Pharmakologische Aspekte in der Neurorehabilitation

Zusammenfassung

Ärzte in der neurologischen Rehabilitation sind mit vielfältigen Aspekten der pharmakologischen Behandlung befasst. Über die Entscheidung angemessener antihypertensiver, antikonvulsiver oder antikoagulativer Behandlung hinaus ergeben sich aber zusätzliche Aspekte für die Hirnerholung positiv bzw. negativ beeinflussende pharmakologische Interventionen.

Von großer Wichtigkeit ist das Vermeiden sogenannter „Detrimental Drugs“ von deren pharmakologischen Profil klar ist, dass sie die Hirnerholung und Hirnreorganisation negativ beeinflussen. Dazu gehören klassische Antikonvulsiva wie Phenytoin und Barbiturate aber auch Benzodiazepine, Butophynone und Antihypertensiva wie Clonidin und Prazosin. Wenn irgend möglich sollte nach einer akuten neurologischen Hirnschädigung auf den Einsatz dieser Substanzen verzichtet werden.

Unter EBM-Kriterien konnte nur für Fluoxetin und Cerebrolysin bisher in größeren randomisiert kontrollierten Untersuchungen eine nachgewiesene Wirksamkeit zur Verbesserung der Funktionserholung nach Schlaganfall nachgewiesen werden. Beide Substanzen wirken offenbar auf multiple molekulare Mechanismen der Hirnerholung ein. Grundsätzlich kann der Einsatz von Antidepressiva (insbesondere SSRI) nach Schlaganfall auch bei nicht depressiven Schlaganfallpatienten zur Förderung der Funktionserholung empfohlen werden.

Auch der Einsatz von dopaminergen Substanzen zeigte in kleinen Studien positive Effekte auf die Funktionserholung nach Schlaganfall. Angesichts des geringen Nebenwirkungspotenzials kann der probatorische Einsatz von z. B. L-Dopa (100 mg am Tag) in der subakuten Phase nach Schlaganfall empfohlen werden.

Auch bei MS-Patienten kann der Einsatz von Antidepressiva zur Verbesserung der Lebensqualität empfohlen werden.

Bei Patienten mit eingeschränktem Bewusstseinszustand (Wachkoma, Minimal Conscious State) ist Amantadin bisher die einzige Substanz, für die in einer größeren randomisiert kontrollierten Studie eine zumindest transiente Wirksamkeit nachgewiesen werden konnte. Der Einsatz von Amantadin kann daher zur Verbesserung der Bewusstseinslage bei diesen Patienten empfohlen werden.

Abstract

Doctors in neurological rehabilitation are concerned with various aspects of pharmacological treatment. In addition to the choice of adequate antihypertensive, anticonvulsive or anticoagulant treatment, novel aspects of pharmacological interventions positively or negatively influencing brain recovery are also emerging.

Of great importance is the avoidance of so-called “detrimental drugs” from whose pharmacological profile it is clear that they negatively affect the brain recovery and brain reorganization. These include the classical anticonvulsants such as phenytoin and barbiturates but also benzodiazepines, butophynones and anti-hypertensives such as clonidine and prazosin. If possible, the use of these substances should be avoided after acute neurological brain damage.

Larger randomized controlled studies have shown fluoxetine and cerebrolysin to improve function after stroke. Both substances apparently act on multiple molecular mechanisms of brain recovery. In general, the use of antidepressants (especially SSRI) after stroke can also be recommended for non-depressive stroke patients to promote functional recovery.

The use of dopaminergic substances also showed positive effects on the functional recovery after stroke in small studies. Because of low potential for side effects, the probatory use of L-Dopa (100/mg per day) in the subacute phase after stroke can be recommended.

The use of antidepressants for improving the quality of life is also recommended in MS patients.

A large randomized controlled trial demonstrated transient efficacy of amantadine in patients with limited arousal (vegetative state, minimal conscious state). The use of amantadine can therefore be recommended for improving the level of consciousness in these patients.

Schlüsselwörter

Neurorehabilitation - Pharmakologie - Hirnerholung - Detrimental Drugs - Neuroprotektion

Key words

neurorehabilitation - pharmacology - brain recovery - neuroprotection - detrimental drugs - neuroprotection

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