Frühdiagnose von Parkinsonsyndromen – Nicht ganz trivial, aber prognostisch und therapeutisch relevant

Die Diagnose des idiopathischen Parkinsonsyndroms (IPS = Parkinsonkrankheit) erfolgt heute nach wie vor klinisch durch den Nachweis der typischen Kardinalsymptome Akinese, Rigor, (Ruhe-)Tremor und posturale Instabilität sowie den Ausschluss anderer Erkrankungen als Ursache eines möglichen symptomatischen (sekundären) Parkinsonsyndroms. Diagnostisch schwierig kann allerdings die frühe Abgrenzung des idiopathischen von sogenannten „atypischen“ Parkinsonsyndromen sein, die im Rahmen anderer neurodegenerativer Erkrankungen auftreten. Hier können sowohl klinische und pharmakologische als auch moderne bildgebende Verfahren hilfreich für die frühe und sichere Einordnung sein.

Today, as ever, the idiopathic Parkinson's syndrome (IPS = Parkinson's disease) is clinically diagnosed by the cardinal symptoms of akinesis, rigour, tremor (when at rest) and postural instability as well as by excluding other diseases which may cause a possibly symptomatic (secondary Parkinson-like) pattern. It may, however, be clinically difficult to diagnostically separate the idiopathic Parkinson's syndrome from so-called „atypical“ Parkinsonian syndromes that may occur with other neurodegenerative diseases. In such cases, both pharmacological and modern imaging methods may be useful for early and safe identification.

Key words

idiopathic Parkinson's syndrome - atypical Parkinson's syndrome - multisystemic atrophy - imaging diagnostics - pharmacological testing - REM-sleep behavioural disorder - olfactory capacity - early diagnosis

Literatur

• 1 Braak H, Del Tredici K, Rub U. et al. . Staging of brain pathology related to sporadic Parkinson's disease.  Neurobiol Aging. 2003;  24 197-211
• 2 Postuma RB, Gagnon JF, Vendette M, Fantini ML. et al. . Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder.  Neurology. 2009;  72 1296-1300
• 3 Stiasny-Kolster K, Doerr Y, Moller JC. et al. . Combination of ,idiopathic' REM sleep behaviour disorder and olfactory dysfunction as possible indicator for alpha-synucleinopathy demonstrated by dopamine transporter FP-CIT-SPECT.  Brain. 2005;  128 126-137
• 4 Seppi K, Schocke MF, Wenning GK, Poewe W.. How to diagnose MSA early: the role of magnetic resonance imaging.  J Neural Transm. 2005;  112 1625-1634
• 5 Becker G, Seufert J, Bogdahn U. et al. . Degeneration of substantia nigra in chronic Parkinson's disease visualized by transcranial color--oded real-time sonography.  Neurology. 1995;  45 182-184
• 6 Berg D, Becker G, Zeiler B. et al. . Vulnerability of the nigrostriatal system as detected by transcranial ultrasound.  Neurology. 1999;  53 1026-1031
• 7 Gaenslen A, Unmuth B, Godau J. et al. . The specificity and sensitivity of transcranial ultrasound in the differential diagnosis of Parkinson's disease: a prospective blinded study.  Lancet Neurol. 2008;  7 417-424
• 8 Gasser T.. Update on the genetics of Parkinson's disease.  Mov Disord. 2007;  22
• 9 Fahn S, Oakes D, Shoulson I. et al. . Levodopa and the progression of Parkinson's disease.  N Engl J Med. 2004;  351 2498-2508

Korrespondenz