Idiopathisches Parkinson-Syndrom

Zusammenfassung

Das idiopathische Parkinson-Syndrom (IPS) ist mit einer Prävalenz von 100 bis 200/100 000 die häufigste altersbedingte, neurodegenerative Bewegungserkrankung. Bei den über 65-Jährigen liegt die Prävalenz bei ca. 1 800/100 000, wobei diese aufgrund der demografischen Entwicklung noch weiter zunehmen wird. Von Bedeutung ist aufgrund der Lebenserwartung ein individuell angepasstes, langfristiges Therapieregime, das Mobilität, Lebensqualität und Komorbiditäten mit berücksichtigt und Komplikationen der Erkrankung sowie der Therapie auf ein Minimum reduziert. Neben den Kardinalsymptomen Bradykinese, Rigor, Tremor und posturale Instabilität sind nicht motorische Symptome im gesamten Verlauf der Erkrankung von enormer Bedeutung. Sie dienen einer frühen Diagnosestellung und sind zudem relevante, die Lebensqualität beeinflussende Symptome, die sich jedoch häufig einer medikamentösen Therapie entziehen. Am Beginn der Erkrankung ist die Auswahl der für den Patienten am besten geeigneten medikamentösen Therapie im Hinblick auf deren Wirkung sowie des möglichen Nebenwirkungsspektrum und Langzeitfolgen entscheidend. Spezifische Bewegungstherapien können in dieser Phase die motorischen Funktionen und möglicherweise langfristig die posturale Instabilität verbessern. Das mittlere und fortgeschrittene IPS ist von beginnenden Fluktuationen gekennzeichnet, die sich oft einer zufriedenstellenden, nebenwirkungsarmen medikamentösen Therapie entziehen. Invasive Therapien sollten dann in Erwägung gezogen werden. Zudem beeinflussen neuropsychiatrische Symptome wie Psychose, Depression und Demenz in dieser Phase erheblich die Lebensqualität der Patienten. Dieser Artikel beschreibt die Phasen des IPS und die zur Verfügung stehenden Therapien unter Berücksichtigung der aktuellen Leitlinien der Deutschen Gesellschaft für Neurologie.

Summary

Ideopathic Parkinson’s disease (PD) is the most common age-related neurodegenerative movement disorder. Its overall prevalence is 100 to 200/100 000 and increases upon aging up to about 1 800/100 000 in the population older than 65 years. Due to an increased life expectancy individualized therapeutic regimes are urgently needed to maintain a high level of quality of life without experiencing severe adverse effects due to the therapy or the progression of the disease. Besides the protoypical symptoms bradykinesia, rigidity, tremor and postural instability, non-motor symptoms have a major impact throughout the course of the disease. These symptoms are important to establish an early and accurate diagnosis. During the course of the disease they significantly reduce quality of life. Medical treatment at early disease stages needs to be selected with respect to its efficiency and putative long-term side effects. Different physical treatment strategies are able to improve motor symptoms and postural stability. Upon progression, motor fluctuations characterize the disease and medical treatment is frequently unable to completely control these symptoms. At that point, invasive strategies should be considered. In addition, neuropsychiatric symptoms such as psychosis, depression, and dementia have a major impact on the patient’s quality of life. This article highlights the different stages of PD and current therapeutic strategies with respect to the guidelines of the German Society of Neurology.

Schlüsselwörter

Morbus Parkinson - idiopathisches Parkinson-Syndrom - Bradykinese - Tremor - Rigor - posturale Instabilität

Keywords

Parkinson’s disease - bradykinesia - tremor - rigidity - postural instability

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