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DOI: 10.1055/s-0028-1090160
© Georg Thieme Verlag KG Stuttgart · New York
Tiefe Hirnstimulation bei Dystonie: Wann und Wo?
Übersicht Sommer 2008[1] Deep Brain Stimulation in Dystonia: When and Where?Survey Summer 2008Publication History
Publication Date:
02 April 2009 (online)
Zusammenfassung
Dystonien umfassen eine klinisch und genetisch heterogene Gruppe von Bewegungsstörungen. Sie können mit einem erheblichen Verlust an Lebensqualität inklusive Invalidität einhergehen (z. B. Rollstuhlpflichtigkeit). Medikamentöse Ansätze sind insbesondere bei generalisierten Dystonieformen limitiert. Die Einführung der tiefen Hirnstimulation für die Behandlung von Bewegungsstörungen (zunächst essenzieller Tremor und fortgeschrittene Parkinson-Syndrome) hat auch die Behandlungsmöglichkeiten für dystone Bewegungsstörungen erweitert. So können heute Hirnregionen mithilfe der sogenannten tiefen Hirnstimulation (populär: Hirnschrittmacher-Therapie, DBS = deep brain stimulation) funktionell beeinflusst werden, d. h. reversibel und ohne bleibende Schädigung durch Gabe von elektrischen Impulsen. In 2 multizentrischen, geblindeten Studien konnte eine Besserung von dystonen Symptomen bei primären generalisierten und segmentalen Dystonien von ca. 50 % nach tiefer Hirnstimulation im Pallidum belegt werden. Das Verfahren ist in der EU aufgrund dieser Ergebnisse seit Anfang 2006 für die Behandlung von primär generalisierten und segmentalen Dystonien zugelassen. In der folgenden Übersichtsarbeit (Stand: August 2008) werden die Ergebnisse und die Erfolgsaussichten zusammengefasst und ein Ausblick für andere Dystonieerkrankungen hinsichtlich einer möglichen Besserung durch eine Hirnschrittmachertherapie dargestellt, inklusive pädiatrischer DBS-Indikationen bei Dystonien.
Abstract
Dystonic disorders comprise a heterogeneous group of movement disorders, reflecting different disease entities. They are accompanied by significant loss of quality of life and may lead to significant motor disablement including wheel chair dependency. Medical therapeutic options are limited, especially in generalised dystonia. The introduction of deep brain stimulation for the treatment of movement disorders (e. g., essential tremor and advanced Parkinson's disease) has opened new therapeutic avenues also for dystonic disorders. Thus, regions deeply located in the brain may be functionally influenced by the reversible application of electrical charge via stereotactically implanted electrodes (deep brain stimulation) without structurally lesioning brain tissue. In 2 multicentre, blinded studies, an improvement of dystonic symptoms in patients with primary generalised or segmental dystonia of approximately 50 % following deep brain stimulation of the internal pallidum has been documented, which led to approval of deep brain stimulation in the EU for the treatment of primary generalised and segmental dystonias. The following review summarises the results and the perspectives of deep brain stimulation in dystonia, also with respect to emerging paediatric indications.
Schlüsselwörter
tiefe Hirnstimulation - Dystonie - Pallidum
Key words
deep brain stimulation - dystonia - pallidum
1 Dieser Artikel stellt eine aktualisierte Version von Kupsch et al., PsychoNeuro 2007; 33: 278–288 dar.
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1 Dieser Artikel stellt eine aktualisierte Version von Kupsch et al., PsychoNeuro 2007; 33: 278–288 dar.
Prof. Dr. med. Andreas Kupsch
Leiter der Ambulanz für Bewegungsstörungen, Charité, Neurologie, Campus Virchow
Augustenburger Platz 1
13353 Berlin
Email: andreas.kupsch@charite.de
URL: http://www.charite.de/bewegungsstoerungen