RSS-Feed abonnieren
DOI: 10.1055/s-0028-1109899
© Georg Thieme Verlag KG Stuttgart · New York
Tiefe Hirnstimulation in der Neurologie – Indikationen und Ergebnisse
Deep Brain Stimulation in Neurology – Indications and ResultsPublikationsverlauf
Publikationsdatum:
09. Februar 2010 (online)

Lernziele
Die Tiefe Hirnstimulation (THS; engl.: Deep Brain Stimulation, DBS) stellt ein neurochirurgisches Verfahren zur Behandlung von Bewegungsstörungen dar. Sie ist dadurch gekennzeichnet, dass ein hochfrequenter, pulsatiler elektrischer Reiz innerhalb definierter Zielstrukturen in den Basalganglien und im Thalamus eine Modulation gestörter Bewegungsmuster erzielt. Die Hauptindikationen der THS sind das idiopathische Parkinson-Syndrom, der essenzielle Tremor und die Dystonie, wobei die Indikationsgebiete für diese Behandlung stetig erweitert werden. Die korrekte Indikationsstellung und die Auswahl geeigneter Patienten sind entscheidend für den Erfolg der THS.
Die folgende Übersicht soll helfen, den richtigen Patienten zum richtigen Zeitpunkt zu identifizieren, um schließlich eine Indikation für eine operative Behandlung zu stellen. Zudem werden die Behandlungsergebnisse des Verfahrens vorgestellt.
Literatur
- 1
Deuschl G, Schade-Brittinger C, Krack P. et al .
A randomized trial of deep-brain stimulation for Parkinson’s disease.
N Engl J Med.
2006;
355
896-908
Reference Ris Wihthout Link
- 2
Sansur C A, Frysinger R C, Pouratian N. et al .
Incidence of symptomatic hemorrhage after stereotactic electrode placement.
J Neurosurg.
2007;
107
998-1003
Reference Ris Wihthout Link
- 3
Hughes A J, Daniel S E, Kilford L. et al .
Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological
study of 100 cases.
J Neurol Neurosurg Psychiatry.
1992;
55
181-184
Reference Ris Wihthout Link
- 4
Lang A E, Houeto J L, Krack P. et al .
Deep brain stimulation: preoperative issues.
Mov Disord.
2006;
21 (Suppl 14)
S171-S196
Reference Ris Wihthout Link
- 5
Defer G L, Widner H, Marie R M. et al .
Core assessment program for surgical interventional therapies in Parkinson’s disease
(CAPSIT-PD).
Mov Disord.
1999;
14
572-584
Reference Ris Wihthout Link
- 6
Charles P D, Van Blercom N, Krack P. et al .
Predictors of effective bilateral subthalamic nucleus stimulation for PD.
Neurology.
2002;
59
932-934
Reference Ris Wihthout Link
- 7
Welter M L, Houeto J L, Tezenas du Montcel S. et al .
Clinical predictive factors of subthalamic stimulation in Parkinson’s disease.
Brain.
2002;
125
575-583
Reference Ris Wihthout Link
- 8
Benabid A L, Koudsie A, Benazzouz A. et al .
Subthalamic stimulation for Parkinson’s disease.
Arch Med Res.
2000;
31
282-289
Reference Ris Wihthout Link
- 9
Kleiner-Fisman G, Herzog J, Fisman D N. et al .
Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes.
Mov Disord.
2006;
21 (Suppl 14)
S290-S304
Reference Ris Wihthout Link
- 10
Krack P, Pollak P, Limousin P. et al .
From off-period dystonia to peak-dose chorea. The clinical spectrum of varying subthalamic
nucleus activity.
Brain.
1999;
122 (6)
1133-1146
Reference Ris Wihthout Link
- 11
Krack P, Pollak P, Limousin P. et al .
Stimulation of subthalamic nucleus alleviates tremor in Parkinson’s disease.
Lancet.
1997;
350
1675
Reference Ris Wihthout Link
- 12
Benabid A L, Pollak P, Gervason C. et al .
Long-term suppression of tremor by chronic stimulation of the ventral intermediate
thalamic nucleus.
Lancet.
1991;
337
403-406
Reference Ris Wihthout Link
- 13
Krack P, Batir A, Van Blercom N. et al .
Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced
Parkinson’s disease.
N Engl J Med.
