Frühtherapie bei Morbus Parkinson

Zusammenfassung

Es ist umstritten wann nach der Diagnosestellung der Parkinson-Erkrankung mit einer Therapie begonnen werden soll. Die frühere Meinung, dass die Therapie erst mit Auftreten relevanter und beeinträchtigender Symptome beginnen sollte, wird durch neue Studien relativiert und durch neue Bewertungen alter Studien infrage gestellt. Früher gab die Befürchtung einer Beschleunigung des Krankheitsverlaufes durch L-Dopa Anlass zur Zurückhaltung, aber dies trifft nach neueren Studien nicht zu. Das Auftreten der Fluktuationen durch L-Dopa bleibt ein Problem, das aber durch zahlreiche Maßnahmen im späteren Krankheitsverlauf kompensiert werden kann. Die Dopaminagonisten haben immer besser bekannte Nebenwirkungen, die beim Management berücksichtigt werden müssen. Zahlreiche andere Therapien, wie die COMT-Hemmer, Amantadin und die MAO-Hemmer stehen zur Verfügung, die für spezielle Konstellationen sinnvoll eingesetzt werden können. Hinzu kommt, dass mit dem MAO-Hemmer Rasagilin erstmals eine Substanz zur Verfügung steht, die möglicherweise die Krankheitsprogression verlangsamt. Die Krankheitsprogression ist im Frühstadium besonders hoch und wahrscheinlich tritt in dieser Zeit eine besonders deutliche Verschlechterung der Lebensqualität ein. Als Konsequenz aus dieser Befundlage hat die Mehrheit der Parkinson-Spezialisten einen Paradigmenwechsel vollzogen und beginnt die Behandlung mit Diagnosestellung. Die Behandlungsmaßnahmen folgen der Leitlinie Parkinson der DGN.

Abstract

The start of therapy for Parkinson’s disease (PD) is still a matter of debate. Concerns against early therapy include possible toxic effects leading to a more rapid disease progression. New studies, however, have contested this view. Another main reason against early therapy was the occurrence of fluctuations and dyskinesias. They, however, can be compensated later with various interventions. Dopamine agonists, another intervention for early treatment, has a well-known adverse event profile which raises concerns for treatment monitoring but not for delaying its early use. Other treatments like amantadine, MAO inhibitors and COMT inhibitors are all available for special clinical constellations. Additionally there is the MAO inhibitor rasagiline may which a slow down disease progression. Disease progression is quite high during the first years as can be estimated from the placebo arms of various trials. There seems to be an associated pronounced loss of quality of life. Therefore, many research clinicians in this field have shifted their procedures for an immediate therapy after diagnosis of PD. The drugs to be used are selected according to the recommendations of the German Society for Neurology.

Schlüsselwörter

Frühtherapie - M. Parkinson - Lebensqualität

Keywords

early therapy - Parkinson’s disease - quality of life

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