Nucleus subthalamicus Stimulation bei Morbus Parkinson

Zusammenfassung

Die operative Behandlung des Morbus Parkinson (MP) mittels Hochfrequenz-Tiefenhirnstimulation (DBS) im Bereich des Nucleus subthalamicus (STN) hat sich im Verlauf der letzten Jahre beinahe als Routineverfahren zur Behandlung fortgeschrittener Erkrankungsstadien etabliert. Die DBS zielt dabei vor allem auf die Behandlung von Patienten mit schweren motorischen Komplikationen wie Wirkungsfluktuationen und Dyskinesien ab. Zur Erzielung eines guten operativen Ergebnisses ist die sorgfältige Selektion geeigneter Patienten eine unabdingbare Voraussetzung. Hierbei ist vor allem auf ein gutes Ansprechen der Symptome auf L-Dopa sowie auf eine geringe psychiatrische und internistische Komorbidität zu achten. Langzeitstudien zur STN DBS konnten mittlerweile signifikante und anhaltende Besserungen der motorischen Fähigkeiten im medikamentösen Off über 3 bis 5 Jahre nachweisen. Der Wirkungsmechanismus der DBS wird aber weiterhin schlecht verstanden. Diverse elektrophysiologische Daten sprechen gegen die nahe liegende Hypothese einer rein läsionellen Inaktivierung des überaktiven STN. Vielmehr sprechen neuere Daten eher für eine aktive Stimulation neuronaler Elemente durch die STN DBS. Unter Umständen könnte die DBS hierdurch in der Art eines Störsenders eine rhythmische prokinetische Aktivität in beim MP pathologisch oszillierende Netzwerke einspeisen.

Summary

High-frequency deep brain stimulation (DBS) within the subthalamic nucleus (STN) has become a widely-used surgical treatment for advanced stages of idiopathic Parkinson’s disease (PD). Severe motor complications like fluctuations and dyskinesias are the main indication for DBS in PD. Careful selection of patients suitable for DBS includesa good response to levodopa anda lack of major psychiatric and general medical comorbidity. Longterm studies of STN DBS have reporteda significant and sustained improvement of motor symptoms even 3 to 5 years post-operatively. Nevertheless, the main mechanism of action of DBS is still unclear. New data suggest that beyond simple ablation of the hyperactive STN, DBS rather allows an active modulation of neuronal circuits. Here, DBS could superimpose rhythmical activity onto pathologically oscillating neuronal networks in PD.

Schlüsselwörter

Morbus Parkinson - Tiefenhirnstimulation - Nucleus subthalamicus

Keywords

Parkinson’s disease - deep brain stimulation - subthalamic nucleus

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