2003;
349
1925-1934
Reference Ris Wihthout Link
- 14
Herzog J, Weiss P H, Assmus A. et al .
Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson’s
disease.
Brain.
2006;
129
3366-3375
Reference Ris Wihthout Link
- 15
Ardouin C, Pillon B, Peiffer E. et al .
Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affects neither
memory nor executive functions: a consecutive series of 62 patients.
Ann Neurol.
1999;
46
217-223
Reference Ris Wihthout Link
- 16
Wojtecki L, Timmermann L, Jorgens S. et al .
Frequency-dependent reciprocal modulation of verbal fluency and motor functions in
subthalamic deep brain stimulation.
Arch Neurol.
2006;
63
1273-1276
Reference Ris Wihthout Link
- 17
Alegret M, Junque C, Valldeoriola F. et al .
Effects of bilateral subthalamic stimulation on cognitive function in Parkinson disease.
Arch Neurol.
2001;
58
1223-1227
Reference Ris Wihthout Link
- 18
Dujardin K, Defebvre L, Krystkowiak P. et al .
Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive
function in Parkinson’s disease.
J Neurol.
2001;
248
603-611
Reference Ris Wihthout Link
- 19
Volkmann J, Allert N, Voges J. et al .
Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD.
Neurology.
2001;
56
548-551
Reference Ris Wihthout Link
- 20
Burkhard P R, Vingerhoets F J, Berney A. et al .
Suicide after successful deep brain stimulation for movement disorders.
Neurology.
2004;
63
2170-2172
Reference Ris Wihthout Link
- 21
Benabid A L, Pollak P, Seigneuret E. et al .
Chronic VIM thalamic stimulation in Parkinson’s disease, essential tremor and extra-pyramidal
dyskinesias.
Acta Neurochir Suppl.
1993;
58
39-44
Reference Ris Wihthout Link
- 22
Limousin P, Speelmann J D, Gielen F. et al .
Multicentre European study of thalamic stimulation in parkinsonian and essential tremor.
J Neurol Neurosurg Psychiatry.
1999;
66
289-96
Reference Ris Wihthout Link
- 23 Fahn S, Tolosa E, Marin C. Clinical rating scale for tremor. Jankovic J, Tolosa E Parkinson’s disease and movement disorders München; Urban und Schwarzenberg 1988: 225
Reference Ris Wihthout Link
- 24
Hassler R, Riechert T.
Indikationen und Lokalisationsmethode der gezielten Hirnoperationen.
Nervenarzt.
1954;
25
441-447
Reference Ris Wihthout Link
- 25
Schuurman P R, Bosch A D, Bossuyt P MM. et al .
A comparison of continuous thalamic stimulation and thalamotomy for suppression of
severe tremor.
N Engl J Med.
2000;
342
461-468
Reference Ris Wihthout Link
- 26
Blomstedt P, Hariz G M, Hariz M I. et al .
Thalamic deep brain stimulation in the treatment of essential tremor: a long-term
follow-up.
Br J Neurosurg.
2007;
21
504-509
Reference Ris Wihthout Link
- 27
Garcia Ruiz P, Muniz de Igneson J, Lopez Ferro O. et al .
Deep brain stimulation holidays in essential tremor.
J Neurol.
2001;
248
725-726
Reference Ris Wihthout Link
- 28
Vidailhet M, Vercueil L, Houeto J L. et al .
Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia.
N Engl J Med.
2005;
352
459-467
Reference Ris Wihthout Link
- 29
Kupsch A, Benecke R, Muller J. et al .
Pallidal deep-brain stimulation in primary generalized or segmental dystonia.
N Engl J Med.
2006;
355
1978-1990
Reference Ris Wihthout Link
- 30
Vidailhet M, Vercueil L, Houeto J L. et al .
Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective
3 year follow-up study.
Lancet Neurol.
2006;
6
223-229
Reference Ris Wihthout Link
- 31
Halbig T D, Gruber D, Kopp U A. et al .
Pallidal stimulation in dystonia: effects on cognition, mood, and quality of life,
J Neurol.
eurosurg Psychiatry.
2005;
76
1713-1716
Reference Ris Wihthout Link
PD Dr. Thomas Gasser
Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Universitätsklinikum Essen
Hufelandstr. 55
45122 Essen
eMail: thomas.gasser@uk-essen.de