Tiefe Hirnstimulation bei Morbus Parkinson

Die tiefe Hirnstimulation ist eine etablierte und evidenzbasierte Therapieoption für die Behandlung des fortgeschrittenen Morbus Parkinson. Es handelt sich um eine symptomatische Behandlung mit dem primären Ziel, die Lebensqualität des Patienten zu verbessern. Der operative Eingriff gilt als relativ komplikationsarm.

Abstract

Deep brain stimulation is an established and evidence-based therapeutic option for the treatment of advanced Parkinsonʼs disease. Main indication and inclusion criteria are the presence of idiopathic Parkinsonism with motor fluctuations and/or dyskinesias and/or with medication refractory tremor, a significant improvement of akinesia/rigidity in response to dopaminergic medication, the absence of relevant cognitive deficits and other significant comorbidities. DBS neurosurgery has a low risk of complications. The clinical programming should follow an established monopolar review algorithm. Regular follow-up visits are required for stimulation monitoring.

Schlüsselwörter

Morbus Parkinson - Tiefe Hirnstimulation - Nucleus subthalamicus

Key words

Parkinsonʼs disease - Deep brain stimulation - Subthalamic nucleus

Publication History

Article published online:
05 June 2020

• Literatur

• 1 Hartmann CJ, Fliegen S, Groiss SJ. et al. An update on best practice of deep brain stimulation in Parkinson’s disease. Ther Adv Neurol Disord 2019; 12: 1756286419838096
• 2 Fahn S, Oakes D, Shoulson I. et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med 2004; 351: 2498-2508
• 3 Ray Chaudhuri K, Poewe W, Brooks D. Motor and Nonmotor Complications of Levodopa: Phenomenology, Risk Factors, and Imaging Features. Mov Disord Off J Mov Disord Soc 2018; 33: 909-919
• 4 Park K, Oeda T, Kohsaka M. et al. Low body mass index and life prognosis in Parkinson’s disease. Parkinsonism Relat Disord 2018; 55: 81-85
• 5 Benabid AL, Pollak P, Gross C. et al. Acute and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease. Stereotact Funct Neurosurg 1994; 62: 76-84
• 6 McIntyre CC, Grill WM, Sherman DL. et al. Cellular effects of deep brain stimulation: model-based analysis of activation and inhibition. J Neurophysiol 2004; 91: 1457-1469
• 7 Gradinaru V, Mogri M, Thompson KR. et al. Optical deconstruction of parkinsonian neural circuitry. Science 2009; 324: 354-359
• 8 Oswal A, Litvak V, Sauleau P. et al. Beta reactivity, prospective facilitation of executive processing, and its dependence on dopaminergic therapy in Parkinson’s disease. J Neurosci Off J Soc Neurosci 2012; 32: 9909-9916
• 9 Lhommée E, Wojtecki L, Czernecki V et al. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson’s disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol. 2018; 17: 223–231. Im Internet: http://www.sciencedirect.com/science/article/pii/S1474442218300358
• 10 Derost P-P, Ouchchane L, Morand D, Ulla M. et al. Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population?. Neurology 2007; 68: 1345-1355
• 11 Schuepbach WMM, Rau J, Knudsen K. et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 2013; 368: 610-622
• 12 Fenoy AJ, Simpson RK. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 2014; 120: 132-139
• 13 Volkmann J, Herzog J, Kopper F. et al. Introduction to the programming of deep brain stimulators. Mov Disord 2002; 17: S181-S187. Im Internet:. https://onlinelibrary.wiley.com/ doi/abs/10.1002/mds.10162
• 14 Dayal V, Grover T, Tripoliti E. et al. Short Versus Conventional Pulse-Width Deep Brain Stimulation in Parkinson’s Disease: A Randomized Crossover Comparison. Mov Disord Off J Mov Disord Soc 2020; 35: 101-108
• 15 Moreau C, Defebvre L, Destée A. et al. STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology 2008; 71: 80-84
• 16 Dembek TA, Reker P, Visser-Vandewalle V. et al. Directional DBS increases side-effect thresholds-A prospective, double-blind trial. Mov Disord Off J Mov Disord Soc 2017; 32: 1380-1388
• 17 Rebelo P, Green AL, Aziz TZ. et al. Thalamic Directional Deep Brain Stimulation for tremor: Spend less, get more. Brain Stimulat 2018; 11: 600-606. Im Internet:. http://www.sciencedirect.com/science/article/pii/S1935861X17310318
• 18 Deuschl G, Schade-Brittinger C, Krack P. et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355: 896-908
• 19 Williams A, Gill S, Varma T. et al. Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 2010; 9: 581-591
• 20 Okun MS, Gallo BV, Mandybur G. et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 2012; 11: 140-149
• 21 Weaver FM, Follett K, Stern M. et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 2009; 301: 63-73
• 22 Krack P, Volkmann J, Tinkhauser G. et al. Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence-Based Therapy. Mov Disord Off J Mov Disord Soc 2019; 34: 1795-1810
• 23 Witt K, Daniels C, Reiff J. et al. Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol 2008; 7: 605-614