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Der Nuklearmediziner 2012; 35(02): 93-101
DOI: 10.1055/s-0032-1312638
Neurodegenerative Erkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Klinische Differenzialdiagnose des Parkinson-Syndroms

Clinical Differential Diagnosis of Parkinson Syndromes
F. Amtage
1   Abteilung Neurologie, Universitätsklinikum Freiburg
,
S. Hellwig
2   Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
,
P. T. Meyer
3   Abteilung Nuklearmedizin, Universitätsklinikum Freiburg
› Author Affiliations
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Publication History

Publication Date:
12 July 2012 (online)

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Zusammenfassung

Die Differenzialdiagnose des Parkinson-Syndroms umfasst neurodegenerative sowie sekundäre Formen des hypokinetisch-rigiden Syndroms. In dieser Übersichtsarbeit soll vorwiegend auf neurodegenerative Erkrankungen eingegangen werden, den Morbus Parkinson, die Demenz mit Lewy-Körper, die Multisystematrophie, die Progressive Supranukleäre Blickparese und die Kortikobasale Degeneration. Die klinische Diagnosefindung anhand gültiger Diagnosekriterien ist eine Aufgabe, die nach eingehender Anamnese und aufmerksamer neurologischer und neuropsychologischer Untersuchung in vielen Fällen gelingt. Pharmakologische Testungen sowie laborchemische, elektrophysiologische und bildgebende Verfahren untermauern die Verdachtsdiagnose. Gelegentlich muss die endgültige Diagnose im zeitlichen Verlauf aufgrund einer Änderung des klinischen Befundes angepasst werden.

Von relevantem therapeutischem und prognostischem Interesse erscheint auf den ersten Blick nur die Unterteilung in ein idiopathisches Parkinson-Syndrom und atypische Parkinson-Syndrome. Diese Sicht trügt, da sich gerade auf dem Gebiet der spezifischen und unter anderem neuroprotektiven Therapien bei MSA oder PSP ein Anwendungsfeld öffnet und viele therapeutische Ansätze derzeit in Studien untersucht werden. Daher ist die Differenzialdiagnose innerhalb der atypischen Parkinson-Syndrome schon längst keine akademische Frage mehr, sondern von großer Bedeutung, um für die Zukunft wirkungsvolle Therapien zu etablieren. Die nuklearmedizinische Diagnostik wird zur korrekten Einteilung der Patienten sicherlich einen großen Beitrag liefern.

Abstract

Differential diagnosis of Parkinson Syndromes includes neurodegenerative and symptomatic disorders of the hypokinetic-rigid syndrome. This review focuses on neurodegenerative diseases as Parkinson’s disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration. The diagnosis is routinely based on clinical findings which are achieved by a careful history and a comprehensive neurological and neuropsychological examination. Pharmacological tests as well as laboratory and electrophysiological investigations and imaging techniques are currently used to affirm the suspected diagnosis based on established diagnostic criteria. Occasionally, the final diagnosis must be revised due to the occurence of new symptoms in the course of the disease.

It is a common supposition that only differentiation between Parkinson’s disease and atypical Parkinson syndromes is of therapeutic and prognostic interest. However, this is not the case, since the correct identification of the right patient population is mandatory for the development of new therapeutical and even neuroprotective strategies for atypical Parkinson syndromes in future trials. Certainly, the nuclear medicine will contribute to this challenge.

Schlüsselwörter

Morbus Parkinson - Demenz mit Lewy-Körper - Multisystematrophie - Progressive Supranukleäre Blickparese - Kortikobasale Degeneration - Atypisches Parkinson-Syndrom

Key words

Parkinson’s disease - dementia with Lewy bodies - multiple system atrophy - progressive supranuclear palsy - corticobasal degeneration - atypical Parkinson syndrome
 

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