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Fortschr Neurol Psychiatr 2024; 92(12): 502-508
DOI: 10.1055/a-2238-1641
Übersichtsarbeit

Synergien statt Rivalitäten – die missverstandenen Rollen von kontinuierlicher intrajejunaler Levodopatherapie und Tiefer Hirnstimulation in der Behandlung des Morbus Parkinson – eine Expertenmeinung

Synergies Instead of Rivalries – Expert Opinion on the Misunderstood Roles of Continuous Intrajejunal Levodopa Therapy and Deep Brain Stimulation in the Treatment of Parkinson̓s Disease
Nils Schröter 
1   Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Freiburg im Breisgau, Germany (Ringgold ID: RIN234507)
,
Wolfgang H. Jost 
2   Parkinson-Klinik Ortenau, Wolfach, Germany
,
Michel Rijntjes
1   Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Freiburg im Breisgau, Germany (Ringgold ID: RIN234507)
,
Volker Coenen
3   Abteilung für Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum Freiburg, Freiburg, Germany (Ringgold ID: RIN14879)
,
Sergiu Groppa
4   Klinik für Neurologie, Johannes Gutenberg University Hospital Mainz, Mainz, Germany (Ringgold ID: RIN39068)
,
Bastian Sajonz
3   Abteilung für Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum Freiburg, Freiburg, Germany (Ringgold ID: RIN14879)
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Zusammenfassung

In der Therapie des Morbus Parkinson kommen sowohl die intrajejunale Applikation von Levodopa/Carbidopa Intenstinalgel (LCIG) und seit kurzem Levodpoa/Carbidopa/Entacapon Intestinalgel (LECIG) als auch die Tiefe Hirnstimulation (THS) zum Einsatz. Obwohl diese Verfahren sich in Ihren Wirkungs- und Nebenwirkungsprofilen sowie dem Zeitpunkt des Einsatzes deutlich unterscheiden, wird die Therapieeinleitung beider Verfahren häufig simultan erst bei Erreichen eines fortgeschrittenen Erkrankungsstadiums geprüft. Aus Sicht der Autoren erreichen Patienten aber mitunter zu unterschiedlichen Zeitpunkten ihrer Erkrankung die Meilensteine für die Indikationsstellung eines der jeweiligen Verfahren. Hierbei spielt die individuelle Krankheitsentwicklung eine tragende Rolle. Die Idee, dass alle Patienten zu einem bestimmten und definierten Zeitpunkt nahezu gleichzeitig Kandidat für ein bestimmtes Verfahren werden, erscheint den Autoren als falsch. Im Rahmen dieser Übersichtsarbeit werden darum die Therapieformen hinsichtlich ihrer Wirksamkeit für verschiedene Ziel-Symptome vorgestellt, die simultane Abwägung über den Zeitpunkt des Einsatzes hinterfragt und eine individualisierte Therapieevaluation – mit Augenmerk auf Lebensqualität und gesellschaftliche Teilhabe – abgeleitet mit dem Ziel das Konzept des „Entweder – Oder“ aufzuweichen und in ein patientenzentriertes „Welches – Wann“ zu überführen.

Abstract

In the therapy of Parkinson̓s disease, both the intrajejunal administration of Levodopa/Carbidopa Intestinal Gel (LCIG) and, more recently, Levodopa/Carbidopa/Entacapone Intestinal Gel (LECIG), as well as deep brain stimulation (DBS), are employed. These approaches differ significantly in their efficacy and side effect profiles, as well as the timing of their use. Yet, the initiation of therapy for both methods is often simultaneously considered when patients have reached an advanced stage of the disease. From the authors' perspective, however, patients may reach the milestones for the indication of one of these respective treatments at different points in the course of the disease. Individual disease progression plays a pivotal role in this regard. The concept that all patients become candidates for a specific treatment at a predefined time appears erroneous to the authors. In the context of this review, therefore, the therapeutic modalities are presented in terms of their efficacy for different symptoms, the notion of simultaneous timing of their initiation is questioned, and an individualized therapy evaluation is derived, with a focus on quality of life and participation.

Schlüsselwörter

Morbus Parkinson - LCIG - LECIG - DBS - Intensivierte Therapieverfahren

Key words

Parkinson̓s Disease - Deep brain stimulation - Levodopa/Carbidopa/Entacapone Intestinal Gel - Levodopa/Carbidopa Intestinal Gel, - Intensified therapeutic procedures


Publication History

Received: 27 September 2023

Accepted after revision: 30 December 2023

Article published online:
12 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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