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Nervenheilkunde 2008; 27(08): 738-745
DOI: 10.1055/s-0038-1627137
Originaler Artikel
Schattauer GmbH

Neues zur Pharmakotherapie und tiefen Hirnstimulation bei IPS

Update Parkinson’s disease: pharmacotherapy and deep brain stimulation
A. Ceballos-Baumann
1   Neurologisches Krankenhaus München, Zentrum für Parkinson-Syndrome und Bewegungsstörungen
› Institutsangaben
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Publikationsverlauf

Eingegangen am: 29. Mai 2008

angenommen am: 29. Mai 2008

Publikationsdatum:
22. Januar 2018 (online)

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Zusammenfassung

In den letzten drei Jahren sind ein neuer MAO-B-Hemmer, Rasagilin, zwei Non-Ergot-Dopaminagonisten, Rotigotin als erstes „Parkinsonpflaster“ und Piribedil zur Mono- als auch zur Kombinationstherapie mit DOPA des idiopathischem Parkinson-Syndroms (IPS) und der Cholinesterasehemmer Rivastigimin für die Demenz bei IPS zugelassen worden. Seit diesem Jahr ist außerdem Ropinirol in einer neuen retardierten Darreichungsform, das eine einmal täglich Gabe ermöglicht. Der Einsatz des parenteralen Non-Ergot- Dopaminagonisten Apomorphin als Penject zum bedarfsorientierten Einsatz oder über eine Micropumpe zur kontinuierlichen Infusion s. c. bei Off-Phasen wächst und eignet sich insbesondere für Patienten in Warteposition für die tiefe Hirnstimulation. Die COMT-Hemmer Entacapon und Tolcapon wirken nur über eine DOPA-Potenzierung und sind für „Wearing-off“-Phänomene hilfreich. Außerdem etabliert sich ein L-DOPA/Carbidopa-Gel zur kontinuierlichen duodenalen Infusion via PEG für ausgewählte Patienten mit schweren Off-Phasen.

Summary

During the last three years a new MAO-B inhibitor, rasagiline, two non-ergot dopamine agonists, rotigotine the first transdermal patch in Parkinson’s disease (PD), and piribedil, were licensed for all PD stages and the cholinesterase inhibitor rivastigmine for PD associated dementia. Ropinirole 24-hour prolonged release, another non-ergot dopamine agonist, will be introduced and allow once daily dosing of ropinirol. The non-ergot parenteral dopamine agonist apomorphine available as penject for on demand use or for continuous subcutaneous infusion in patients with offphases has an important role in patients with in complex motor fluctuations, also for those waiting for deep brain stimulation. Levodopa is still the gold standard in PD therapy. The COMT inhibitors entacapone and tolcapone work only by increasing the bio-availability of levodopa and are helpful for wearing-off phenomenons. Levodopa/carbidopa as a gel for continuous duodenal infusion via PEG represents an alternative to the apomorphine pump for selected patients.

Schlüsselwörter

Parkinson-Syndrom - Dopaminagonisten - DOPA - MAOB- Hemmer - COMT-Hemmer - Rivastigmin

Keywords

Parkinson’s disease - dopamine agonists - levodopa - MAO-B inhibitor - COMT inhibitor - rivastigmine
 

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