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Fortschr Neurol Psychiatr 2010; 78(8): 445-455
DOI: 10.1055/s-0029-1245500
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Therapie autonomer Dysfunktion bei Patienten mit extrapyramidalen Erkrankungen

Treatment of Autonomic Dysfunction in Patients with Extrapyramidal DisordersC. Friedrich1 , H. Reichmann1 , T. Ziemssen1
  • 1Autonomes und neuroendokrinologisches Funktionslabor, Neurologische Klinik und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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Publication Date:
20 July 2010 (online)

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Zusammenfassung

Obwohl allgemein angenommen wird, dass extrapyramidale Krankheiten allein das (extrapyramidal) motorische System beeinflussen, werden häufig nicht motorische Symptome wie Verhaltensauffälligkeiten, Dysautonomien, Schlafstörungen und sensorische Störungen beobachtet. Autonome Dysfunktionen sind wichtiger Bestandteil extrapyramidaler Erkrankungen (wie des idiopathischen Parkinson-Syndroms, der Multisystematrophie, der progressiven supranukleären Blickparese, der Lewy-Body-Demenz), dennoch werden sie oft formal nicht mit bewertet und daher häufig falsch diagnostiziert. Aber gerade die Symptome der Störungen des autonomen Nervensystems nehmen im Allgemeinen mehr Einfluss auf die Lebensqualität als die motorischen Symptome. Eine geeignete symptomorientierte Diagnostik und eine symptomatische Behandlung als Teil einer interdisziplinären Herangehensweise können von größtem Nutzen für die Patienten sein. Leider sind doppelblinde, randomisierte, kontrollierte Studien selten, was zur Folge hat, dass die meisten Empfehlungen nicht evidenzbasiert sind.

Abstract

Although extrapyramidal diseases are commonly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction as an important clinical component of extrapyramidal disease (idiopathic Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies) is often not formally assessed and thus frequently misdiagnosed. Symptoms of autonomic dysfunction in general impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can provide a great benefit for the patient. Unfortunately, double-blind, randomised, controlled studies are scarce with the consequence that most recommendations are not based on the highest level of evidence. This review presents a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunctions in various extrapyramidal syndromes.

Schlüsselwörter

extrapyramidale Erkrankungen - Morbus Parkinson - autonome Dysfunktion - Multisystematrophie

Keywords

extrapyramidal disease - Parkinson’s disease - autonomic dysfunction - multiple system atrophy

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Dr. Tjalf Ziemssen

Autonomes und neuroendokrinologisches Funktionslabor, Neurologische Klinik und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden

Fetscherstr. 74

01307 Dresden

Email: Ziemssen@web.de