Lebensqualität als Ziel therapeutischer Interventionen bei Morbus Parkinson

Zusammenfassung

Bei der Bewertung des Krankheitszustandes sowie des Einflusses von therapeutischen Interventionen beim Morbus Parkinson spielt die Erfassung der Lebensqualität eine zunehmend größere Rolle. Insbesondere die gesundheitsbezogene Lebensqualität (Health-related Quality of Life, HRQoL) wird in immer mehr klinischen Studien als Zielparameter integriert und kann mithilfe von generischen oder krankheitsspezifischen Skalen erfasst werden. Die HRQoL von Parkinson-Patienten wird durch unterschiedliche klinische Faktoren ungünstig beeinflusst, u. a. Schwere und Dauer der Erkrankung, aber auch Fluktuationen, Dyskinesien, nächtliche und morgendliche Akinesie, axiale Symptome, Schlaflosigkeit und mentale Störungen. Metaanalysen zeigen, dass sich das Vorliegen einer Depression und axialer Symptome einschließlich Gangstörungen besonders ungünstig auf die Lebensqualität von Parkinson-Patienten auswirkt. Nach den Kriterien der evidenzbasierten Medizin können derzeit die tiefe Hirnstimulation des Nucleus subthalamicus, die unilaterale Pallidotomie sowie die medikamentöse Therapie mit Rasagilin als klinisch effektiv gelten. Zukünftige Therapiestrategien werden einen Schwerpunkt auf die Behandlung depressiver und axialer Symptome legen, um einen substanziellen therapeutischen Effekt für Parkinson-Patienten erzielen zu können.

Abstract

Assessment of quality of life parameters plays an increasingly important role in the evaluation of the health state of patients with Parkinson's disease (PD) and has an influence on therapeutic interventions. More specifically, the health-related quality of life (HRQoL) is usually investigated by clinical studies using both generic and PD-specific evaluation scores. Clinical factors including disease duration and severity, fluctuations, dyskinesias, nocturnal akinesia, insomnia, axial and mental symptoms have been shown to negatively impact on the HRQoL. Based on meta-analyses, depression and axial symptoms including freezing of gait are largely responsible for the variability in life quality of PD patients. Therefore, future therapeutic approaches might focus on the amelioration of these specific symptoms. At present, following the criteria of evidence-based medicine, unilateral pallidotomy, bilateral subthalamic stimulation as well as rasagiline are regarded as clinically efficacious with respect to improvement of HRQoL.

Schlüsselwörter

Lebensqualität - Morbus Parkinson - medikamentöse Therapie - tiefe Hirnstimulation

Key words

quality of life - Parkinson's disease - Pharmacology - deep brain stimulation

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