Störungen von Verhalten und Impulskontrolle beim Morbus Parkinson

Zusammenfassung

Ein kleiner Teil der Parkinsonpatienten entwickelt unter dopaminerger Therapie Verhaltensmuster, die mit einer Störung der Impulskontrolle zusammenhängen: Dazu zählen Impulskontrollstörungen im engeren Sinn, wie pathologisches Glücksspiel, Hypersexualität und impulsives Essen und Einkaufen, die eng mit Agonistentherapie assoziiert sind und bereits unter niedriger Dosierung auftreten können. Bei manchen prädisponierten Patienten mit fortgeschrittener Erkrankung und meist auch Wirkfluktuationen und Dyskinesien kann unter höher dosierter Therapie ein Medikamentenabhängigkeitssyndrom mit charakteristischen Verhaltensstörungen beobachtet werden (dopaminerges Dysregulationssyndrom) oder ein Syndrom repetitiver, stereotyper langdauernder Bewegungsmuster, das Punding. Alle diese Phänomene können isoliert oder gemeinsam auftreten.

Die Pathophysiologie der impulskontrollassoziierten Verhaltensstörungen ist nicht zur Gänze geklärt. Bei dysregulierenden Patienten konnte vermehrter Dopamin-Release im ventralen Striatum gezeigt werden, vereinbar mit der zentralen Rolle von Dopamin bei der Mediierung von motivationsgesteuertem Verhalten und im Belohnungssystem.

Summary

A small number of patients with Parkinson's disease (PD) develop characteristic behavioural abnormalities related to impulse control: This includes impulse control disorders in a strict sense, such as pathological gambling, hyper-sexuality and compulsive eating or shopping. These are closely associated with dopamine agonist treatment and may occur on low or medium doses. Some predisposed patients with more advanced disease, usually with motor fluctuations and dyskinesia and typically on higher dopaminergic doses, develop a drug dependency syndrome with characteristic behavioural changes (dopamine dysregulation syndrom), or a syndrome of repetitive, stereotyped motor patterns termed punding. These phenomena may occur in isolation or in any combination.

The pathophysiology of these impulse control associated behavioural abnormalities has not been fully determined. In dysregulating patients, increased ventral striatal dopamine release has been demonstrated, in keeping with the central role of dopamine in the mediation of motivation driven behaviour and reward.

Schlüsselwörter

M. Parkinson - Impulskontrollstörungen - dopaminerges Dysregulationssyndrom - Punding

Keywords

Parkinson's disease - impulse control and repetitive behavioural disorders - dopamine dysregulation syndrome - punding

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