Glukokortikoide in der Neurologie: Wirkmechanismen, Anwendungen und Nebenwirkungen

Zusammenfassung

Glukokortikoide sind ein wesentlicher Bestandteil der Therapie neurologischer Erkrankungen. Auch wenn der Wirkmechanismus noch nicht restlos aufgeklärt ist, ist bei vielen immunologischen und nicht-immunologischen Erkrankungen des Zentralnervensystems oder des peripheren Nervensystems die Gabe von synthetischen Glukokortikoiden das Mittel der ersten Wahl. Bei vielen dieser Erkrankungen ist aber der Evidenzgrad für den Nachweis der Wirksamkeit noch zu gering, als dass eine Evidenz-basierte Empfehlung für eine Steroidtherapie ausgesprochen werden könnte. Wegen der vielen akuten und chronischen Nebenwirkungen ist es wichtig, dass die Wirksamkeit in größeren, randomisierten und kontrollierten Studien nachgewiesen wird. Generell sind Glukokortikoide aber aus der Therapie vieler akuter oder chronischer neurologischer Erkrankungen nicht mehr wegzudenken. Die Indikation für eine Glukokortikoid-Therapie sollte aber wegen der vielfach schwachen Evidenzlage für ihre Wirksamkeit immer sorgfältig abgewogen werden.

Abstract

Glucocorticoids represent a cornerstone in the therapy for many neurological disorders. Even though their mechanism of action is still not completely understood, synthetic glucocorticoids are given as first line drugs in a number of immunological and non-immunological disorders of the central or peripheral nervous system. For most of these disorders, however, the level of evidence that glucocorticoids are truly effective is still not sufficient. This is why treatment with glucocorticoids cannot be recommended on an evidenced-based level for many of these disorders. Due to the huge number of acute or chronic side effects, it is essential that the effects are documented by more randomised placebo-controlled cross-over trials. Generally, glucocorticoids can no longer be omitted in the treatment of neurological disorders, the indication to apply glucocorticoids, however, needs to be thoroughly balanced in the light of their many side effects.

Schlüsselwörter

Steroide - Behandlung - Immunologie - Immunsuppression

Key words

steroids - treatment - immunology - immunosuppression

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