Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom

Die tiefe Hirnstimulation (THS) kann bei idiopathischem Parkinson-Syndrom (IPS) durch Linderung der motorischen Symptome und Reduktion der Medikamentendosis die Lebensqualität deutlich verbessern. Dieser Beitrag beleuchtet Aspekte der präoperativen Beratung, Operationsplanung und -technik, sowie postoperatives Patient*innenmanagement, Auswirkungen der THS auf Sprechen und Sprache, sowie langfristige Nachbetreuung und Prognose.

Abstract

Deep brain stimulation (DBS) has been approved in Europe for the treatment of idiopathic Parkinson's syndrome (PD) since 1998. Indications for DBS in PD are fluctuations in efficacy with on-off phases and dyskinesia under drug therapy and/or a drug-resistant tremor. Careful determination of the indication and preoperative consultation of the patient are essential for the success of the treatment. DBS improves the quality of life by improving motor symptoms and reducing the dose of medication. Possible side effects of DBS are speech and language disorders, psychological changes and dyskinesia.

Schlüsselwörter

Idiopathisches Parkinson-Syndrom - IPS - tiefe Hirnstimulation - THS - Rigor - Tremor - Dysarthrie

Key Words

idiopathic parkinsonian syndrome - PD - deep brain stimulation - DBS - Rigidity - Tremor - dysarthria

Publication History

Article published online:
29 November 2022

• Literatur

• 1 Krüger R, Klein C. Genetik der Parkinson-Krankheit. Medizin Genet 2013; 25: 215-220
• 2 Ascherio A, Schwarzschild MA. The epidemiology of Parkinsonʼs disease: risk factors and prevention. Lancet Neurol 2016; 15: 1257-1272
• 3 Postuma RB, Berg D, Stern M. et al. MDS clinical diagnostic criteria for Parkinsonʼs disease. Mov Disord 2015; 30: 1591
• 4 Deutsche Gesellschaft für Neurologie (DGN). S3-Leitlinie Idiopathisches Parkinson-Syndrom – Kurzversion. AWMF-Register-Nummer: 030–010. Berlin: 2016
• 5 Santin MDN, Voulleminot P, Vrillon A. et al. Impact of subthalamic deep brain stimulation on impulse control disorders in Parkinson’s disease: A Prospective Study. Mov Disord 2021; 36: 750-757
• 6 Schuepbach WM, Rau J, Knudsen K. et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 2013; 368: 610-622
• 7 Shih LC, Tarsy D. Deep brain stimulation for the treatment of atypical parkinsonism. Mov Disord 2007; 22: 2149-2155
• 8 Deep-Brain Stimulation for Parkinson’s Disease 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
• 9 Bunjo Z, Bacchi S, Chandran AS. et al. Orthostatic hypotension following deep brain stimulation in Parkinson’s disease: a systematic review. Br J Neurosurg 2020; 34: 587-590
• 10 Zong H, Meng F, Zhang Y. et al. Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson’s disease. Clin Interv Aging 2019; 14: 1159-1166
• 11 Bjerknes S, Skogseid IM, Hauge TJ. et al. Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease. NPJ Parkinsons Dis 2020; 6: 29
• 12 Tanaka Y, Tsuboi T, Watanabe H. et al. Longitudinal speech change after subthalamic nucleus deep brain stimulation in Parkinsonʼs disease patients: a 2-year prospective study. J Parkinsons Dis 2020; 10 : 131-140
• 13 Karlsson F, Malinova E, Olofsson K. et al. Voice tremor outcomes of subthalamic nucleus and zona incerta deep brain stimulation in patients with Parkinson disease. J Voice 2019; 33 : 545-549
• 14 Leimbach F, Atkinson-Clement C, Wilkinson L. et al. Dissociable effects of subthalamic nucleus deep brain stimulation surgery and acute stimulation on verbal fluency in Parkinsonʼs disease. Behav Brain Res 2020; 388: 112621
• 15 Kluin KJ, Mossner JM, Costello JT. et al. Motor speech effects in subthalamic deep brain stimulation for Parkinsonʼs disease. J Neurosurg 2022; 28: 1-7
• 16 Demmel W, Pfister R. Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom - Planung, operatives Vorgehen und Risiken. Nervenheilkunde 2021; 40: 794-801
• 17 Montaurier C, Morio B, Bannier S. et al. Mechanisms of body weight gain in patients with Parkinsonʼs disease after subthalamic stimulation. Brain 2007; 130 : 1808-1818
• 18 Dembek TA, Reker P, Visser-Vandewalle V. et al. Directional DBS increases side-effect thresholds-A prospective, double-blind trial. Mov Disord 2017; 32 : 1380-1388
• 19 Van Lancker Sidtis D, Rogers T, Godier V. et al. Voice and fluency changes as a function of speech task and deep brain stimulation. J Speech Lang Hear Res 2010; 53 : 1167-1177
• 20 Wyman-Chick KA. Verbal Fluency in Parkinsonʼs Patients with and without Bilateral Deep Brain Stimulation of the Subthalamic Nucleus: A Meta-analysis. J Int Neuropsychol Soc 2016; 22 : 478-485
• 21 Ehlen F, Krugel LK, Vonberg I. et al. Intact lexicon running slowly – prolonged response latencies in patients with subthalamic DBS and verbal fluency deficits. PLoS One 2013; 8 : e79247
• 22 Leimbach F, Atkinson-Clement C, Wilkinson L. et al. Dissociable effects of subthalamic nucleus deep brain stimulation surgery and acute stimulation on verbal fluency in Parkinsonʼs disease. Behav Brain Res 2020; 388: 112621
• 23 Vos SH, Kessels RPC, Vinke RS. et al. The Effect of Deep Brain Stimulation of the Subthalamic Nucleus on Language Function in Parkinsonʼs Disease: A Systematic Review. J Speech Lang Hear Res 2021; 64 : 2794-2810
• 24 Le Goff F, Derrey S, Lefaucheur R. et al. Decline in verbal fluency after subthalamic nucleus deep brain stimulation in Parkinsonʼs disease: a microlesion effect of the electrode trajectory?. J Parkinsons Dis 2015; 5 : 95-104
• 25 Fenoy AJ, McHenry MA, Schiess MC. Speech changes induced by deep brain stimulation of the subthalamic nucleus in Parkinson disease: involvement of the dentatorubrothalamic tract. J Neurosurg 2017; 126 : 2017-2027
• 26 Greif TR, Askari A, Cook Maher A. et al. Anterior lead location predicts verbal fluency decline following STN-DBS in Parkinsonʼs disease. Parkinsonism Relat Disord 2021; 92: 36-40
• 27 Grover T, Georgiev D, Kalliola R. et al. Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinsonʼs Disease: A Double-Blind Study. J Parkinsons Dis 2019; 9 : 141-151
• 28 Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol 2019; 15: 234-242
• 29 Weiss D, Wächter T, Breit S. et al. Involuntary eyelid closure after STN-DBS: evidence for different pathophysiological entities. J Neurol Neurosurg Psychiatry 2010; 81: 1002-1007
• 30 Bangash OK, Thorburn M, Garcia-Vega J. et al. Drowning hazard with deep brain stimulation: case report. J Neurosurg 2016; 124: 1513-1516
• 31 Reuter S, Deuschl G, Falk D. et al. Uncoupling of dopaminergic and subthalamic stimulation: life-threatening DBS withdrawal syndrome. Mov Disord 2015; 30: 1407-1413