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Aktuelle Neurologie 2014; 41(05): 267-276
DOI: 10.1055/s-0034-1376952
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Dysarthrie bei der Parkinson-Krankheit – Phänomenologie, Pathophysiologie und therapeutische Ansätze

The Hypokinetic Dysarthria of Parkinson’s Disease – Phenomenology, Pathophysiology and Therapeutic Approaches
S. Skodda
1   Neurologie, Knappschaftskrankenhaus, Ruhr-Universität, Bochum
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Publication History

Publication Date:
18 June 2014 (online)

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Zusammenfassung

Bei der hypokinetischen Dysarthrie des idiopathischen Parkinson-Syndroms (IPS) handelt es sich um eine multidimensionale Störung, die bei der Mehrzahl der Patienten zu einer relevanten Kommunikationsstörung führen kann. Neben dem pathognomonischen Befund einer leisen, monotonen Sprechweise („monopitch and monoloudness“) kommt es in unterschiedlichem Ausmaß auch zu Beeinträchtigungen von Sprechatmung, Stimmbildung (Phonation), Aussprache (Artikulation) und Sprechgeschwindigkeit und -rhythmus. Während in frühen Erkrankungsstadien gewisse Aspekte der Dysarthrie auf dopaminerge Therapie ansprechen, sind insbesondere in weiter fortgeschrittenen Erkrankungsstadien die medikamentösen Therapiemaßnahmen meist wirkungslos. Die Tiefe Hirnstimulation/THS kann im Einzelfall eine gewisse Besserung distinkter Sprechmodalitäten wie Stimmqualität oder Lautstärke bewirken; bei einer Subgruppe von Patienten es kann aber auch zu einer relevanten Zunahme der Dysarthrie unter der THS kommen. Therapie der Wahl ist aktuell eine Stimm-/Sprechtherapie, die bereits frühzeitig vor einer relevanten Einschränkung der Kommunikationsfähigkeit initiiert werden sollte. Aktuell gibt es allerdings keine Daten darüber, welche Form der Logopädie zur Behandlung der hypokinetischen Dysarthrie besonders geeignet ist, wobei ein spezielles Verfahren mit Fokus auf einer Verbesserung der Lautstärke (LSVT®) sich zumindest in kleineren Studien als effektiv gezeigt hat. Zum aktuellen Zeitpunkt ist die hypokinetische Dysarthrie beim Morbus Parkinson eine therapeutische Herausforderung, die ein multidisziplinäres und auf die individuelle Symptomkonstellation des einzelnen Patienten angepasstes Therapiekonzept erfordert.

Abstract

The hypokinetic dysarthria of Parkinson’s ­disease (PD) is a multidimensional impairment which can induce a considerable communication disorder with relevant impact on quality of life in the majority of patients in the course of the disease. The typical pattern of Parkinsonian dysarthria consists of a reduction of loudness and intona­tion variability (“monopitch and monoloudness”) often in combination with alterations of speech respiration, phonation, articulation and temporal aspects of speech as speech rate and rhythm. Some aspects of hypokinetic dysarthria seem to respond to dopaminergic therapy especially in the early stages of disease, however, with advancing disease progression, pharmacological interventions become disappointing and typically cannot prevent the progressive impairment of overall speech intelligibility. Deep brain stimulation/DBS, although very effective as symptomatic therapy of motor impairment in advanced PD, has been reported to ameliorate some distinctive speech modalities in individual pa­tients; however, a subgroup of patients experience relevant deterioration of speech function under DBS. Up till now, speech/language therapy (SLT) is estimated as the gold standard in the treatment of Parkinsonian dysarthria, although none of the existing therapeutic SLT approaches have proven its effectiveness according to evidence-based medicine standards. The best documented SLT method is LSVT® which focusses on the amelioration of disturbed loudness of speech in PD. Therapy of dysarthria in PD is often challenging and ideally follows multidisciplinary therapeutic concepts adapted to the individual patient's needs.

Schlüsselwörter

idiopathisches Parkinson-Syndrom - hypokinetische Dysarthrie - dopaminerge Therapie - Tiefe Hirnstimulation - Stimm-/Sprechtherapie

Keywords

Parkinson’s disease - hypokinetic dysarthria - dopaminergic therapy - deep brain stimulation - speech therapy
 

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