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Aktuelle Neurologie 2014; 41(10): 579-585
DOI: 10.1055/s-0034-1395638
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Optimales Timing der Tiefen Hirnstimulation bei M. Parkinson

Optimal Timing of Deep Brain Stimulation for Parkinsonʼs Disease
S. J. Groiss
1   Institut für klinische Neurowissenschaften und Medizinische Psychologie & Neurologische Klinik – Zentrum für Bewegungsstörungen und Neuromodulation, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
,
A. Schnitzler
1   Institut für klinische Neurowissenschaften und Medizinische Psychologie & Neurologische Klinik – Zentrum für Bewegungsstörungen und Neuromodulation, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
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Publication History

Publication Date:
08 January 2015 (online)

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Zusammenfassung

Die Tiefe Hirnstimulation (THS) gilt als bedeutendste Entwicklung in der Behandlung des idiopathischen Parkinson-Syndroms (IPS) seit der Einführung von Levodopa. Bisher wurde die THS beim IPS allerdings erst im weit fortgeschrittenen Krankheitsstadium als Ultima Ratio zur Behandlung medikamentös austherapierter, schwerer motorischer Fluktuationen und Dyskinesien oder medikamentenrefraktärer Tremores eingesetzt. Oft hat die Erkrankung jedoch bereits in mittleren Krankheitsstadien erhebliche psychosoziale Auswirkungen und führt z. B. durch Berufsunfähigkeit oder soziale Isolation zu einer deutlichen Einschränkung der Lebensqualität. Neuere Studienergebnisse zeigen, dass eine THS des Nucleus subthalamicus (STN) im Vergleich zur medikamentösen Therapie die Lebensqualität auch bei Patienten mit motorischen Komplikationen in früheren Stadien signifikant und relevant verbessern kann. Zur möglichst langfristigen Erhaltung der Lebensqualität ist deshalb die STN-THS bereits in früheren Krankheitsstadien nach dem Auftreten von motorischen Komplikationen als Therapieoption in Betracht zu ziehen.

Abstract

Deep brain stimulation (DBS) is considered the most important development in the treatment of Parkinsonʼs disease (PD) since the introduction of levodopa. So far, DBS has been used as ultima ratio for the treatment of severe motor fluctuations and dyskinesias or refractory tremor in advanced PD. However, the disease frequently leads to considerable psychosocial consequences such as occupational disability or social isolation with consecutive impairment in quality of life already at earlier disease stages. Recent research has shown DBS of the subthalamic nucleus (STN) to be superior to best medical treatment in improving quality of life and motor symptoms in PD patient with motor complication at an earlier disease stage. STN-DBS should be considered as treatment option earlier in the disease course after the occurrence of motor fluctuations preferably for long term maintenance of quality of life.

Schlüsselwörter

Tiefe Hirnstimulation - EARLYSTIM - Morbus Parkinson

Keywords

Deep brain stimulation - EARLYSTIM - Parkinsonʼs disease
 

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