Rehabilitative Therapien bei Morbus Huntington

J. D. Rollnik

doi:10.1055/s-0035-1553092

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2015; 83(06): 334-343
DOI: 10.1055/s-0035-1553092

Übersicht

Rehabilitative Therapien bei Morbus Huntington

Rehabilitation in Huntington’s Disease

J. D. Rollnik

Abstract

Zusammenfassung

Beim Morbus Huntington (Huntington`s disease, HD) handelt es sich um eine chronische neurodegenerative Erkrankung, für die bisher keine krankheitsmodifizierende Therapie zugelassen ist. HD-Patienten sind früh von motorischen und kognitiven Störungen betroffen, so dass sowohl Einzeltherapien (Physiotherapie, Logopädie, Ergotherapie) als auch multidisziplinäre neurorehabilitative Angebote erforderlich sind. Die vorliegende Übersicht trägt die vorhandene Evidenz für solche Interventionen zusammen. Tierexperimentell gibt es Hinweise darauf, dass ein motorisches Training, entweder isoliert oder als Bestandteil eines Enriched-Environment-Settings, einen günstigen Einfluss auf Krankheitsmanifestation und -progression haben kann. Für die Wirksamkeit physiotherapeutischer Behandlungen, v. a. im Rahmen eines nach Anleitung in der Häuslichkeit durchzuführenden Trainingsprogramms, liegen immerhin vier randomisierte kontrollierte Studien (RCT) vor. Vor allem stationäre multidisziplinäre neurorehabilitative Behandlungen erbrachten Hinweise auf eine günstige Beeinflussung der Selbständigkeit (Aktivitäten des täglichen Lebens, ATL). Eine nicht-kontrollierte Studie zeigte darüber hinaus eine Reduktion von Parametern des oxidativen Stresses und der Neurodegeneration, eine weitere Untersuchung belegte sogar eine in der Magnetresonanztomografie nachweisbare Volumenzunahme des Nucleus caudatus und des dorsolateralen präfrontalen Kortex durch eine multidisziplinäre Rehabilitation. Unter den Studien zu neurorehabilitativen (multidisziplinären) Therapiekonzepten findet sich leider nur ein RCT, so dass weitere kontrollierte Studien zu diesem Thema notwendig sind.

Abstract

Huntington’s disease (HD) is a chronic neurodegenerative disease for which as yet no disease-modifying therapy is available. Even at the early stage of the disease, HD patients suffer from motor and cognitive impairments. They are in need of physical, occupational and speech therapy or (inpatient) multidisciplinary rehabilitation. This paper reviews the available evidence for the usefulness of these therapeutic interventions. Studies using HD animal models have shown that motor training per se or as part of an enriched environment setting may have a positive impact on disease onset and progression. There are four clinical randomized controlled trials (RCT) showing beneficial effects of physical therapy (standardized home-based training program). In particular, inpatient neurological rehabilitation may have positive effects on activities of daily living (ADL) in HD patients. A non-controlled trial on multidisciplinary rehabilitation showed a reduction of oxidative stress and associated neurodegeneration, with another study even demonstrating an increase in the volume of the right caudate and the dorsolateral prefrontal cortex. Among the studies focusing on multidisciplinary rehabilitation, there is only one RCT. Further controlled studies are needed.

Schlüsselwörter

Huntington - Rehabilitation - Physiotherapie - Ergotherapie - Logopädie - ICF

Key words

Huntington’s disease - rehabilitation - physical therapy - occupational therapy - speech therapy - ICF

Full Text

References

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