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Nervenheilkunde 2025; 44(03): 86-97
DOI: 10.1055/a-2449-1461
Schwerpunkt

Multimodale Therapieangebote bei der Parkinson-Krankheit

Wo stehen wir heute?Multimodal therapy options for Parkinson’s diseaseWhere are we now?
Kerstin Ziegler
1   Abteilung für Neurologie und klinische Neurophysiologie mit Parkinson-Fachklinik, Schön Klinik, München Schwabing
,
Urban M. Fietzek
1   Abteilung für Neurologie und klinische Neurophysiologie mit Parkinson-Fachklinik, Schön Klinik, München Schwabing
2   Neurologische Klinik und Poliklinik, Klinikum der Universität München
,
Andrés O. Ceballos-Baumann
1   Abteilung für Neurologie und klinische Neurophysiologie mit Parkinson-Fachklinik, Schön Klinik, München Schwabing
3   Neurologische Klinik der Technischen Universität München
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Zusammenfassung

Die Parkinson-Krankheit (PK) ist durch komplexe motorische und nicht-motorische Symptome charakterisiert, die den Alltag und die Lebensqualität der Personen mit Parkinson (PmP) individuell beeinflussen. Multimodale Ansätze, die pharmakotherapeutische Interventionen und nicht-medikamentöse, aktivierende Verfahren, beispielsweise der Physio- und Ergotherapie, Logopädie oder Neuropsychologie kombinieren, gelten mittlerweile als optimales Behandlungsregime. Diese sollten den PmP, unter Berücksichtigung persönlicher Fragestellungen und Bedarfe, entlang des Kontinuums der PK – von der Diagnose bis zum Lebensende – empfohlen werden. Dafür stehen entsprechende Möglichkeiten im ambulanten, tagesklinischen und stationären Setting zur Verfügung. Spezialisierte, multimodale und in Netzwerken organisierte Therapieangebote des ambulanten Sektors wirken sich auf Mobilität, Lebensqualität und Komplikationen wie Stürze günstig aus, können aber in Deutschland, anders als in den Niederlanden, nur lokal in Anspruch genommen werden. Tageskliniken decken Bedarfe zwischen ambulanter und stationärer Versorgung ab und beeinflussen die Symptome der PK und Lebensqualität günstig. Im stationären Sektor wird für PmP in Deutschland die multimodale Parkinsonkomplex-Therapie (PKT) flächendeckend vorgehalten. Die zusammenfassende Beurteilung aus 8 publizierten Beobachtungsstudien (N = 1022) zeigt, dass die PKT motorische und nicht-motorische Symptome, Alltagsleistungen und die Lebensqualität signifikant, und für die PmP klinisch relevant, verbessert. Noch 4–6 Wochen nach der PKT sind positive Effekte hinsichtlich Motorik und Alltagsleistungen nachweisbar. Gerade jüngere PmP mit ausgeprägten motorischen Defiziten vor der PKT scheinen durch geringere motorische Symptome nach der PKT zu profitieren. Bestanden zu Beginn der PKT größere ADL-Defizite, scheint die Chance, Alltagsleistungen klinisch relevant durch die PKT verbessern zu können, höher. Ein jüngeres Alter, keine psychiatrischen oder kognitiven Störungen, eine gute Feinmotorik und ein gleichmäßigerer Gang mit geringer Schrittzeitvariabilität wirken sich dafür günstig aus.

Abstract

Parkinson’s disease (PD) is characterized by complex motor and non-motor symptoms that individually affect the activities of daily living (ADL) and quality of life of people with PD (PwPD). Multimodal treatment approaches that combine pharmacotherapeutic treatment and non-pharmacological, exercise-based interventions, such as physiotherapy, occupational therapy, speech therapy or neuropsychology, are now considered to be the optimal treatment regime. They should be recommended to PwPDs along the continuum of PD – from the diagnosis to the end of life – considering the patient’s personal issues and needs. Appropriate options are available in outpatient, day-clinic, and inpatient facilities. Specialized, multimodal health-care services organized in networks in the outpatient sector have a positive effect on mobility, quality of life and complications such as falls, but in Germany, unlike in the Netherlands, they can only be accessed regionally. Day-clinics cover needs between outpatient and inpatient care and have a beneficial effect on the PD-symptoms and quality of life. In the inpatient sector, the multimodal Parkinson’s complex therapy (MCT) is available nationwide for PwPD in Germany. The review of eight published observational studies (N = 1022) shows that MCT significantly improves motor and non-motor symptoms, ADL, and quality of life in a clinically meaningful response. Even four to six weeks after PKT, positive effects in terms of motor symptoms and ADL performance are still detectable. Younger PwPDs with more pronounced motor deficits before MCT appear to benefit from fewer motor symptoms after MCT. If PwPD suffer from greater ADL deficits at MCT-baseline, the chance of improving ADL-disabilities in a clinically meaningful way through the MCT appears to be higher. A younger age, no psychiatric or cognitive disorders, good fine motor skills and a more stable gait with low step time variability seem to have a favorable effect.

Schlüsselwörter

Motorische und nicht-motorische Symptome - Alltagsleistungen - Lebensqualität - multimodale Therapieangebote - ambulante Therapien - Tageskliniken - multimodale Parkinsonkomplex-Therapie

Keywords

Motor and non-motor symptoms - activities of daily living - quality of life - multimodal treatment approaches - outpatient treatment - day-clinic - multimodal Parkinson’s complex treatment


Publication History

Article published online:
04 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
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