Praktische Anwendung der kontinuierlichen Apomorphin-Pumpentherapie

Lars Tönges; Andrés Ceballos-Baumann; Holger Honig; Alexander Storch; Wolfgang H. Jost

doi:10.1055/s-0043-110095

Fortschritte der Neurologie · Psychiatrie, Inhaltsverzeichnis

Fortschr Neurol Psychiatr 2017; 85(09): 516-535
DOI: 10.1055/s-0043-110095

Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Praktische Anwendung der kontinuierlichen Apomorphin-Pumpentherapie

Practical use of continuous apomorphine infusion via pump

Lars Tönges

¹Ruhr-Universität Bochum, St. Josef-Hospital, Klinik für Neurologie

,

Andrés Ceballos-Baumann

²Schön Klinik München-Schwabing, Neurologie und klinische Neurophysiologie

,

Holger Honig

³Klinikum Bremerhaven Reinkenheide, Neurologie

,

Alexander Storch

⁴Universitätsmedizin Rostock, Neurologie; DZNE Rostock

,

Wolfgang H. Jost

⁵Parkinson-Klinik Ortenau; Universitätsklinikum Freiburg

› Institutsangaben

Abstract

Zusammenfassung

Das idiopathische Parkinson-Syndrom ist nach der Alzheimer Erkrankung die zweithäufigste neurodegenerative Erkrankung und im fortgeschrittenen Stadium durch zahlreiche Besonderheiten gekennzeichnet. Neben nicht-motorischen Symptomen stehen oft motorische Komplikationen im Vordergrund, die mit pulsatilen oralen Therapien nur unzureichend verbessert werden können. Mithilfe der kontinuierlichen dopaminergen Stimulation lassen sich jedoch auch im fortgeschrittenen Stadium Optimierungen vornehmen, die neben der Verbesserung motorischer und nicht-motorischer Symptome auch eine höhere Lebensqualität erzielen können. Etabliert hat sich in diesem Zusammenhang die kontinuierliche subkutane Gabe von Apomorphin mittels Medikamentenpumpe, deren Nutzen, Indikationen, Anwendungsbeschränkungen und praktische Umsetzung in dieser Expertenempfehlung ausführlich dargestellt werden. Besonders hervorzuheben ist das vorteilhafte therapeutische Fenster der Apomorphin-Pumpentherapie, das durch einfache medikamentöse Titration bei einem schnell reversiblen Verfahren optimal ausgenutzt werden kann. Im vorliegenden Artikel werden die Ergebnisse eines Experten-Meetings zur Apomorphin-Therapie vorgestellt, das am 6. Juli 2016 in Frankfurt am Main stattgefunden hat.

Abstract

Parkinson’s disease is the second most common neurodegenerative illness after Alzheimer’s disease. In its advanced stages, it is characterized by various special symptoms. In addition to non-motor signs, motor complications are most prominent and most often can only be inadequately improved with pulsatile oral therapies. However, with the aid of continuous dopaminergic stimulation, improvements can be achieved even in advanced stages of the disease. This will not only alleviate motor and non-motor symptoms, but will also lead to a better quality of life. In this context, continuous subcutaneous apomorphine administration by means of a pump has been well established. Its benefits, indications, limitations and practical implementation will be thoroughly described in the expert recommendation. Particularly noteworthy is the rather broad therapeutic window of apomorphine pump treatment, which can be optimally utilized by simple drug titration in a rapidly reversible process. This article presents the results of an expert meeting on apomorphine therapy which took place on July 6, 2016, in Frankfurt (M), Germany.

Schlüsselwörter

Parkinson-Erkrankung - fortgeschrittenes Parkinson-Syndrom - Apomorphin - Apomorphin-Pumpentherapie - kontinuierliche dopaminerge Stimulation - Motorische Fluktuationen

Key words

Parkinson’s disease - advanced Parkinson’s disease - continuous dopaminergic stimulation - motor fluctuations - apomorphine - apomorphine pump therapy

Volltext

Referenzen

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