Tiefe Hirnstimulation bei idiopathischem Parkinson-Syndrom und essenziellem Tremor

Zusammenfassung

Die tiefe Hirnstimulation als stereotaktisches Verfahren hat in kurzer Zeit einen festen Platz in der Therapie des fortgeschrittenen idiopathischen Parkinson-Syndroms (IPS) und der funktionell beeinträchtigenden Tremor-Formen erhalten. Trotz differenzierter medikamentöser Therapie und der Entwicklung neuer Medikamente kommt es im Verlauf des IPS zu Wirkfluktuationen und Nebenwirkungen, die durch die tiefe Hirnstimulation bei eindeutig L-DOPA-responsiven Patienten wirksam gebessert werden können. Auch ist die tiefe Hirnstimulation wirksam bei essenziellem Tremor. Ziel dieser Übersicht ist es, die wesentlichen Grundlagen und die Rationale der tiefen Hirnstimulation sowie die Indikationsstellung für dieses aufwendige und invasive therapeutische Verfahren zu erklären und das peri-, intraund postoperative Vorgehen sowie psychiatrische, psychosomatische und rehabilitative Aspekte zu skizzieren.

Summary

Deep brain stimulation (DBS), the stereotactic guided implantation of electrodes in deep brain structures and chronic stimulation has become an established option in the treatment of advanced Parkinson’s disease and essential tremor. Despite new anti-parkinsonian drugs levodopa fluctuations and long term complications such as on-offphenomena and dyskinesias continue to represent a challenge. In those patients who are clearly responsive to levodopa, DBS can alleviate the symptoms effectively. DBS is also effective in treatment of essential tremor. This review discusses the rationale of DBS and patient selection and describes pre-, intra- and postoperative management and psychiatric, psychosomatic and rehabilitative aspects.

Schlüsselwörter

Tiefe Hirnstimulation - Stereotaxie - idiopathisches Parkinson-Syndrom - Dopaminergika - Tremor

Keywords

Deep brain stimulation - stereotactic surgery - Parkinson’s disease - dopamine agonists - tremor

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