Aktuelles in der Parkinson-Therapie - Differenzialdiagnose und Therapie des idiopathischen Parkinson-Syndroms

Zusammenfassung

Die präzise klinische Differenzierung des idiopathischen Parkinson-Syndrom (IPS) von anderen Parkinson-Syndromen ist Grundvoraussetzung für eine rationale, sichere und gesundheitsökonomisch sinnvolle Therapie. Nur ein Teil der Patienten mit Parkinson-Symptomen leidet an dem gut behandelbaren IPS im engeren Sinne. Heute sind acht Dopaminagonisten einschließlich des Apomorphins zur subkutanen Injektion, verschiedene L-Dopa-Darreichungsformen, COMT- und MAO-Hemmer, Amantadin, mit Einschränkungen das Budipin, das Clozapin und die tiefe Hirnstimulation für die Therapie dieser Erkrankung zugelassen. In Situationen, in denen auch eine optimierte medikamentöse Feineinstellung keinen Behandlungserfolg mehr bringt, hat bei Patienten mit schweren Dopa-Wirkungsschwankungen (On-off-Phänomen), Dyskinesien und Tremor inzwischen die tiefe Hirnstimulation („Hirnschrittmacher”) einen festen Platz erobert. Anticholinergika sollten auch bei Tremor-Dominanz nur noch in Ausnahmefällen eingesetzt werden. Cholinesterasehemmer sind hilfreich bei nicht kognitiven Demenz-Symptomen ohne die Parkinson-Symptomatik zu verschlechtern. Kurz vor der europäischen Zulassung stehen momentan spezifische Medikamente gegen Dopa-Dyskinesien. Und mit der Implantation dopaminerger Retinazellen besteht eine weitere Perspektive zur Therapie des idiopthischen Parkinson-Syndroms, die sich bereits in einer fortgeschrittenen Phase der klinischen Prüfung befindet.

Summary

The precise differentiation of Parkinson's disease (PD) from other forms of parkinsonism is the basis for a rationale, safe and pharmacoeconomically sound therapy. Drugs are usually unsatisfactory in other parkinsonian syndromes besides Parkinson's disease proper. Parkinson's disease is a well characterised syndrome which represents only a part of the various causes of parkinsonism. Eight dopamine agonists including apomorphine for subcutaneous injections, various distinct levodopa preparations, amantadine, COMT- and MAO-inhibitors, with restrictions also budipine, clozapine, and deep brain stimulation represent approved therapies for Parkinson's disease. Deep brain stimulation is emerging as treatment strategy for patients with severe on-off fluctuations, levodopa dyskinesias and tremor otherwise refractory to medical therapy. Anticholinergics should be only prescribed exceptionally even in tremor dominant Parkinson's disease. Cholinesterase-inhibitors are effective in non-cognitive symptoms of dementia without worsening parkinsonism. Specific compounds for the management of levodopa induced dyskinesias may gain approval shortly. The implantation of dopaminergic retinal cells represents a new perspective which is already in an advanced stage of clinical trial.

Key Words

Parkinson's disease - levodopa - dopamine agonists - deep brain stimulation - cholinesterase inhibitors - cell implantation

Literatur

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1 Deutsche-Parkinson-Vereinigung e.V., Moselstr. 31, 41464 Neuss

2 deprenyl and tocopherol antioxidative therapy of parkinsonism

Anschrift des Verfassers