation die dopaminerge Medikation um etwa 50% reduziert werden. In kontrollierten Studien konnte gezeigt werden, dass durch diese symptomatischen Effekte bei operierten Patienten die Lebensqualität signifikant besser ist als bei vergleichbaren Patienten unter optimierter medikamentöser Therapie. Derzeit wird die STN-Stimulation meist in fortgeschrittenen Krankheitsstadien angewendet, wenn durch eine orale Medikation keine Verbesserung mehr erzielt werden kann. Zukünftige Studien werden zeigen, ob die STN-Stimulation auch früher eingesetzt werden sollte, um sekundären Komplikationen der Erkrankung vorzubeugen und die bereits früh einsetzende psychosoziale Behinderung bei Parkinsonpatienten abzumildern.

Summary

Subthalamic deep brain stimulation (STN-DBS) has been established as a highly effective therapeutic approach for amelioration of motor symptoms in Parkinson’s disease (PD). STN-DBS results in a mean reduction of off-motor symptoms by about 50% and hypo- and hyperkinetic fluctuations by 70%. Simultaneously, the dopaminergic medication can be reduced by about 50%. It has been shown that no other therapy is as effective as STN-DBS in improving life quality of PD patients. Nowadays, STN-DBS is recommended for patients in progressive stages of PD who will not improve by adjustment of medication. Future studies will show whether STN-DBS might also be an option earlier in the course of the disease to prevent motor complications as well as social maladaption of PD patients.

