Schluckstörungen und Therapiemöglichkeiten bei typischen und atypischen Parkinson-Syndromen

Zusammenfassung

Schluckstörungen sind ein häufiges Symptom bei Parkinson-Syndromen. Die Zahlen in der Literatur schwanken zwischen 18 und 100%. In der Regel treten manifeste Schluckstörungen im späteren Verlauf der Erkrankung auf. Sie können als negativer Prädiktor gewertet werden. Die Symptome können in allen Phasen des Schluckvorgangs auftreten, häufig sind Störungen der ösophagealen Phase. Da Penetrationen und Aspirationen häufig “still” verlaufen, ist die Aufdeckung dieser Symptomatik in einer klinischen und instrumentellen Diagnostik (endoskopische und/oder videofluoroskopische Schluckuntersuchung) von großer Bedeutung, um Komplikationen wie Aspirationspneumonien zu vermeiden und die Lebensqualität zu verbessern. Da medikamentös nur wenig für die Verbesserung der Schluckfunktionen erreicht werden kann, basiert die Schlucktherapie auf funktionellen Methoden und Strategien zur Kompensation und Adaptation, mit dem Ziel, Dehydratation, Mangelernährung, Aspiration und Aspirationspneumonien zu verhindern. Es gibt sehr wenige klinische Studien, die die Effektivität dieser Methoden belegen. Deshalb sollten Outcome-Erhebungen auf klinisch relevante Parameter abzielen, z. B. Ernährungsskalen, Gewichtszunahme oder Lebensqualität.

Summary

Swallowing disorders are a frequent symptom in Parkinson´s disease. In literature the prevalence is given between 18 and 100%. Normally, they occur in the late stages of the disease as a prognostic hint. The symptoms may be present in all phases of the swallowing, mainly in the esophageal phase. Symptoms like penetration and aspiration occur frequently “silent”. Therefore the evaluation by clinical and instrumented diagnostics (endoscopic and/or video fluoroscopic evaluation) are urgent to prevent complications like aspiration pneumonia and to enhance quality of life. Since there is only little improvement of swallowing function by medication, swallowing therapy is mainly based on functional methods and strategies for compensation and adaptation with the aim to prevent dehydration, malnutrition, aspiration and aspiration pneumonia. But there are few clinical studies which contribute to the effectiveness of these methods. Therefore outcome assessment should focus on clinically relevant parameters, such as nutrition scores, weightgain or health-related quality of life.

Schlüsselwörter

Schluckstörungen - Diagnostik - evidenzbasierte Therapie - M. Parkinson

Keywords

Swallowing disorders - diagnostics - evidencebased-therapy - Parkinson’s disease

• Literatur

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