Indikationsstellung für invasive medikamentöse Therapien

Zusammenfassung

Im Verlauf der Langzeitbehandlung des idiopathischen Parkinson-Syndroms entwickeln sich Wirkfluktuationen und Dyskinesien, aber auch nicht-motorische Störungen (autonome Dysfunktionen, psychiatrische Störungen), die sich mit den oralen Kombinationstherapien zunehmend schlechter ausgleichen lassen. Mit der kontinuierlichen subcutanen Apomorphin-Gabe und der duodenalen L-Dopa-Infusionstherapie (Duodopa-Pumpe) stehen 2 medikamentöse invasive, aber auch ökonomisch aufwändige alternative Therapieoptionen zur Verfügung. Nachfolgend werden die Differenzialindikationen beider Verfahren und ihr klinischer Stellenwert diskutiert.

Abstract

In the advanced stages of Parkinson’s disease, oral pharmacotherapy is often insufficient to obtain stable control of motor symptoms such as wearing-off phenomena, dyskinesias or non-motor symptoms. Invasive therapies like continuous subcutaneous infusion of apomorphine or the duodenal infusion of levodopa are promising options for the treatment of severe response fluctuations. In the present review the differential indications for these medical invasive treatments will be discussed.

Schlüsselwörter

Apomorphin - Duodopa - motorische Wirkfluktuationen - nicht-motorische Störungen - fortgeschrittenes idiopathisches Parkinson-Syndrom

Keywords

apomorphine - duodopa - motor flucutations - non-motor symptoms - advanced Parkinson’s disease

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