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Fortschr Neurol Psychiatr 2016; 84(S 01): S18-S23
DOI: 10.1055/s-0042-107245
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Dysphagie im Verlauf der Parkinson-Krankheit: Pathophysiologie, Diagnostik und Therapie

Dysphagia in Parkinson’s Disease: Pathophysiology, Diagnosis and Therapy
I. Suttrup
,
T. Warnecke
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Publication History

Publication Date:
14 June 2016 (online)

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Zusammenfassung

Oropharyngeale und ösophageale Dysphagien sind ein häufiges, aber zu selten diagnostiziertes Symptom der Parkinson-Krankheit. Mehr als 80 % aller Parkinsonpatienten entwickeln eine klinisch relevante Dysphagie im Verlauf der Erkrankung. Folgen hiervon sind eine Reduktion der Lebensqualität, eine erschwerte Einnahme der Medikation, ein unzureichender Effekt von Dopaminergika sowie Malnutrition und Aspirationspneumonien, die bei Parkinsonpatienten im fortgeschrittenen Stadium der Erkrankung die häufigste Todesursache darstellen. Die Pathophysiologie der parkinsonbedingten Schluckstörungen ist nicht eindeutig geklärt. Es wird eine multifaktorielle Genese angenommen, die Beeinträchtigungen dopaminerger und nichtdopaminerger Bahnsysteme des zentralen Schlucknetzwerks sowie zusätzliche periphere neuromuskuläre Einflüsse umfasst. Als diagnostische Screening-Methoden stehen Parkinson-spezifische Fragebögen sowie ein modifizierter Wassertest zur Verfügung. Die Goldstandards der apparativen Dysphagiediagnostik sind die endoskopische Evaluation des Schluckaktes (FEES) sowie die Videofluoroskopie (VFSS), die sich in ihrer Aussagekraft ergänzen. Zur Evaluation von ösophagealen Schluckstörungen steht zudem die High-Resolution-Manometrie (HRM) zur Verfügung. Als therapeutische Option kann neben einer störungsmusterspezifischen logopädischen Therapie auch eine Optimierung der dopaminergen Medikation sinnvoll sein. Eine erfolgversprechende neue Methode stellt zudem ein intensives Training der expiratorischen Muskelkraft (EMST) dar. Die Tiefe Hirnstimulation hat dagegen keinen klinisch relevanten Effekt auf die Schluckfunktion von Parkinsonpatienten.

Abstract

Oropharyngeal and esophageal dysphagia are a frequent, but seldom diagnosed symptom of Parkinson’s disease (PD). More than 80 % of patients with PD develop dysphagia during the course of their disease leading to a reduced quality of life, complicated medication intake, malnutrition and aspiration pneumonia, which is a major cause of death in PD. The underlying pathophysiology is poorly understood. Impaired dopaminergic and non-dopaminergic mechanisms of the cortical swallowing network as well as peripheral neuromuscular involvement have been suggested to contribute to its multifactorial genesis. Diagnostic screening methods include PD-specific questionnaires and a modified water test. Fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), which complement each other, are the gold standard for evaluation of PD-related dysphagia. For evaluation of esophageal dysphagia, the high-resolution manometry (HRM) may be a helpful tool. In addition to dysphagia-specific treatment by speech and language therapists (SLTs), optimized dopaminergic medication is a meaningful therapeutic option. A promising novel method is intensive training of expiratory muscle strength (EMST). Deep brain stimulation does not seem to have a clinically relevant effect on swallowing function in PD.

Schlüsselwörter

Dysphagie - Schluckstörung - Parkinson-Krankheit - FEES - Logopädie

Key words

dysphagia - swallowing dysfunction - Parkinson’s disease - FEES - speech and language therapy
 

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