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Nervenheilkunde 2010; 29(12): 825-833
DOI: 10.1055/s-0038-1628860
Schwabinger Neuro-Seminar
Schattauer GmbH

Relevante Studien zur ParkinsonTherapie 2009-2010

Medikamente, aktivierende Therapien und tiefe HirnstimulationRelevant studies in the treatment of Parkinson’s diseasePharmacotherapy, physiotherapy and deep brain stimulation
A. Ceballos-Baumann
1   Schön Klinik München-Schwabing, Neurologisches Krankenhaus, Zentrum für Parkinson-Syndrome und Bewegungsstörungen
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Publikationsverlauf

Eingegangen am:11. Oktober 2010

angenommen am:11. Oktober 2010

Publikationsdatum:
31. Januar 2018 (online)

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Zusammenfassung

Bei Durchsicht von therapierelevanten Studien zu Medikamenten, aktivierenden Therapien und der tiefen Hirnstimulation der letzten zwei Jahre lassen sich folgende Trends und Fragestellungen erkennen: Bei Dopaminagonisten werden erwünschte und unerwünschte Wirkungen wie Impulskontrollstörungen, Entzugssyndrom und ihr intrinsischer antidepressiven Effekt sowie der Langzeitnutzen näher untersucht. Sind trizyklische Antidepressiva bei Parkinson besser als SSRI zur Behandlung der Depression? Spielt Memantin zur Behandlung der Parkinson-Demenz ein Rolle? Wie sieht es mit der Krankheitsmodifizierenden Wirkung durch Rasagilin aus? Sollten Parkinson-Patienten wegen ihrer gehäuften Neuropathie Vitamin B12 supplementiert bekommen? Wie gehen wir das Problem von Haltungsanomalien wie das der Kamptokormie an? Aktivierende Therapien spielen eine zunehmende Rolle in der Versorgung von Parkinson-Patienten. Studien erbringen immer mehr Evidenz, insbesondere physiotherapeutische Ansätze. Der Wert der tiefen Hirnstimulation wird durch große Studien weiter untermauert, allerdings zeigen 8-Jahres Verlaufsdaten Einbrüche in Aktivitäten des täglichen Lebens. Neue Zielpunkte wie der Ncl. pedunculopontinus werden für Gangstörung und Freezing evaluiert.

Summary

The following trends and questions emerge after review of the therapy focused studies on pharmacotherapy, physiotherapy and deep brain stimulation for Parkinson disease of the two previous years. Dopamine agonists are scrutinized for long-term benefit, intrinsic antidepressive action, withdrawal syndrome and impulse control disorder. Are tricyclic antidepressants better than SSRI for treatment of depression in Parkinson disease. What is the role of memantine in the treatment of Parkinson disease associated dementia? What is behind the postulated disease modifying effect of rasagiline? Shall we treat Parkinson disease patients with vitamine B12 supplementation for their increased associated neuropathy? Non-medical therapies such as physiotherapy play an increasing role in the care of Parkinson disease patients. New studies underscore their evidence based value. Deep brain stimulation is proven efficacious in large studies, however 8 year follow up shows a “dramatic” impairment in functional state. New targets such as the pdunculopontine nucleus (PPN) for freezing and gait disorder are evaluated.

Schlüsselwörter

Therapie - Parkinson-Syndrom - Dopaminagonisten - aktivierende Therapien - tiefe Hirnstimulation

Keywords

Therapy - Parkinson disease - dopamine agonists - physiotherapy - deep brainstimulation
 

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