Parkinson-Syndrome: Klinische Symptomatik, Differenzialdiagnose und Verlauf

Zusammenfassung

Parkinson-Syndrome können im Rahmen des idiopathischen Parkinson-Syndroms (IPS; auch Morbus Parkinson), anderer neurodegenerativer Erkrankungen, den so genannten atypischen Parkinson-Syndromen, und der symptomatischen Parkinson-Syndrome vorkommen. Das IPS ist dabei mit ca. 80 % aller Parkinson-Syndrome die häufigste Ursache. Neurodegenerative atypische Parkinson-Syndrome sind die wichtigsten Differenzialdiagnosen des idiopathischen Parkinson-Syndroms. Die beiden häufigsten Formen sind die Multisystematrophie (MSA) und die progressive supranukleäre Blickparese (PSP). Die meisten Parkinson-Syndrome lassen sich anhand klinischer Kriterien und morphologischer Bildgebung bereits differenzialdiagnostisch einordnen. Klinisch-pathologische Studien haben jedoch gezeigt, dass bei ungefähr 25 % der Patienten mit einem Parkinson-Syndrom eine falsche Diagnose gestellt wird. Eine exakte Diagnosestellung hat jedoch vielfältige therapeutische und prognostische Implikationen. Verschiedene apparative Zusatzuntersuchungen, insbesondere funktionelle bildgebende Verfahren zur Darstellung des nigrostriatalen Systems mittels SPECT oder PET, können die diagnostische Sicherheit erhöhen. Die folgende Übersicht möchte die typischen klinischen Zeichen der verschiedenen Parkinson-Syndrome und deren klinischen Verlauf ins Blickfeld rücken und die Probleme der Früh- und Differenzialdiagnose darstellen.

Abstract

Parkinsonian syndromes include idiopathic Parkinson’s disease (IPD), other neurodegenerative diseases with parkinsonism, the so-called atypical parkinsonian syndromes, and symptomatic parkinsonian syndromes, such as Wilson’s disease. IPD is the most frequent disease with parkinsonism as the main clinical feature and is responsible for approx. 80 % of all parkinsonian syndromes. Atypical parkinsonian syndromes are the most important differential diagnoses of IPD. The two most frequent types are multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). For clinical diagnosis it is essential to take a careful medical history and to examine the patients physically in regular intervals. However, various clinico-pathological studies have shown that approx. 25 % of patients with clinical diagnosis of IPD may have other causes of parkinsonism. Selected technical investigations, in particular functional imaging of the central dopaminergic system using PET or SPECT, may help to make clinical diagnosis more secure. This paper reviews the clinical features and diagnostic findings in diseases with parkinsonism and summarises the difficulties in establishing early and differential diagnoses.

Morbus Parkinson - atypische Parkinson-Syndrome - Differenzialdiagnose - Neuroprotektion - Neuroimaging

Parkinson’s disease - atypical parkinsonian syndromes - differential diagnosis - neuroprotection - neuroimaging

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