Schlüsselwörter

Tiefe Hirnstimulation - Morbus Parkinson - subthalamischer Kern

Keywords

Deep brain stimulation - Parkinson‘s disease - subthalamic nucleus
 

  • Literatur

  • 1 Pramipexole vs levodopa as initial treatment for Parkinson disease: A randomized controlled trial. Parkinson Study Group. Jama 2000; 284 (Suppl. 15) 1931-1938.
    CrossrefPubMedSearch in Google Scholar
  • 2 Agid Y, Schupbach M, Gargiulo M, Mallet L, Houeto JL, Behar C. et al. Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so?. J Neural Transm Suppl 2006; 70: 409-414.
    CrossrefPubMedSearch in Google Scholar
  • 3 Benabid AL, Deuschl G, Lang AE, Lyons KE, Rezai AR. Deep brain stimulation for Parkinson’s disease. Mov Disord 2006; 21 (Suppl. 14) S168-170.
    CrossrefPubMedSearch in Google Scholar
  • 4 Charles PD, Van Blercom N, Krack P, Lee SL, Xie J, Besson G. et al. Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 2002; 59 (Suppl. 06) 932-934.
    CrossrefPubMedSearch in Google Scholar
  • 5 Deuschl G, Herzog J, Kleiner-Fisman G, Kubu C, Lozano AM, Lyons KE. et al. Deep brain stimulation: postoperative issues. Mov Disord 2006; 21 (Suppl. 14) S219-237.
    CrossrefPubMedSearch in Google Scholar
  • 6 Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K. et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355 (Suppl. 09) 896-908.
    CrossrefPubMedSearch in Google Scholar
  • 7 Dupont E, Andersen A, Boas J, Boisen E, Borgmann R, Helgetveit AC. et al. Sustained-release Madopar HBS compared with standard Madopar in the long-term treatment of de novo parkinsonian patients. Acta Neurol Scand 1996; 93 (Suppl. 01) 14-20.
    CrossrefPubMedSearch in Google Scholar
  • 8 Kleiner-Fisman G, Herzog J, Fisman DN, Tamma F, Lyons KE, Pahwa R. et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006; 21 (Suppl. 14) S290-304.
    CrossrefPubMedSearch in Google Scholar
  • 9 Koller WC, Hutton JT, Tolosa E, Capilldeo R. Immediate- release and controlled-release carbidopa/ levodopa in PD: a 5-year randomized multicenter study. Carbidopa/Levodopa Study Group. Neurology 1999; 53 (Suppl. 05) 1012-1019.
    CrossrefPubMedSearch in Google Scholar
  • 10 Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL. Stimulation of subthalamic nucleus alleviates tremor in Parkinson’s disease. Lancet 1997; 350 9092 1675.
    CrossrefPubMedSearch in Google Scholar
  • 11 Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E. et al. Deep brain stimulation: preoperative issues. Mov Disord 2006; 21 (Suppl. 14) S171-196.
    CrossrefPubMedSearch in Google Scholar
  • 12 Langston JW, Widner H, Goetz CG, Brooks D, Fahn S, Freeman T. et al. Core assessment program for intracerebral transplantations (CAPIT). Mov Disord 1992; 7 (Suppl. 01) 2-13.
    PubMedSearch in Google Scholar
  • 13 Montaurier C, Morio B, Bannier S, Derost P, Arnaud P, Brandolini-Bunlon M. et al. Mechanisms of body weight gain in patients with Parkinson’s disease after subthalamic stimulation. Brain 2007; 130 Pt 7 1808-1818.
    CrossrefPubMedSearch in Google Scholar
  • 14 Poewe WH, Lees AJ, Stern GM. Low-dose L-dopa therapy in Parkinson’s disease: a 6-year follow-up study. Neurology 1986; 36 (Suppl. 11) 1528-1530.
    CrossrefPubMedSearch in Google Scholar
  • 15 Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med 2000; 342 (Suppl. 20) 1484-1491.
    CrossrefPubMedSearch in Google Scholar
  • 16 Rinne UK, Bracco F, Chouza C, Dupont E, Gershanik O, Marti Masso JF. et al. Early treatment of Parkinson’s disease with cabergoline delays the onset of motor complications. Results of a doubleblind levodopa controlled trial. The PKDS009 Study Group. Drugs 1998; 55 (Suppl. 01) 23-30.
    CrossrefPubMedSearch in Google Scholar
  • 17 Rodrigues JP, Walters SE, Watson P, Stell R, Mastaglia FL. Globus pallidus stimulation improves both motor and nonmotor aspects of quality of life in advanced Parkinson’s disease. Mov Disord 2007; 22 (Suppl. 13) 1866-1870.
    CrossrefPubMedSearch in Google Scholar
  • 18 Schrag A. Quality of life and depression in Parkinson’s disease. J Neurol Sci 2006; 248 1–2 151-157.
    CrossrefPubMedSearch in Google Scholar
  • 19 Schrag A, Banks P. Time of loss of employment in Parkinson’s disease. Mov Disord 2006; 21 (Suppl. 11) 1839-1843.
    CrossrefPubMedSearch in Google Scholar
  • 20 Schupbach M, Gargiulo M, Welter ML, Mallet L, Behar C, Houeto JL. et al. Neurosurgery in Parkinson disease: a distressed mind in a repaired body?. Neurology 2006; 66 (Suppl. 12) 1811-1816.
    CrossrefPubMedSearch in Google Scholar
  • 21 Seif C, Herzog J, van der Horst C, Schrader B, Volkmann J, Deuschl G. et al. Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol 2004; 55 (Suppl. 01) 118-120.
    CrossrefPubMedSearch in Google Scholar
  • 22 Visser-Vandewalle V, Temel Y, Colle H, van der Linden C. Bilateral high-frequency stimulation of the subthalamic nucleus in patients with multiple system atrophy--parkinsonism. Report of four cases. J Neurosurg 2003; 98 (Suppl. 04) 882-887.
    CrossrefPubMedSearch in Google Scholar
  • 23 Voges J, Hilker R, Botzel K, Kiening KL, Kloss M, Kupsch A. et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord 2007; 22 (Suppl. 10) 1486-1489.
    CrossrefPubMedSearch in Google Scholar
  • 24 Volkmann J. Update on surgery for Parkinson’s disease. Curr Opin Neurol 2007; 20 (Suppl. 04) 465-469.
    PubMedSearch in Google Scholar