Medikamentöse Therapie bei Patienten mit Morbus Parkinson nach Tiefer Hirnstimulation

Zusammenfassung

Patienten mit Morbus Parkinson und Tiefer Hirnstimulation durchlaufen postoperativ oftmals eine dramatische Umstellung der medikamentösen Therapie. Da viele Patienten wegen eines medikamentös nicht ausreichend therapierbaren L-Dopa-Langzeitsyndroms operiert werden, muss auch die postoperative Therapie diesem Krankheitsstadium gerecht werden. Daher ist der Einsatz von lang wirksamen Dopaminagonisten, z. B. in transdermaler Applikation oder in retardierter Form, zu empfehlen. Diese sollten, wenn notwendig, erst im zweiten Schritt mit L-Dopa, direkt in Kombination mit einem COMT-Hemmer und ggf. einem MAO-B-Hemmer gegeben werden. Spezifische postoperative Probleme wie eine Dysarthrie, eine Verschlechterung des Gangbildes und Stürze, eine demenzielle Entwicklung, aber auch neuropsychiatrische Veränderungen wie hypomanische Zustände, Apathie und Depression oder eine Impulskontrollstörung machen spezifische Interventionen in Stimulation und medikamentöser Therapie notwendig.

Abstract

After deep brain stimulation it is often necessary to dramatically change the medication of patients with Parkinson's disease. As many patients have been operated on due to a long-term Dopa syndrome, the postoperative therapy must be in line with the needs of this disease stage. That is why the use of long-acting dopamine agonists, for example, by transdermal delivery or by the use of retarded dopa preparations is recommended. If necessary, they should be given only in a second step, in combination with a COMT inhibitor and an MAO inhibitor. Specific postoperative problems like dysarthria, a worsening of the gait and drops, dementia, but also neuropsychiatric symptoms like hypomania, apathia and depression or an impulse control disorder necessitate specific interventions in stimulation and drug therapy.

Schlüsselwörter

Tiefe Hirnstimulation - Parkinson - medikamentöse Therapie - Fluktuationen - Freezing

Keywords

deep brain stimulation - Parkinson's disease - drug therapy - fluctuation - freezing

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1 Hilker, Frankfurt a. M.; Lange, Regensburg; Schrader, Hannover; Sixel-Döring, Kassel; Timmermann, Köln; Vogel, Wiesbaden; Advisory board: Bennecke, Rostock; Deuschl, Kiel; Kupsch, Berlin; Volkmann, Kiel.