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Nervenheilkunde 2021; 40(10): 803-813
DOI: 10.1055/a-1592-3610
Schwerpunkt

Geräteunterstützte Therapien bei fortgeschrittenem idiopathischem Parkinson-Syndrom

Device assisted therapies in advanced Parkinson disease patients
Andrés Ceballos-Baumann∗
1   Abteilung für Neurologie und klinische Neurophysiologie mit Parkinson-Fachklinik, Schön Klinik München Schwabing
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ZUSAMMENFASSUNG

Wirkungsschwankungen der Dopaminersatztherapie gelten als eines der am meisten störende Symptome bei Patienten mit idiopathischem Parkinson-Syndrom (IPS) im fortgeschrittenen Stadium. Es besteht Konsens, dass bei Patienten, die Levodopa mehr als 5-mal täglich benötigen und trotz optimaler oraler levodopa- und nicht levodopabasierter oraler/transdermaler Therapien weiterhin schwere, störende Off-Phasen (länger als 1–2 Stunden am Tag) aufweisen, geräteunterstützte Therapien erwogen werden können. 3 Arten von geräteunterstützten Therapien (GUT) stehen zur Verfügung: die subkutane Infusion von Apomorphin, die Infusion in das Jejunum über eine perkutanen endoskopischen Gastrostomie (PEG) eines Levodopa/Carbidopa intestinalen Gels (LCIG) mit oder ohne Entacapon (LECIG) und die tiefe Hirnstimulation (THS). Das Angebot an den äußerlich tragbaren batteriebetriebenen Medikamenten-Pumpen sowie der Systeme für die tiefe Hirnstimulation wird größer. Die Entscheidung, welche der GUT zum Zuge kommt, sollte in einem ausführlichen Abwägungsprozess zusammen mit dem Patienten und seinem Umfeld zustande kommen. Dabei sind die Präferenzen des Patienten und seiner Bezugspersonen sowie Alter, Verlauf des Parkinson-Syndroms, Ausmaß axialer Symptome, Komorbiditäten, neuropsychiatrischer und kognitiver Befund zu berücksichtigen. Die Entscheidungsfindung und die weitere Betreuung sollte idealerweise an Zentren stattfinden, die Erfahrungen in allen GUT haben.



Publikationsverlauf

Artikel online veröffentlicht:
05. Oktober 2021

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